Doc Lipes Performs an appendectomy on a Submarine by Artist John Falter
I don’t know how other branches instill passion in their medics, but in the US Navy it’s done by telling the legends of our craft. The heroes who’ve gone before us to set the example and show us what being a combat medic means.
One of these who inspired me early in my career was the story of Pharmacist’s Mate 1st Class Wheeler Lipes, who, while at sea and underwater in enemy territory, preformed an illegal surgery that saved the life of his shipmate.
Seems like I’ve been on a bit of a pressure bandage kick. Which is fine with me cause I can only write about tourniquets for so long before my eyes start to bleed.
If you didn’t already know, a pressure bandage is a stretchy material wrapped around the victim to provide constant firm pressure to the wound and wound packing gauze for bleeding control.
This is important to know because not all life-threatening injuries occur on the arms and legs where TQs do their best and only work.
There are plenty of different pressure dressings on the market and they vary widely in size, function, and style, but the two that are leading the pack are the Israeli style and the OLAES Modular Pressure Dressing.
I’ve never thought more about tourniquets then I have in this job. Bleeding control being such an important topic of discussion means devoting a good amount of time to all the various ways people have developed to save lives.
It takes some time to run through all the various options out there, and this week we’re looking at the Gen 4 Recon Medical Tourniquet.
But first, before we get into all the little details, we have to address something important.
We can’t be prepared all the time. Even if you’re the kind of person who has every pocket full of life saving materials, you still need to shower at some point and when that day comes you may very well find yourself having to save a life without any gear at all.
Tourniquets are normally your best bet for controlling severe bleeding from an arm or a leg, but that leaves a large portion of the human body where a TQ won’t work.
It would be nice for emergencies to happen in the very best locations. A well-lit ER is a great place to have an emergency if you happen to be in one at the time. But Emergencies don’t happen like that. Usually it’s cold, wet, and dark, and with no help available.
Emergencies are especially scary because, you’re “it.” The casualty might be relying on you because no one else is willing or able. And if it’s dark and you don’t have help, it’s nice to be able to use your hands AND see what you’re doing.
Working as a Corpsman and EMT, I wasn’t given the choice of what medical gear I used. People with much more experience, training and education decided ahead of time what was acceptable and what wasn’t.
As a result, I only used gear that was issued and available to me and I never thought about if there might be a better option because it wouldn’t matter if there was. It would go against SOPs (Standard Operating Procedures) and that was always strictly forbidden.
Now that I’m free to explore and look into other life saving equipment, I’m given the opportunity to search out the answers for myself and question my reasons for doing what I do.
An emergency usually means you have little or no resources available to recover from a bad situation. Being able to extend the life of precious resources like trauma gear might become an essential skill set, and it happens to be one that medics pride themselves in.
Unless you're heading out to do errands in a fully stocked ambulance, you aren’t going to be able to carry all the things you might need for trauma control. And the situation only gets worse for multiple casualties.
Some things you just can’t get around, like carrying tourniquets for life threatening bleeds or seals for chest wall punctures. But if possible, carrying items that can be used for more then one type of injury is good for extending the number, and different kinds of emergency trauma you might encounter.
Here’s a list of items that can handle more than one job:
Full disclosure: I’m the one that decides what gear should go in our kits. And if it isn’t obvious already, I receive a financial kick back for talking about the MMM kits.
But I’m also confident this is an excellent trauma kit full of top-of-the-line gear and priced better than any comparable kit on the market. I take a lot of pride in the value we offer, and it’s my hope that more trauma gear is placed where it can save more lives.
One of my favorite jobs during my career in the medical field has been teaching trauma classes to organizations looking to be proactive in preparing for a disaster, either natural or manmade.
You might’ve gotten into trouble for it in school, but daydreaming can be great for your survival.
I learned this the hard way as a method of keeping myself present in the rocky hills of Afghanistan. While on patrol with my fireteam, it was easy for my mind to wander back to what must be happening in the normal world instead of focused on the dangers around me.
A few weeks ago, I made a video on the Mountain Man Medical YouTube channel about an Officer who was stabbed in the neck while attempting to apprehend a suspect.
After the altercation is complete, the body cam footage ends with the officer walking away to pack gauze into his own neck wound.
If you’ve been reading this blog in the past few weeks, you’ll already know why junctional wounds are uniquely dangerous, and why bleeding control is so difficult.
If you haven’t read these articles, I highly recommend that you do so you’ll better understand what I’m talking about here. They’re short reads, and I try to make them entertaining and educational.
After completing the video review of the injured Officer, I kept thinking about how important it is that everyone know how to pack a junctional wound. As I’ve said repeatedly in the last few posts, tourniquets, while important and effective, don’t fix everything.
I hear all the time from instructors about how important it is everyone to learns to self-apply a TQ to save your own life, but never anything about a technique for packing your own junctional wounds and/or improvising effective pressure dressings.
This is an unusual and potentially deadly blind spot in the normal training of medical skills for personal preparedness and protection.
I worry for the person who carries around a trauma kit for their own personal safety, confident they can control bleeding with their TQ, only to bleed out from a junction wound because they don’t know what to do.
Learning how to control your own junctional bleed is equally important as learning how to self-apply a tourniquet.
I started thinking of a way where an injured person suffering from a knife wound to the neck, might go about controlling bleeding until help arrives.
How to Improvise a Pressure Dressing with a Flannel Shirt
This method, like all improvised equipment, has its flaws. Improvised medical gear will never be better than commercially produced gear, and whenever possible I recommend you maintain your own supplies of pressure dressings like the Israeli Style or OLAES, so you don’t have to do any of this.
But the reality of emergencies is that they can occur when you are least prepared and knowing how to fix this problem might be handy when you need it most.
Here is a demonstration so you understand what I’m talking about here, but come back after you watch it and I’ll add some tips that might make the process easier.
Tip #1
This technique won’t work well if your shirt doesn’t have long enough sleeves. I wear a lot flannel (yeah, yeah, make your jokes) so this isn’t really an issue for me, since I’m usually wearing a long sleeve shirt. But if you don’t, this won’t be quite as simple.
That said, learning this technique means the material doesn’t have to be a shirt. Look around for something suitable to replace the shirt and you’re still accomplishing the goal. This is your shining opportunity to think outside the box.
Tip #2
You must practice. Self-application of a tourniquet must be practiced, and so must pressure dressings. Play around with it until you can do it without stumbling. It will probably take a few tries so don’t give up.
And if you happen to figure out a better way to do it, please don’t hesitate to share with the rest of the community so we can all benefit!
Tip #3
Yes, the shirt must be flannel. Flannel shirts are naturally imbued with the powers of Mountain Men, which is why it works so well as an improvised pressure dressing…
