Wound Packing: Foley Catheter – EXCERPT FROM ONLINE ATC2 / CTC2
Junctional wounds are those wounds of the neck, axilla (armpit), and groin, where they are not amenable to tourniquet application but are frequent sources of massive hemorrhage. There are many different ways to manage these wounds, this is one technique using a Foley Catheter (designed for urine drainage) to tamponade bleeding. It is best studied in neck wounds. This includes both an excerpt from the lecture section and skills station in the Advanced & Complete TC2 online courses.
This section includes additional informational topics relevant to TECC and TCCC concepts.
Carpet to improvised litter in 60-seconds
Never underestimate the power of an improvised litter to make moving casualties easier. This technique works best in residential structures because in many commercial buildings, the carpet is not “wall to wall” but rather individual squares, to allow for easy replacement so this technique will not work there. (Also, never leave a training building without fully exploiting it.)
*this video was taken during an in-person Crisis Medicine Tactical Casualty Care course
Versatile Safety Pins
The safety pin is a versatile and useful piece of equipment that has been around for over 150 years. Each military cravat comes with two and this video demonstrates ways to use safety pins that you may not have thought of.
*this video is an excerpt from the Crisis Medicine Tactical Casualty Care series
Carrying people is hard work. Carrying them with a litter makes the task easier. Non-Rigid litters are lighter and easier to store than their rigid counterparts, but they are harder to use. See a discussion of non-rigid litters, understand the assets and liabilities, and consider some improvised alternatives in case you need to move a casualty unexpectedly.
*Excerpt taken from the in-person Complete Tactical Casualty Care course
NAR Tracheotomy airway
The North American Rescue Tracheostomy airway with bougie introducer is demonstrated in a surgical airway.
Wound packing 4-ways with the Phokus Wound Cube
Teaching wound packing has always been challenging as there are few good wound packing models. The Phokus wound cube has 4 different wound profiles and has a realistic texture. In this short video, see the wound cube packed with Combat Gauze, Kerlix Gauze, the XStat 12, and a Foley Catheter.
Moving casualties is always hard. Use a tool whenever possible. Even a folding chair makes it easier to carry casualties quickly and over distance.
In A Book of Five Rings, Miyamoto Musashi says, “Make your combat stance, your everyday stance and your everyday stance your combat stance.” Walking backwards is not combat effective.
It’s challenging to creatively free think under stress. Plan on using chairs to evacuate casualties. With rolling chairs, you can really move out. See more improvised techniques on the website and on the blog.
You can eliminate arterial flow in nearly any limb you can get your fingers and hands wrapped around. Teaching the technique in our Advanced Tactical Casualty Care course.
Dragging a casualty with a slung weapon presents a safety problem. Learn what it is & how to deal with it.
Pretty cool using the X-Stat 30 trainer in class on a TrueClot wound model. The sponges immediately expand in the wound and rapidly exert pressure you can feel under your hand.
Used the X-Stat trainers in class today on a hog thigh with a simulated femoral artery laceration. This narrow wound track is a challenge to pack with Kerlix Gauze, the X-Stat 12 applicator worked awesomely.
In the 7th generation CAT tourniquet, the double eyelet was removed in favor of a perceived quicker single eyelet. Using the single routed eyelet for leg application requires reliance on only the velcro of the tourniquet band to hold pressure. If the Velcro fails or releases, the entire tourniquet would disengage with catastrophic results. More info on the blog.
In our race to use tourniquets for controlling hemorrhage, we often lose sight of the value of good direct pressure as a hemorrhage control technique.
Proven commercially available tourniquets are almost always going to be better options for controlling significant extremity hemorrhage than direct pressure because tourniquets can be made “hands-free” once secured in place. Additionally, you can carry many more tourniquets than you have hands. However, dedicated medical equipment may not always be available and even when present, takes time to put into action. More on the blog.
Our first plan is to use a proven commercially available tourniquet. Barring that, an improvised tourniquet using a cravat, or a strip of fabric, with a windlass for leverage. Given no other choices, you can may be able to use the casualty’s clothing with a rigid windlass, such as a metal pen, kitchen utensil, small tool, etc, to make a wearable improvised tourniquet. This is verified effective with doppler ultrasound. For more information on pediatric tourniquets generally, see the blog.
Having proven the improvised pant-leg tourniquet works on children via doppler ultrasound, Dr. Shertz demonstrates the technique on an adult. If no commercially available tourniquet is available, a successful tourniquet can be made using the casualty’s own clothing: Cut up the pants line including the seams, wrap the fabric around the limb, tie a square knot, and tighten with a windlass. *Ideally, the windlass should be secured with another strip of fabric. This video demonstrates an easy way to hold the windlass in place without an additional tie, but it could come loose during casualty movement.
Thanks to Full Spectrum for coming up with a novel concept to deal with junctional hemorrhage using two CAT tourniquets and a helmet. We proved the concept today with doppler ultrasound. A creative solution to a difficult problem.