Stop the Bleed is a must for a anyone

[cmgee67]

I took a stop the bleed class today and it’s a must for anyone especially those who carry a firearm, are on a church security team, and many other things. It’s not a long class. Mine was an hour and a half. It makes you really asses your preparedness. We are certainly more likely to come across a medical emergency than anything else. They teach how to properly use a tourniquet and also how to pack a wound. Specifically ours was a fake gun shot wound. If your in the Dallas area and need a contact for a fantastic instructor feel free to PM me and I will give you the contact info for the guy that taught us today.

[flechero]

Yes, Stop the Bleed is a good class and was free. (is it still free?)

Our class was focused on actual scenarios. Gun shots (pistol and rifle), car wrecks, etc. We had a neat class- a couple EMT's, a trauma surgeon, his head nurse, an ER Dr. and more. There were 1/2 as many instructors as students. Quality time.

It's a perishable skillset though, I think it should be repeated every 2-3 years... as I'm sitting here thinking I need a refresher on tourniquets.

[cmgee67]

Ours was free. Our instructor told us that we could register to be instructors also since we took the course. He also said he will come assist if asked so we get it down correctly. He recommended the CAT tourniquet. That’s what I have stocked and will be buying more

[howdy]

How many people walk around with a tourniquet? How many have a trauma kit close at hand? You can pack a sucking chest wound until the cows come home but the victim will die without a trauma surgeon. External bleeding with a chest wound is not THE major problem. Even an upper leg wound can bleed out very quickly. Tourniquets are good for extremities and marginal for upper leg wounds. Learn to use the stuff you have on hand. Carry a sharp knife and you can make a tourniquet out of the clothes you cut off the victim. A sucking chest wound needs a hand over the wound so the victim does not collapse a lung and put pressure on the heart. Internal bleeding is the killer and the only solution to that is a trauma hospital. Learn what hospitals can handle what kind of emergency. Most don't have surgeons on standby or a cardiologist and a heart cath lab. Going to a wrong hospital could be a death sentence. I live in Houston so we have a wide variety of hospitals to chose from. Most ambulances don't have Paramedics. There is a big difference in what a Paramedic is trained/allowed to do than a basic EMT ambulance. Some Paramedics are better than other's. I was a fairly inexperienced Paramedic and there were guys/girls in my department that were very knowledgeable and skilled.

[troglodyte]

How many people walk around with a tourniquet? How many have a trauma kit close at hand? You can pack a sucking chest wound until the cows come home but the victim will die without a trauma surgeon. External bleeding with a chest wound is not THE major problem. Even an upper leg wound can bleed out very quickly. Tourniquets are good for extremities and marginal for upper leg wounds. Learn to use the stuff you have on hand. Carry a sharp knife and you can make a tourniquet out of the clothes you cut off the victim. A sucking chest wound needs a hand over the wound so the victim does not collapse a lung and put pressure on the heart. Internal bleeding is the killer and the only solution to that is a trauma hospital. Learn what hospitals can handle what kind of emergency. Most don't have surgeons on standby or a cardiologist and a heart cath lab. Going to a wrong hospital could be a death sentence. I live in Houston so we have a wide variety of hospitals to chose from. Most ambulances don't have Paramedics. There is a big difference in what a Paramedic is trained/allowed to do than a basic EMT ambulance. Some Paramedics are better than other's. I was a fairly inexperienced Paramedic and there were guys/girls in my department that were very knowledgeable and skilled.

Not sure what you are trying to get across?

STB teaches the proper use of a TQ, teaches you pack extremities, and seal the torso. It also encourages carrying, or having close at-hand, at least a TQ if not a more complete “trauma kit”.

It also teaches that we are just trying to keep the victim alive until the Calvary shows up, hopefully in a fairly short time.

Studies show improvised TQs have a 60%+ failure rate. Making a TQ or scrounging for materials takes time, time the victim may not have. Yes, an improvised TQ may be better than nothing but it isn’t hard to carry a TQ.

I cannot control what kind of first responder that shows up, the type of hospital they go to, or the training of any of the personnel. My concern is trying to give the victim a chance.

I can’t control how many people carry a TQ. I can train them and encourage them but I can’t make them. I can encourage them to learn how to improvise when they find they don’t the proper tools with the caveat that the improvising may not work and take too much time.

STB training is good for lay people. It covers the basic of how to keep someone alive for long enough for EMS to get there in most populated localities. If STB doesn’t work or it takes EMS too long to get there then it probably didn’t matter anyway, too much damage already done. Nothing is promised, just trying to give a chance.

[cmgee67]

The question was never how many people carry these things around. This class gives people the basic knowledge on how to try and keep someone alive until real medical help shows up. The instructor that taught our class was an emt and paramedic for 19 years. He said improvised tourniquets hardly ever work and can sometimes cause more trouble than they are worth. This class is supposed to motivate people to KEEP supplies close by for such events. I’m not sure what your post was trying to convey but it didn’t do very much. Thanks for your thoughts tho.

[howdy]

I think something important would be for us to get businesses to have a trauma kit/AED on location. I would hope that shooting ranges have at least tourniquets on location. (might be an interesting question) Most will not have them because they are afraid of litigation if it "fails" to work. Washington State has CPR in high School and many business locations have AED's. Their survival rate between sudden cardiac arrest and release from the hospital with a working brain is about 5 times higher than ours. The point of my comment was to get people to think about other things that can be used instead of a store bought tourniquet. I think your training is good. It gives people the courage to get involved in an emergency. Most will stand back and video it. Someone has to take charge. Give orders to people...."you call 911 and give them our address., you go out and lead the ambulance here to the scene of the accident". It is not a given that the ambulance crew is familiar with your location. You make a very good point in that the care giver is giving that victim one more chance at life. There are no guarantees out there. Do all you can and know you tried.

[Tex1961]

I carry a small Israeli trauma kit on my belt when at the range. Especially during classes. My most used medical aid however seems to be thumb bandages for the ones who seem no matter how many times I tell and show want to cross thumbs behind the slide.

[cmgee67]

I think something important would be for us to get businesses to have a trauma kit/AED on location. I would hope that shooting ranges have at least tourniquets on location. (might be an interesting question) Most will not have them because they are afraid of litigation if it "fails" to work. Washington State has CPR in high School and many business locations have AED's. Their survival rate between sudden cardiac arrest and release from the hospital with a working brain is about 5 times higher than ours. The point of my comment was to get people to think about other things that can be used instead of a store bought tourniquet. I think your training is good. It gives people the courage to get involved in an emergency. Most will stand back and video it. Someone has to take charge. Give orders to people...."you call 911 and give them our address., you go out and lead the ambulance here to the scene of the accident". It is not a given that the ambulance crew is familiar with your location. You make a very good point in that the care giver is giving that victim one more chance at life. There are no guarantees out there. Do all you can and know you tried.

Thanks for the clarification! I appreciate it.

[Jago668]

I have some medical training from a few places. Nothing like an actual paramedic, but how to put tourniquets on, chest seals, etc. I keep tourniquet, chest seals, and pressure bandage in my range bag. I have a kit I wear on my ankle. I keep a trauma bag in my car along with a boo boo kit. My rifle and shotgun setups both have ifaks on them. While I have the bag in my car, I still carry the ankle kit. If something goes down I figure the bag in the car will be about as useful as a gun in the car. None of them are setup for anything other than trauma. That is what the boo boo kit is for. It has the sting relief wipes, tylenol, bandaids, etc in it. It gets used fairly regularly. Luckily I've never had to get into my trauma stuff.

[oljames3]

IFAK rides in a cargo pocket: Olaes bandage, chest seals, SOFTT-W Gen 3, gloves and emergency blankete. Trauma kit in car or on range bag as appropriate: same gear as IFAK plus CAT7, shears, tape, more gauze, triangle bandages. 11 years as Army Combat Lifesaver and CPR/AED with the Red Cross. More recent training with Lone Star Medics and Stop The Bleed. Plus boo-boo kit in the range bag.

[Paladin]

Agree with cmgee67. I've done Stop the Bleed many times and it is a great free class that everyone should take at least once.

Pressure is generally the first thing you want to use to stop the bleed, and that takes no special equipment. The TQ is not for every situation, but the TQ is used for arterial bleeds that can not easily be stopped with pressure.

At TDSA a guy ended up with a small lower extremity cut that should have been treated with pressure and a bandage, but some people got carried away and put a TQ on the leg. Not a major issue as long as everything is handled properly, but on the spot treatment went a bit overboard.

I carry 2 TQ's and 2 medical kits in my vehicle. One goes to the range with me. I have many more at the house.

On duty I used to always carry a TQ on my person.

[The Annoyed Man]

I haven’t done a Stop the Bleed class, but I have taken Lonestar Medics' "Medic 1" class.

https://www.lonestarmedics.com/services

The “Medic 1” class is two-days filled with lectures, skills practices, and scenarios with live role players. Students will learn how to identify and treat injuries related to car wrecks, falls, allergic reactions, penetrating and blunt trauma, chest injuries, patient assessments, medical gear selection, and more. Our goal in this class is not to make you the medic, but what to do until the medics get there.

I keep a well-supplied stomp bag in my vehicle, and an IFAK in my EDC bag. TQs in both.

[oljames3]

I haven’t done a Stop the Bleed class, but I have taken Lonestar Medics' "Medic 1" class.

https://www.lonestarmedics.com/services

The “Medic 1” class is two-days filled with lectures, skills practices, and scenarios with live role players. Students will learn how to identify and treat injuries related to car wrecks, falls, allergic reactions, penetrating and blunt trauma, chest injuries, patient assessments, medical gear selection, and more. Our goal in this class is not to make you the medic, but what to do until the medics get there.

I keep a well-supplied stomp bag in my vehicle, and an IFAK in my EDC bag. TQs in both.

For me, Medicine X EDC. Causey is fantastic. I'll be seeing him this weekend at Tac-Con 2022. https://taccon.info/

[Mike S]

Lots of good discussion points already posted on this thread, so I'll only add a couple of quick thoughts.

1. In cmgee's original post, the instructor said anyone who's completed the training could then submit an application to become an instructor. A slight caveat to this; attending a STB class is generally required before requesting to become an instructor, but only the categories listed here are actually eligible to become an instructor:. https://cms.bleedingcontrol.org/applicant/create

2. I've seen the statistic that field expedient TQs generally fail to completely occlude the arterial flow at an alarming rate, and as has already been posted an improperly applied TQ, even a commercially made TQ, can be worse than no TQ at all. At a quick glance the increased risk is threefold:
(1). the veins returning blood to the heart may be occluded, thus lowering the blood available to the heart/brain/organs;

(2). the artery isn't completely occluded which allows blood to continue either bleeding out, and/or blood pooling into the extremity resulting in compartment syndrome (so, increased blood pressure where the bleed is, but no return flow back to the body this increasing the risk of hypovolemic shock); &

(3). if the TQ is too narrow, the construction increases the risk of nerve & tissue damage (TQs should be 1 1/2" wide to ensure compression area is wide enough to occlude all blood flow to the extremity, & mitigate nerve tissue damage).

However, there are also MDs who have shown that a 'properly applied expedient TQ' can be just as effective in occluding arterial flow, albeit likely slower to apply as you're fashioning the TQ out of available materials (slower because you're scrounging stuff to make the TQ on the fly).

The leading talking point I've seen regarding the reduced efficacy of improvised TQs is the Boston Bombing, & the vast majority of those improvised TQs were found ineffective when the patient reached the hospital. I would postulate that those applying the TQs were untrained, & were doing the best they could under the circumstances.

3. I'm of the opinion that the best TQ is a commercially made one. For self-aid, my opinion is the CAT TQ is the best as it's a little easier to apply to your own upper extremities. For applying to others, especially if the casualty will be dragged to safety, I believe the SOFTT-W is better as there's no Velcro to bust loose (* note: regardless of TQ type, always re-check the TQ each & every time the casualty is moved. If it loosened, retighten immediately, or apply a second TQ immediately above the first one). This being said, I wouldn't hesitate to fashion an improvised TQ out of available materials in a mass-casualty event once I've run out of commercial TQs, as long as I can make it correctly & apply it properly. ((By 'proper', I mean flat materials that are at least 1 1/2" wide, & something to use as a windlass or 'stick' to twist until there's no pulse in the limb below the TQ)).

4. The Stop the Bleed campaign focuses on the major 'PREVENTABLE' cause of death in trauma (ie , major blood loss / bleeding out). Both TCCC & TECC (military & civilian versions of treating traumatic injury in a tactical or mass-casualty event) use the M.A.R.C.H. algorithm, which differs from the PHTLS algorithm of the "ABC"s, or "A.B.C.D.E." which I understand is used in a more traditional approach to medical evaluation. The ABC's put "Airway" & "Breathing" ahead of "Circulation"; MARCH puts uncontrolled "Major Hemmorage" first, as that's what will result in death before lack of O2 exchange. This is where Stop the Bleed puts it's focus. As also indicated in another post above, at the point of injury the only areas where massive hemmorage can be stopped using direct pressure, TQ, or wound packing is in the extremities or junctional areas (armpit; shoulder; groin; neck). Any internal bleeding inside the 'Box' (chest & abdomen) or brain has to be addressed by a surgeon; hence these casualties aught to be pointed out to first responders so they can assess/triage for evac if there's multiple casualties exceeding haul capacity of first responders.

The A & R in MARCH are where airways & respiration is covered; if a casualty bleeds out there's no use for an open airway & breathing. R is where a chest seal would be applied, & the most recent TECC guidance is only a vented chest seal should be used. I'm of the opinion anything is better than nothing, as long as the casualty is constantly monitored for a tension pneumothorax (air building up inside the chest wall where it shouldn't be, & pushing against the heart / aorta). If the casualty has signs of increasing agitation, difficulty breathing, shortness of breath, & increased anxiety/panic as if suffocating, the chest seal may need to be 'burped', meaning a clot may have formed & not allowing the built up pressure in the chest wall to escape (or, your non-vented chest seal is causing more life-threatening problems than just leaving it alone...). Also, tension pneumothorax can result from blunt force trauma injury to the lungs even without a penetrating injury to the chest wall, so it's wise to monitor for that if the mechanism of injury is blunt trauma.

5. There's a concept called 'The Die Off Curve'. Some injuries are so bad no one could survive, regardless of proximity to surgical care. The longer the trauma casualty survives, the likelihood of survival increases, but the risk of death shifts from blood loss to other issues, such as multiple organ failure or sepsis days later.