Monday, 3 December 2007

The mother of invention is necessity

Thanks in part to recent military conflicts in Iraq and Afghanistan and also the ongoing troubles in Israel and Palestine. There have been recent improvements in the quality of the available kit to be used for dealing with certain kinds of trauma. Tonight we were introduced to two of these. They will both be made available in our first aid kits to be used onboard the lifeboat.This first bit of kit is a tourniquet. It is called the CAT or 'Combat Application Tourniquet', no prizes for guessing that it's of American origin! It is made of Velcro and webbing and has a quite intricate design which allows tension to be applied to it using a little windlass which is attached to it. It is so good it can even be used single handed and applied to oneself! Indeed, I have it on good authority that some members of our special forces wear one on each arm and leg when going into battle.......what incredible and cold blooded foresight.Here you can see it applied to my leg. It ought really to be applied further up my thigh but it hurt too much so I did it here. Believe me you can get it very, very tight, indeed, sufficiently tight that you can..............cut off the blood flow. Because of their design these can be put on and left for at least 2 hours.This is our new design of pressure bandage/wound dressing. It's awesomely easy to put on and (as you can see from the colour of Chad's hand in the photo) puts a great deal of pressure on the wound. Apparently these were designed by the Israelis and work very well. I can imagine they do.


Unknown said...

I would be interested to learn the thinking behind this move.

Both of these inventions are designed for use in combat situations. General (Urban) First Aid advises against the use of tourniquets, because of the complications that can be caused if used incorrectly (and even if they are used correctly).

Clearly, these items aren't particularly cheap, whilst I appreciate the issues of catastrophic bleeds in remote locations - I would be very interested to see some figures as to how many bleeds that required the use of a tourniquet the RNLI have dealt with. Perhaps I should rephrase that... how many lives have been lost for want of a tourniquet?

I am sure that the RNLI aren't just going to throw money at some new kit just because it's there, I hope that they do have some research and some science that has identified that this kit is required on Lifeboats, I'd be very interested to find out more.

From my reading of pre-hospital research, direct pressure, elevation, and the body's natural reaction to severe blood loss are effective in controlling the vast majority of serious bleeds. A common exception (and hence the combat applications) is with blast injuries, particularly mines.


lifeboatjohn said...

I'll ask Paul to get back to you on this Dan as he will know more than me.


Anonymous said...


I will answer your points in the order you raise them.

1: The CAT tourniquet is now supplied and issued to 2 of the 11 UK Ambulance service trusts. Following a conference in Poole that I was a speaker at - a large faculty of the top trauma consultants of the UK such as Keith Porter - presented the research and requirement for the civilian use of pre-hospital tourniquets.
If used correctly, and kept on for under 2 hours - research shows 0% occurrence of the 2 major side effects ( nerve palsy and potential amputation).
In fact - a paper soon to be released by the military will show that overseas they have extended use - up to 12 hours continual application - with no recorded side effects. Also - bottom line - an alive patient is always preferable to a bled out one- as I am sure you will agree.

2: On to cost. Lets iron this out. Replacing 12 poor trauma dressings with 5 good ones is actually near as damn it cost neutral. Equipping the fleet with a CAT per boat costs under £3000 for the whole fleet.
So £3k kits out the whole of the UK and Ireland to cope with major bleeds. Not bad value I am sure you will agree.

3:The RNLI does deal with some significant bleeds in various locations. I can assure you that the RNLI does not buy kit "willy nilly" and this has had to pass thru 2 high level committees to gain approval. We also now take guidance and advice from 2 Ambulance service trusts along with some contacts in the military and at Hereford - who are at the cutting edge of current best practice. In fact - the whole course and theory behind is at the forefront of prehospital care rather than several years behind. It does appear that a void is emerging between the voluntary societies ( Red Cross etc ) and the emergency services. We have had to choose our side of the fence.

4:Without doubt, direct pressure and elevation works. Our crews are taught to try that first. However - the body's reaction as you call it - (arterial spasm) only lasts for 20 mins max., then your patient starts to bleed to death. What the new kit does is allow crew - after just 20 hours training - to stop serious bleeds and have the confidence to control bleeds and save lives.

Direct pressure and elevation is hard to achieve when: the fisherman has wound his hand into a winch and severed an artery in a location inside the winch , of when a merchant fisherman has had his leg crushed under some cargo etc etc.

The use of CAT tourniquets for victims of limb crush injuries - mean that after tourniquet of the limb, release can be achieved without the need of a medical team and the patient can be brought into definitive care where ITU staff can monitor the release and counter the problems arising.

All interesting and exciting stuff.

Please feel free to reply if this does not settle your concerns

Paul Savage