Life in exchange for health: why quality tourniquets are needed at the front

Life in exchange for health: why quality tourniquets are needed at the front



A tourniquet is a device that is expensive and works very quickly. Without it, it is almost impossible to stop critical bleeding in the field. A fighter, medic or civilian has a couple of minutes before he himself or the wounded person loses consciousness or dies altogether. So why did tourniquets, and especially American CATs, become the number one paramedic request in the conditions of the Ukrainian war? A little from the history of tactical medicine Let’s just look at the past: World War II, Afghanistan, all military conflicts with the participation of the Soviet Union – this is the combat experience that the Ukrainian army had before 2014. Unfortunately, in our experience there was no such concept as “tactical medicine”. Some of the best medics on the battlefield and mentors in all tactical exercises are now Americans. First, over three decades of NATO peacekeeping missions, they have gained not only military, but also medical experience. Second, they collect all the statistical data, process it and, according to the results, change or edit the protocols that currently exist. For example, during the time of military companies in the Middle East, doctors found out that almost 75% of personnel losses were caused by excessive bleeding. And if it could be stopped in time, then the wounded with damage to the main vessels would have a high chance of survival. “First aid protocols are pure statistical data: deaths or causes of death. Every fatal case or case of injury to Americans is carefully recorded and transmitted,” says Victoria Tkach, a combat medic of the Hospitalier paramedics volunteer organization, which has saved hundreds of soldiers since 2014. Three minutes to survive What happens during blood loss? Any injury triggers a surge of adrenaline in the body to be able to survive. But as soon as adrenaline drops, a person begins to feel weak, dizzy, nauseous, lose consciousness, feel, and fine motor skills become difficult. The injured person has from 1 to 3 minutes to stop the bleeding and save his life. Needless to say, there is unlikely to be a paramedic near her. Maksym Dengub, who currently serves as a combat medic in the Armed Forces, and before that worked for 22 years in an ambulance, constantly repeats that without a high-quality tourniquet it is too difficult for soldiers to cope with heavy bleeding: “To somehow cover the wound, you need a lot of time, which is not available on the field fight”. “The evacuation stage is very difficult, it can take 2-3 hours. Unfortunately, we cannot reach the wounded quickly in all sectors. Therefore, the soldier will have to wait and this time is critical for his further healthy life,” explains Victoria Tkach. The American CAT tourniquet is currently the most effective and easiest to use. In addition, as of 2014, this design was the most common in Ukraine and was used in most training sessions. As the paramedics keep reminding us, this tourniquet is designed for the average American soldier, who quickly knows how to do what he’s been taught: “That’s why all these things are so expensive, they don’t require much intelligence, they’re purely mechanical. You don’t have that luxury on the battlefield , as a time to solve turnstile puzzles.” Yes, now there are several proven and popular models of turnstiles in the world – these are SOFT, TMT, SAM and several other worthy manufacturers. However, it takes time and effort to learn how to use them. CAT still remains the easiest and most convenient to use. This is something you can put on yourself with one hand. “There were many cases even during the Donbas campaign, when guys who had injuries to three limbs at once perfectly bandaged themselves with CAT, all three limbs, on their own. And only then they lost consciousness, and later in the hospital they heard what heroes they were,” he says Victoria Tkach. There is a saying among military medics that the best tourniquet is the one you know how to use. This is true, but it still needs to be of good quality. “Critical bleeding occurs most often after artillery wounds. And this is already a whole complex – barotrauma of the head, cranial brain, there can be multiple fragments. Believe me, a person is in such a condition that it becomes impossible to deal with an intricate tourniquet,” adds Victoria Tkach. “In addition, CAT is easy to relax if the bleeding has slowed down. This tourniquet is convenient for regulating the pressure on the blood vessels, which means that such a disaster as amputation can be prevented,” says Maksym Dengub. Why do you need a Combat application tourniquet – CAT and what are the alternatives? Their design makes it easy and quick to stop bleeding. Americans have learned to do things that really work and do not injure human health. “The CAT tourniquet has the best modern design, it can be tightened as much as possible and tightened if the muscle has changed in volume during the evacuation,” explains Iryna Kostenko, a certified tactical medicine instructor. Before the advent of the tactical tourniquet, of course, there were other means of stopping bleeding. If we recall the famous Esmarch tourniquet, which will soon be 200 years old (Esmarch invented his hemostatic tourniquet back in the 1860s) and which was in all Soviet military first-aid kits, then we can say that yes, it really works, but… Any medicine outside in hospital conditions, it operates according to the principle of “life in exchange for health” – and this directly concerns the Esmarch harness. It has many contraindications and is quite traumatic. But the biggest disadvantage is that it is difficult to impose it on yourself, even under fire, even when you are already losing consciousness. “It’s true that we often used harnesses, like Esmarch, but they are already a thing of the past. To tighten such a harness yourself is an extremely difficult task,” says Maksym Dengub. The harness is made of rubber, which is not stable to the external environment and depending on the temperature, it either dries out or stretches. And there is no question of the important constant pressure on the wound. In addition, the tourniquet compresses the nerve fibers, and after this it is unlikely that the fighter’s arm or leg will function normally. “The harness must be stored in the factory bag with the factory powder, so that the rubber is more or less stable. If the harness is stored differently, it will not work properly. No one stores Esmarch in the factory packaging, believe me” – Victoria. Everything is important in turnstiles: construction, material, how it is stitched and glued, whether every detail has been worked out and tested for dozens of years. Low-quality textiles, plastic, untested parts can cost lives. “If you think that “if I can apply this tourniquet, then a fighter can too,” it doesn’t work like that. I’m tired of explaining to people that you can’t make a tourniquet yourself. The only certified tourniquet in Ukraine is SICH*. And they are working,” emphasizes Victoria Tkach. *These turnstiles appeared in 2015 as a result of research by Ukrainian doctors, volunteers and the military. Official first aid kits of the Armed Forces of Ukraine, the National Guard and the Police are equipped with the SICH turnstile. Turnstiles are slightly different in design from CAT. But so far it is the only reasonable alternative to CAT in our conditions. How dangerous are analog turnstiles? The work of military personnel and medics on the battlefield is work according to a clear algorithm. Any analogue of CAT can cost lives. The tourniquet can be kept up to 2 hours, after which it must be replaced: “There are a number of further protocols and rules to preserve both life and health. But no one wants to understand this. Everyone just wants a tourniquet. As a result, something is wrong they copy and it turns out, to put it mildly, poorly. I even saw how instead of a “TIME” sticker they used ordinary store price tags, on which the price of beer is written. Or they put wooden wheels without any polishing, you twist – and drive splinters into your fingers . And how many of those tourniquets break. In the best case, they can be used only in hospital conditions, under a towel,” explains Victoria Tkach. “In three cases out of five, the analog will break: the low-quality material from which such tourniquets are made becomes the cause of fatal consequences. And the loss of a soldier is grief for a medic, as well as grief for his family and the entire country now,” adds Maxim money loser “Physically, analogues cannot provide effective equal pressure on the blood vessels. Any bleeding is stopped by pressure, it is precisely a high-quality tourniquet that can create it without human effort. Of course, if you wish, you can improvise and press the wound with at least a piece of tank, but we all perfectly understand that these are games with life,” says Iryna Kostenko. The priority of every military man is to complete the task. If a fighter is wounded and is still in the fire zone, he must stop the bleeding in order to continue the operation. It is impossible to do this without a turnstile. Now there are many hemostatic instruments, tamponades, but all this can be used only in shelter: “Understand, the fighters have slightly different tasks. They know that tourniquets are needed, they get them, they put them in the end. And when the time really comes, these tourniquets can simply be throw away. People pay money to be certified, to work legally, but the problem is that their turnstiles don’t work. It’s very dangerous. People just don’t understand that they’re playing with their lives. It’s the same as making saline at home: take a pot , pour salt and pour it all forward,” explains Victoria Tkach. The biggest problem with all analog turnstiles is that they are not tested enough time. In the conditions of a difficult evacuation, this can negate all the efforts of medics: “I have had many cases when we took a soldier who had previously put a tourniquet on himself. We start the evacuation, we transport him, he shakes on the way in the pits, and because the material, from which a tourniquet was made, it is not suitable for this, the blood starts to flow again. Imagine that we are in the process, trying to clear the airways, somehow patch up the wounded, and here I see that our 300th is also starting to “flow”. In such conditions of “preserving health” are out of the question. Of course, I just take the CAT and move the tourniquet. But the dream of every medic on the front is that the wounded person does not bleed, that he does not worry about it and can continue to be normal to save,” adds Victoria. Of course, quality US CATs cost money, that’s the biggest problem right now, as is where to get enough of them. Today, Ukrainian foundations, organizations and volunteers are engaged in the search and purchase of high-quality turnstiles for soldiers and paramedics. Most often, this becomes possible thanks to help from abroad. It is worth remembering that these modern harnesses are only consumables. Expensive, but necessary. And there is always a need for them. They are checked and tested so that every detail in them is in its place, they really save lives. And we can help it if we support those who deliver really better turnstiles right to the front. We remember that even 1 CAT is someone’s life and health, the whole story of a saved Ukrainian. Darya Drygina, writer of the NGO Small Heart with Art, specially for UP. Life Publications in the “View” section are not editorial articles and reflect exclusively the author’s point of view.



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