First Aid

[Mr Monkey Nuts]

You should not carry a tourniquet for airsoft!. A torniquet ("Combat Aplication Tourniquet" or otherwise) is for managing major haemorrhage caused by vascular damage, uncontrollable by direct pressure to the site.

In reality this equates to a few very specific situations, namely traumatic amputation or partial amputation (including blast trauma) of a limb, and Penetrating trauma to a limb. Can be as a result of blunt trauma, Sharp trauma (stab wounds) or ballistic trauma.

 

The evidence coming out of recent conflicts have noted that CATs significantly increased the mortality rates of blast trauma victims, mainly IED and ground level shrapnel discharges. Soldiers that have their legs shredded by shrapnel and multiple vascular injuries can bleed out very quickly, and with that type of injury there is more than one wound to dress, so the only way to stop the haemorrhage is to isolate the limb.

Complications can lead to nerve damage at best, but will inevitably lead to a loss of the limb and a build up of potentially fatal toxins as the cells start to necrose. If a CAT is released incorrectly then it is a death sentence!

 

In airsoft we should never ever be in a position where any of these injurys are a legitimate risk to need to carry one. If you ever do find yourself in a position like this then you need to get onto 999 and move the patient to a suitable assess point for the ambulance crews.

[Mike636]

Never say never but I agree never use trauma kit like CATs without knowledge or training.

 

I've not seen anyone mention gloves and sanitiser - I know how mucky and sweaty my hands get so I don't want to be poking my big meaty paws in an injury without protecting myself and the casualty as best I can

[Deek]

Combat tourniquets (as the Combat Application Tourniquet - CAT is one such device) do have relevance in the realm of pre-hospital care for the rapid arrest of catastrophic haemorrhage, and the standard approach to any trauma patient is now <C>ABC where <C> is Catastrophic Haemorrhage.

 

However, this is assuming the responder is trained appropriately and has the right equipment with them and can identify what is a catastrophic haemorrhage.

 

As Mr Monkey Nuts pointed out there are complications, but evidence has suggested they are not as severe as once thought and most evidence regarding tourniquet complications are not from the use of the combat tourniquet but from the use of pressure tourniquets in theatre. In fact, there has been one reported case of a combat tourniquet being in situ for 16 hours with the patient regaining almost full function of their limb. If you are interested in a little bit of light reading regarding tourniquets this is quite good: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660095/

 

I am always cautious when saying a particular injury won't occur in a particular environment as there will always be that one exception... it is easier to deal with what the most common injuries are rather than complicating it with the "what ifs".

[NickM]

To be fair Mike I thought gloves was a given, I also have a CPR face shield. Always 2 pairs of powder free vinyl gloves ( I have checked and so far none of the doctors/nurses and first aid instructors I trust have ever come across cases of allergies to vinyl) in my pack, if I need more than that I hope people will have reached me to help in that situation.

 

The likelihood of most injuries we deal with are that they will be minor and not require further medical treatment. Also they are likely to be only a single casualty.

 

The worst cases that are "likely" I can think of would be complex compound fractures, heart attacks and impaling. For the first and third on that list might be the kind of thing where applying pressure to blood vessels elsewhere would be important and perhaps the use of a tourniquet would be useful, but its a case by case thing.

[Deek]

If anybody is really interested I could knock something together regarding suggested first aid equipment to carry?

[Mr Monkey Nuts]

Never say never, but that's why we have the 999 system to come and do the more clinically complex stuff within a short space of time.

 

I don't carry on the field but, i do have a full ILS kit in my car should I ever need to use it.

 

as a rough guide for an Airsoft first aid kit, I would recommend carrying:

 

Mobile Phone!

Triangular Bandage

X2 No 2 Ambulance Dressings

Micropore Tape

Sterile packed Gauze

Antiseptic Chlorhexadine Wipes

Compression (crepe) Bandage

Resuscitation Face Mask

Paracetamol or even co-codamol

Piriton / Cetirizine / Loratadine

Tweezers (for stings bites and splinters)

Gloves

Alcogel

Babywipes

All wrapped in a Clear sealable waterproof sandwich bag with a printed list of when each item goes out of date.

That kit should be small, light and cover you for most first aid eventualities from big traumatic wounds, to twisted ankles, to wasp stings and to Arrests.

Don't underestimate the power of paracetamol pain relief is an often overlooked aspect of first aid and as we are playing outside piriton can make a bad meeting with nettles bearable.

Anything that your not comfortable with call in the cavalry.

[Mr Monkey Nuts]

The worst cases that are "likely" I can think of would be complex compound fractures, heart attacks and impaling. For the first and third on that list might be the kind of thing where applying pressure to blood vessels elsewhere would be important and perhaps the use of a tourniquet would be useful, but its a case by case thing.

 

The issues with complex compound fractures and specifically the femur disecting the femoral artery, is that you no longer know where that vessel is and where the tourniquet needs to be applied. By the nature of our vascular system is is flexible and elastic, and is capable of changing its shape, size and will spasm of its own accord.

 

The femur is a very long strong bone, and the force required to beak it is very significant, that huge force has the potential to splinter bone, meaning the parts you may see sticking out near the knee may not be the primary concern, it may be unseen break much higher in the thigh that is causing the bleed. The higher you place a CAT the less effective it becomes, so it makes this type of patient very difficult to manage.

[Deek]

Fairly sensible list Mr Monkey Nuts... just a couple of comments - be careful with mobile phones when calling for an ambulance from an organised site; it might be better for the organisers to call 999 as they may be able to give a more accurate location to the ambulance service when calling. There is no harm in two calls being made for something serious and the call handler can give pre-arrival advice if needed - just make sure they are aware of where you are.

 

Medications are great for yourself but be careful giving them out to other people. Of course if you know them and they ask if you have a couple of paracetamol (for instance) there shouldn't be too much of a problem.

[NickM]

Don't get me wrong, calling for help is always the number 1 action in this whole scenario, personally I would go with organiser calling the ambulance unless I knew where I was very well. I don't carry Aspirin for heart attacks and I don't carry a tourniquet I was simply suggesting a possible scenario where one might be useful at an airsoft skirmish. I've played for 3 years and never seen anything close, some large lacerations and some shot out teeth.

 

I do have bits and pieces in my kit that I could rig together to make one but I probably wouldn't go so far as to buy one and carry it regularly unless I was doing something that increased the likelihood of requiring it and then I would get the training to be able to use it effectively. It was more a question to satisfy my curiosity and because if you are going to put a piece of kit like that on your rig it really should be functional in my eyes.

 

My main thing with all of this is that getting trained to do first aid is important to all, having a first aid kit is important but in most situations you could improvise a solution of sorts. If you carry, carry the things you know how to use and use your knowledge if the time comes.

[Chock]

As far as I'm aware, first aid training certificates last for three years, or at least the one I have which I did the course for earlier this year does anyway. This is worth noting if you have done a first aid course a few years ago, as there have been some changes to recommended procedures for CPR and AR on adults, but more particularly when doing so with youngsters (this I know because the course I did included covering Pediatric First Aid).

 

Coincidentally, I actually used my First Aid last week at work, when someone I was training exhibited three of the main symptoms of a stroke, although of course the main thing I had to do was to simply call an ambulance and let them get her to hospital after I done the tests to confirm my suspicions. It's worth noting here too, that the girl in question was only 24, so don't imagine that you have to be old to have a stroke, and it's worth being able to spot one, because the sooner you get someone to a hospital if they've had a stroke, the less likely it will be that they'll suffer pernament injury.

 

If you are likely to be at an airsoft site where an ambulance might not get there easily or quickly, I'd recommend a few other things for a medic bag, such as some sort of clamps or forceps (useful for pulling bits out of a wound amongst other things), some small scissors (good for cutting bandages, cutting away clothing to get at an injury, etc), some eyewash (for obvious reasons), a space blanket (to keep someone warm if they are suffering from shock, which is likely with severe bleeding, and very dangerous if not treated). There is also the possibility that you might consider an epi-pen if you are a first aider at a woodland site, although it should be noted that these are not all the same, and specific training is required to know when and when not to use one of these. Nevertheless, it is possible that someone could get an adverse reaction to a bee or wasp sting (particularly when combined with running around) and suffer anaphylaxis, and this can easily be fatal if not treated.

 

You might even go 'all Vietnam' and throw in some cyanoacrylate superglue (which as you probably know, was tested successfully in the Vietnam War for closing wounds, in order to slow down bleeding, and this was before it was actually medically approved for that use, although it did work and apparently saved quite a few lives). A word of caution here though, actual medically approved 'superglue' (branded as Dermabond if you buy it) uses a 2-octyl cyanoacrylate formula, whereas the kind of superglue you get from a DIY store uses methyl-2-cyanoacrylate. This is because the latter can cause skin irritation and it also generates considerable heat as it goes off, although this is only likely to cause a burn if you use a lot of it. Nevertheless, for a really bad injury where you have to stop bleeding if an ambulance is a long way off, you never know, it might actually be useful to have some to hand, after all, you don't have to use it, but you can't use it if you don't have it.

[Deek]

I would personally advise against carrying an epi-pen. Whilst it has been agreed by the Health and Safety Executive (HSE) that a First Aider can administer adrenaline via an auto injector device (epi-pen) in-line with the Section 7 of the Prescription Only Medicines (Human Use) Order 1997 you cannot legally obtain such devices as they are Prescription Only Medicines. The guidance is there to cover a first aider when administering a patient's own epi-pen.

 

I would also advise against using glue to close wounds as well - glue is used as a semi-permanent to permanent wound closure and as such you would need to ensure the wound is completely clean before the wound is closed. Glueing will only close small wounds and you would be better off using other methods such as direct pressure for a time and a covering (such as a non-adherent dressing) and advising the person to go visit a walk-in centre to get it looked at.

[Ian_Gere]

The advice on tourniquets has changed many times over the years - TBH I've not bothered keeping up to date. My attitude towards them is that you wouldn't even think of using one unless there was bright red blood pumping out of the casualty and pressure on the apparent wound site was not controlling it. These are the circumstances where the best and most sensible courses of action for most injuries go out of the window. People can and do bleed to death from the femoral or brachial artery in just a few minutes. Yeah, get someone to call an ambulance, but if you are johnny on the spot - the only person who has a clue and the confidence to proceed, stopping the red stuff coming out is the priority and until that is achieved, even things like cleanliness are not important if they slow you down... give the gawkers something to do, tell them to phone, to find sterile gloves, to run for the site's 1st aid kit and firstaider, to talk to the casualty and take note of any allergies, existing medical conditions and medication, family history of illness, etc in case the cazh passes out before the ambulance service are on the phone and/or arrive.

 

A person may lose a hand or a foot due to poor tourniquet practice, although once the ambulance does arrive they will ask when it was put on and take over so that is unlikely. However, just as the kind of wounds which may require such drastic measures are very rare, but worth considering because of their dire nature, it is worth considering the worst possible outcomes, and that would be a real pisser. However, for it to be such a pisser, the injured person would have to be alive... I would hope that nobody would sit there without even trying to use a belt, a gun sling, some paracord, a bit of rope, fencing wire, etc. while a person bled to death because their mates were unsure whether it was 1" above the closest undamaged fleshy part or 2", whether it should be loosened after 15mins or 10, or what should they do if they didn't have a permanent marker to write the time it was applied on the patient's body...

 

BTW, while we're on the subject, what is the current thinking on how to use tourniquets?

 

I have an issue CAT, but it's attached to the stock of my tac AK for the look, not something I always carry. I've held an Element replica and i'd say that the only real difference is that the plastic rod on the airsoft one may not be as rigid as the issue ones - i haven't actually put one under any great strain though - it just feels like the kind of plastic washing up bowls etc are made from as opposed to high quality nylon.

[jcheeseright]

The replica tourniquet is obviously just a bit of dress up kit, if someone's got an arterial bleed then using a replica on them is probably better than nothing... but still not really appropriate, belt or sling would be better

 

Current doctrine is 2" above the wound, or above the joint if there's one in between. If you can't tell where the wound is, or the trauma is so significant the artery could be smashed up inside, go to the base of the limb, couple of inches below the groin or armpit (though this will be less effective at stopping the bleeding and carries greater risk of unnecessary damage to the limb). Fit the tourniquet, wind on the windlass til the patient stops leaking and mark it with the time of application. Haemostatic agents then get deployed en masse to to block up any residual bleed since even the tightest tourniquet isn't going to be 100% effective.

 

That said, if you're applying a CAT to someone at an airsoft game then shit has hit the fan MASSIVELY and that person is lucky you had one on you!

[Deek]

There are a few tourniquet manufacturers now, with their devices being touted as 'the best'.

 

The original was the Combat Application Tourniquet (CAT) which is in wide use by a lot of ambulance services. They are a good bit of kit and not that expensive, and can be self applied but the windlass bar is made of plastic and there have been reports of it failing in cold temperatures.

 

The Mechanical Advantage Tourniquet (MAT) has a mechanical action (sort of a ratchet affair) which is easy to use and is reported to be reusable (!). Easy to apply and looks ok, but is normally the more expensive option.

 

The final contender is the Special Operations Forces Tactical Tourniquet (SOFTT) - normally has a wider strap then the CAT and had the advantage of an aluminium windlass, which has less chance of failing in colder weather. Slightly more complicated than the CAT and not really suitable for self application.

 

As jcheeseright has said though, tourniquets are better if supplemented with haemostatic agents.

[Zak Da Mack]

I remember one time a royal marine came to our session and he was talking about the medical kit he carries. When he showed us his CAT, he said that when applying it to yourself, it should be put above the wound and then twisted until you absolutely can no longer stand the pain, and then give it one more twist for good measure.

 

Another thing that I've seen people carry is quick clot. But, some people use it on injuries that don't require quick clot and when they go to hospital, the wound has to be cleaned for ages to get it out, wasting precious time that they don't have. I've also heard that using quick clot can create secondary burns

[Mr Monkey Nuts]

what is the current thinking on how to use tourniquets?

 

Same as it always has been, if you haven't been trained in it don't use it! That same thinking also extends to quick-clot and vascular surgery!

[Deek]

There is a newer version of QuikClot that doesn't produce heat when applied. The complication with QuikClot is that it is mineral based, so it does need cleaning out of the wound when used. The other big name is Celox - this works on a similar principle, but it is made from chitosan, a natural product. Chitosan is broken down by the body into natural sugars, so left over Celox doesn't need to be cleaned out of the wound, making it safer to use.

[Ian_Gere]

So Mr MM, would you suggest that a person should not make the best of their limited knowledge, when applying pressure to a wound is not preventing arterial blood from leaking and the ambulance is at least 15mins away?

[Mr Monkey Nuts]

Yes, yes I would. Blindly applying a tourniquet or hacking into someone's leg is only going to cause significant problems further down the line. And it's not just the motor skill of applying the physical tools, it's the overall patient management and incident management that can't be taught over the internet. How can you tell that this is life threatening bleed and not just a bad bleed? How much blood loss are you looking for how are you judging it? Can you tell the difference between 1 litre of blood and 3 litres of blood once it's on the ground? Because it's significantly harder than you can imagine it is.

We have left the realms of first aid and moved into a different game altogether. It's not as simple as just applying a bandage.

 

I would much prefer you get the appropriate training if you feel compelled that this level of major haemorrhage is something that concerns you.

[Mike636]

I heard an little rhyme once from a medic about arterial bleeds "If it goes further than a foot you're fucked"

[Ian_Gere]

Well Mr MN, I find you quite patronising and lacking imagination. Just because accidents and violence which result in heavy blood loss are not common events, that doesn't mean that I, or anybody else reading this, hasn't seen it happen, or been involved. Certainly blood has a way of seeming like more than it actually is and, if someone turns up when it is already on the ground (in the clothes, covering the hands, spattering faces, on the foliage, etc), it may indeed be difficult to tell 3L from 1L, however if even the dopiest person to ever wield an AEG came across somebody with bright red blood spurting out of a wound around the fingers of the desperate casualty, they would very quickly be able to tell that if blood is not prevented from spurting out quite soon, the casualty will die.

 

It doesn't matter how much is already out, it's the rate at which it keeps coming out and the state of the casualty. If s/he has blue lips and grey skin, is out cold, and the blood is losing power in how far it sprays, it is clearly because no matter how much has come out, it is too much. At which point the urgency of the situation has gone from "Shit, I need to do whatever I fully understand to try to stabilise him/her until paramedics arrive," to "Shit, unless someone can tell me for sure that paramedics will be here in 3mins or less, we need to do whatever we can, because otherwise it won't matter."

 

Of course it helps if you have picked up tips from healthcare professionals, like if you pinch the skin immediately above the biceps hard and there is no change in pallor nor slight reddening around the imprint when you let go, the casualty has dangerously low blood pressure (and that works on people with any skin colour), or if someone is unconscious you can find out if that is because they have passed out due to fear (erroneously referred to as 'passing out from shock'), or whether it has resulted from damage caused by the injury, by rubbing your knuckles hard up and down the breastbone - it hurts enough to bring you round if you can come round. If you can't get at the breastbone, you can stick your fingers into the armpit and squeeze the pectoral muscle with your thumb to get the same wakeup pain effect. Or my personal favourite for when performing CPR, "If you don't break at least one rib, you're not doing it properly!"

[NickM]

My original question and statements regarding tourniquets revolves around the fact I had been taught about them years ago, and haven't heard much about them since other than first aiders were discouraged from using them and they were no longer part of the any first aid training.

 

Notice MMN that we haven't asked how to apply them, just about current thinking about their use and it appears they are regaining ground. They are still not part of the average first aid qualification. You may also have noticed in my previous post I mentioned my other pass times, kayaking, canoeing and hiking. In these are environments help won't necessarily be minutes away but potentially hours and the potential for severe traumatic injuries are ever present. Now I have found out from this thread there are additional steps I could take in the event that I ever encounter a life threatening bleed I will endeavour to look for someone to provide training that would allow me to use it confidently should the need ever arise.

 

In no way are Ian and I suggesting we would rush out and buy a tourniquet set today and start applying them to people with a minor graze using information we have gained from an internet forum.

[Ian_Gere]

Actually I need to rephrase what I said above. What I meant was that, in this thread, I find what Mr Monkey Nuts has written patronising and lacking in imagination, not that he is either of those in general. As far as I'm aware he is a decent enough bloke and is without doubt a valuable member here, in that he has opinions and states them. Whether I agree with them in this instance or not, the forum thrives on discussion and we often learn something from disagreements, so long as, like here, they remain civil.

[Unrustle_Thine_Jimmies]

I'm not trained in anything but I do carry basic antiseptic stuff like Zelenka and Perekis (Don't know the english for them,sorry) Zelenka is a strong antiseptic that gets it's name from leaving a green stain on skin for a long time. Perekis is a mix between some sort of quick clotting thing and an antiseptic,helps reduce bleeding,it's mostly used for nosebleeds but works excellently for smaller cuts,like a nick of a knife or a thorn. Also have some bandages in my pack. Staff on site are all medically trained,I just carry this for bad scenarios,the site I play it is 400 acres large so I'm bound to be hiking along and some bugger of a thorn could cut my arm or something,it's happened before.

[Deek]

An interesting thing I have noticed recently is that the manufacturers of QuikClot and Celox are both now aiming products at domestic / first aid users - QuikClot for instance have developed a range of dressings for sports use and Celox have been promoting their products for work place use.

 

You still can't walk into somewhere like Boots and buy these products over the counter yet, but they are available to buy if you know the right places.