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Improvised TECC/TCCC by the Numbers

🕖 Reading Time, 6 minutes

It’s always better to have proven, dedicated medical equipment in an emergency. But when you don’t, you improvise.

Why use improvised materials at all? Eventually you could find yourself in a situation when you will not have the supplies that you would prefer to use to treat a casualty.

In an MCI, you could have depleted all of your equipment.

You may find yourself in a location that you do not have your usual gear. It might not be allowed.

Placing a tourniquet on a wounded casualty before they are in shock has a 20-fold greater survival than waiting for someone to arrive with commercial equipment and putting that on after they’re in shock.

There is literature showing 80% of combat fatalities died within 10-minutes of wounding: waiting for someone to arrive with the equipment you want to use may result in watching your casualty die.

Don’t just make something up, do something that might work.

Improvised by the numbers: Tourniquet placement before the onset of shock has a 20X higher survival rate for the casualty than placement after shock occurs.
Improvised by the numbers: Complete occlusion of an adult femoral artery is nearly impossible with a 1 inch wide tourniquet.
Improvised by the numbers: In 80 improvised tourniquet attempts using a cotton t-shirt, but without a windlass, only one applied adequate pressure on the HapMed Leg trainer.
Improvised by the numbers: In a study of 168 prehospital tourniquet applications in King County, Washington from 2018 to 2019, 38% were placed by bystanders. Of the total data set, 44 were improvised tourniquets.
Improvised by the numbers: 102 bleeding control trained lay people placed commercial and improvised tourniquets on the HapMed Leg trainer. Half of all improvised tourniquets made from leather belts broke during testing.
Improvised by the numbers: On average, improvised tourniquets placed on human volunteers are twice as painful as commercial tourniquets.
Improvised by the numbers: In 249 attempts to make an improvised tourniquet using military cravats and various improvised windlasses, 237 were successful applying adequate pressure on a HapMed Leg trainer.
Improvised by the numbers: 72% of twenty improvised tourniquets placed on casualty thighs by IDF soldiers were effective at hemorrhage control.
Improvised by the numbers: Based on two hour survival, Kerlix gauze was 100% effective at controlling hemorrhage in a porcine model with a 6 mm femoral artery laceration. Combat gauze, Celox rapid, and Celox gauze were also 100% effective as well.
Improvised by the numbers: There was no difference is amputation rate between 40 improvised and 157 commercial tourniquets placed on 197 US trauma patients treated at 9 urban trauma centers.
Improvised by the numbers: 197 mmHg downward pressure was exerted by former Special Forces medics packing a shot glass sized wound in ballistic gelatin.
Improvised by the numbers: Presence or absence of a wetsuit didn’t significantly affect the ability of 34 Australian volunteers to manually compress and eliminate femoral artery blood flow with inguinal compression verified by Doppler ultrasound.
Improvised by the numbers: Most “ultra absorbency“ tampoons absorb about 17 ml of menstrual blood. That is slightly over a tablespoon and thus inadequate for hemorrhage control
Improvised by the numbers: 35 “elite” IDF combat medics were able to provide manual compression of a human volunteers subclavian (97% effective) and femoral (100% effective) artery on Doppler ultrasound.
Improvised by the numbers: 61 anesthesia, Emergency Medicine, and Critical Care physicians performed surgical airways on hog tracheas with equal success whether using a scalpel, endotracheal tube and bougie or Swiss Army Knife and pen.
Improvised by the numbers: 12 paramedics, using a 2 handed technique, were able to achieve 100% cessation of blood flow by compressing each other’s abdominal aortas, verified by Doppler ultrasound. However, they only held pressure for 10 seconds.
Improvised by the numbers: 32% of casualties with bilateral lower extremity amputations from an IED blast have an associated pelvic fracture.
Improvised by the numbers: In 30 adult volunteers an improvised pelvic binder made from a SAM moldable splint and CAT as a tightening device generated as much circumferential pelvic force as an actual SAM pelvic sling.
Improvised by the numbers: In a study including two improvised pelvic binders, neither held the recommended circumferential force for two hours, the maximum amount of time recommended in NATO before damage control surgery.
Improvised by the numbers: In a study of 50 comatose overdose patients, placed in the recovery position, whether they were placed on their left or right side, there was no difference in their rate of aspiration from vomiting.
Improvised by the numbers: In two studies each of 50 consecutive finger thoracostomies, there were no recurrent tension pneumothoracies.
Improvised by the numbers: There was a 29% rate of cartilage fracture associated with improvised surgical airways on cadavers using scalpels and a Papermate pen body
Improvised by the numbers: A study looking at potential improvised chest seals made from the plastic packaging from a bandage was ineffective at sealing a 15 mm hole in pig chest walls.
Improvised by the numbers: A study of 352 finger thoracostomies showed a 10.6% rate of complications, including injury to associated organs, induced hemothorax, and infection.

Improvised TECC/TCCCMedical literature, not the Good Idea Fairy

Mike Shertz MD/18D

Dr. Mike Shertz is the Owner and Lead Instructor at Crisis Medicine. Dr. Shertz is a dual-boarded Emergency Medicine and EMS physician, having spent over 30 years gaining the experience and insight to create and provide his comprehensive, science-informed, training to better prepare everyday citizens, law enforcement, EMS, and the military to manage casualties and wounded in high-risk environments. Drawing on his prior experience as an Army Special Forces medic (18D), two decades as an armed, embedded tactical medic on a regional SWAT team, and as a Fire Service and EMS medical director.

Using a combination of current and historical events, Dr. Shertz’s lectures include relevant, illustrative photos, as well as hands-on demonstrations to demystify the how, why, when to use each emergency medical procedure you need to become a Force Multiplier for Good.

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