By Dr. Brock Blankenship
Most preppers think a lot like deployed military personnel: it’s not “if” but “when” concerning a SHTF event. Let’s focus this article on the big question: when we head to the hills, if myself or my family were injured, is there anything that may help us survive?
We are not talking BandAids here, so lets draw from military experience to help us prepare.
First, the obvious, try not to get yourself injured. This is basically a “tactic” like we use in the military. Tactics speak to everything from shooting, close quarters, troop movement, surviving, to evading. Tactics would tell us it is not great to cross a near freezing river in a survival situation. They would also say it is not a great idea to go around sampling wild mushrooms. Knowing your environment and preparing your tactics is key to survival.
Second, be prepared for what is likely to cause you problems medically. The military looks at this as “what is the most likely thing to kill you.” Looking at it from a survivalist perspective, you must account for chronic medical conditions (like diabetes). Being unprepared with medications may be the biggest threat to the diabetic.
For the purposes of this article, we will focus more on the military perspective, which fortunately encompasses people in good to great general health.
The department of defense has done tons of work in the area of Tactical Combat Casualty Care (TCCC) where our warriors have lessons learned in blood. It is these lessons that we will draw from, and these lessons that will help keep us alive.
In the mid 90’s, while looking at war munitions data from the Vietnam-era and applying them to what our soldiers found in Mogadishu, a couple of doctors working for the Department of Defense – Dr. John Hagmann and Dr. Frank Butler – made some discoveries that created doctrine and the foundation for TCCC. This doctrine holds true today, and continues to save lives on the battlefield. This doctrine may save your family’s life too.
What is Going to Kill You, and When
The findings from the Hagmann and Butler research is broken down into two simple categories: what is going to kill you, and when. These findings are specific to injuries created by penetrating trauma (gunshot wounds, blast, stabbings). The findings were then evaluated from the special operations military perspective to answer the question, “How do we prevent these losses of life?” We will take their discovery a step further and apply them to you and your go bug-out bag.
|Timeline (when the person dies)||Primary Cause of death||What steps are needed to prevent these deaths|
|0-6 minutes||Lethal head injury or injury to the great vessels in the chest/abdomen
Multiple vessels injured (from multiple wounds)
|Key Tactic is to not get shot multiple times.
Body Armor helps avoid injury to critical areas.
|6 minutes – 1 hour||Hemorrhage: mainly from penetrating injury to arms and legs
|Hemorrhage control – primarily with tourniquets. Nearly 70 percent of preventable deaths can be saved by tourniquets alone.
Airway positioning will help so long as the obstruction is from debris or the tongue (recovery position in semi-conscious or unconscious may help).
|1 hour – 6 hours||
Shock – primarily from blood loss
Tension Pneumothorax: collapsed lung that restricts breathing/inhibits circulation
|Shock: The best treatment is prevention. For instance, hypothermia and shock work together to produce a bad outcome (so prevention of blood loss is paramount, as is keeping the casualty warm by preventing heat loss). Shock reversal requires treatment of the cause with things like blood transfusions.
Tension Pneumothorax: Easily treated, but generally requires someone with an additional skill-set (paramedic level or higher).
|6 hours – 72 hours||Infection||Infection: Treatments can get advanced from a wound management standpoint, but a lot of this is basic wound care (washout, wet-to-dry dressings). Antibiotics can help, but are unlikely to help a wound if the dirt is left in it.|
How to read the above: After penetrating injury, people who die within 0-6 minutes die from lethal head or major/multiple vessel injury. The way to prevent deaths here is body armor & tactics (not getting shot in the head, chest or shot multiple times).
The research shows that we can save 75 percent of preventable deaths from time zero (point of injury) through one hour with self-aid and buddy care alone. Current tactics such as armor and self-aid/buddy care accounts for between 15-30 American or Allied lives saved per 100 wounded. While these numbers are rough, this means we would only need to treat three to six people to save one life. How many people are in your family, group or bug-out plan? As stated earlier, much of this treatment is basic stuff (self-aid and buddy care).
Things certainly get more advanced when you are seriously injured outside of that first hour. For the military, teams of surgeons deploy nearer to the battle (forward surgical teams) to rapidly deal with the injured. Since you are probably not going to have a surgical team, learning the basics are essential. There are plenty of YouTube videos on each topic, but because tourniquets are important to major critical injuries, tourniquet companies have their online training videos available to the public.
By definition, proficiency means advanced knowledge or skill. In a TEOTWAWKI situation, I advise all of your family or team members to accumulate knowledge and experience in the following areas:
- Controlling hemorrhage – initial tourniquets, downgrading tourniquets (removal), pressure dressings, wound packing, basic splinting of fractures;
- Airway management – Simple positioning of the semi-unconscious victim can be lifesaving. The recovery position prevents choking on the tongue and on vomit/debris in the airway. Nasopharyngeal Airways are carried by many non-medical military personnel to help manage a victim’s airway. They are easy use, and they prevent airway obstruction.
- Chest injury management – Treating a sucking chest wound with either a $15 chest seal, or improvise one out of duct tape and plastic (baggie, etc.).
- Prevent shock – Control not only the major blood loss, but minor blood loss too. Keep the casualty warm (e.g. use a mylar blanket). Hydrate alert patients by giving them water to drink. Prevent shock from infection by wound care pressure irrigation (washing out). Consider adding antibiotics to your bug-out bag. In fact, the Department of Defense now trains soldiers to self administer antibiotics just after injury to prevent later losses of life from infection. Soldiers are given “Combat Pill Packs” that contain Avelox, Tylenol, and Mobic.
After an injury, the number one killer is blood loss. A solution to limit and ultimately stop blood loss is critical.
Gun shot wounds and blast trauma are most likely to injure legs, followed by the arms. For this reason, tourniquets have saved the lives of thousands American and Allied military personnel.
Believe it or not, a tourniquet was previously taboo because many felt it caused more harm than helped. This myth has been dispelled. Now tourniquets are standard of care and taught in the pre-hospital trauma life support classes just as cardiopulmonary resuscitation or CPR is taught by the American Red Cross.
Tourniquets should be applied early (after limb injury and significant bleeding is occurring), and in many circumstances these can be applied by those with little training. Using the device before the onset of shock (from critical blood loss) is key.
Applying the tourniquet allows someone to move or be moved, continue to deal with the threat (finish the fight), and then to control the bleeding with things like gauze packing and a pressure dressing (which could allow the tourniquet to be be removed).
If the wound is bad enough to continue bleeding after that treatment, then the tourniquet should be moved one to two inches above the wound, and left in place.
A tourniquet left in place for hours may cause loss of the limb, but it prevents the loss of a life! It is not recommended to remove tourniquets that have been left in place more than six hours. When used for two hours or less, commercially available tourniquets show no increased risk of losing a limb or limb dysfunction.
Many respected medical professionals support this idea.
A report called the Hartford Consensus established the protocols that push for tourniquets to be widely available at mass gatherings in the U.S. In fact, every floor of the Hartford Hospital has a disaster bag that includes military grade tourniquets. Recently, as active shooter programs for schools and federal facilities have becoming the norm, so have trauma equipment including tourniquets and gauze. Lay persons, especially those with survival or tactical mindsets, should carry tourniquets as an essential item.
While improvised tourniquets (making one out of a belt, cravat, or other materials) are not favored by the military due to high failure rates (the military recommends commercially available tourniquets), there have been multiple lives saved by improvised tourniquets. For instance, quick thinking individuals saved lives and limbs at many of the infamous crime scenes in the last few years: the Aurora, Colo. theater shooting, Virginia Tech campus shooting, Boston Marathon bombing, among many others. There have also been lives lost where improvised tourniquets were tried, but failed.
The SWAT-T (or SWAT-Tourniquet) is a military grade tourniquet that is currently being carried by U.S. and Allied troops abroad, as well as at home by law enforcement, SWAT teams, federal personnel and contractors who work in environments with high incidents of penetrating trauma. The name states how to use the device – Stretch, Wrap, And Tuck. It has been tested and published in the peer reviewed military journals such as Military Medicine and the Journal of Special Operations Medicine. It has proven to be more effective than the windlass tourniquets, and safer (source: Military Medicine magazine, 2013, SWAT-T vs. CAT Tourniquet and The Journal of Special Operations Medicine, 2015, SWAT-T vs. CAT, RMT-P, SOFTT-W).
Additionally, and felt to be most important by survivalist/preppers, the SWAT-T serves as a multi-purpose and multi-function wrap (pressure dressing, among other uses). In a survival situation, the SWAT-T can be used for many essential non-medical functions. It is the most affordable tourniquet and is low space/weight…easy to use, with minimal training needed. Specific to the SWAT-T, it works great on small limbs (children), but also active limbs (canine, horse, etc.).
Because there were three lives saved after the Boston Marathon bombing in 2013, approximately 3,500 SWAT-T’s were deployed in and around the 2014 Boston Marathon. The SWAT-T is a proven life-saver.
Military personnel would never deploy without a tourniquet solution, and if you had to head for the hills it is the one essential piece of kit you may be missing.
How To Use a Tourniquet
Improvised (with a cravat/handkerchief/thick strip of clothing) – 5 steps
- Tie a half-knot (a half-knot is the same as the first part of tying a shoe lace).
- Place a stick (or similar rigid object) on top of the half-knot.
- Tie a full knot over the stick.
- Twist the stick until the tourniquet is tight around the limb and/or the bright red bleeding has stopped. Dark oozing blood may continue for a short time. This is the blood trapped in the area between the wound and tourniquet.
- Secure by tying the stick with a separate piece of fabric. Ensure no re-bleeding.
Note: The military specifically recommends carrying a commercially available tourniquet due to high failure rates with improvised tourniquets (related to user inexperience with improvised tourniquets)
Windlass system tourniquets – 4 steps
- Wrap the windlass tourniquet tightly around the limb and ensure it is secure.
- Crank down the windlass/bar until bleeding has stopped and pulse is lost, dark oozing blood may continue for a short time. This is the blood trapped in the area between the wound and tourniquet.
- Secure the device using its locking mechanism.
- Reassess in 1-2 minutes as bleeding is likely to occur from tissue relaxation beneath strap.
SWAT-T – 3 steps
- Stretch; as you,
- Wrap around the extremity; then,
- Tuck the free end to secure the device. The name states how to use, Stretch, Wrap and Tuck. Markers on the device indicate proper tension. After placement ensure pulse is lost and bleeding has stopped.
Commercially available tourniquets like the SWAT-T will have training videos on the company website or YouTube.
Best advice: plan/prepare for the need to place a tourniquet, then train with whatever solution you have chosen (improvised, windlass/strap, SWAT-T/elastomer).
About the Author: Dr. Brock Blankenship is currently a practicing emergency medicine physician, tactical medical instructor, and developer of the SWAT-T. In his prior positions, he served as a paramedic, and as a special operations combat medic with two combat zone deployments. His background in the military includes Survival Rescue while attending both U.S. Army and Air Force S.E.R.E training programs.