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>>64178518
I've heard a doctor say that picrel are superior for this exact reason.]
My training says to use a cat7 and put it on tight or they'll die but the doctor I mentioned says differently.
It's to do with the time to medivac, wound packing and/or hemostatic wouldn't completely cut off blood flow to the limb I guess but if it's a day before the patient gets to an OR, is the limb still going to survive that?
I'm not even remotely qualified to say.

4th year medical student here, not a 68W and not a doctor yet, but the ultimate answer is "It depends."

The primary problem is the application of tourniquets as a primary method of controlling massive hemorrhage. The goal of the tourniquet is to stop potentially fatal bleeding - the question then becomes, "Would something else have worked instead?"

Let's take a pretty serious case: a piece of shrapnel tears the femoral artery. Depending on the severity of the tear (did it sever it competely? Longitudinal laceration? simple nick?), other methods may work before a tourniquet is required. Wound packing can be incredibly effective when done properly. I've done live tissue models and a VERY mangled internal iliac can be controlled with a single combat gauze, two rolls of kerlex, and an ace wrap. That being said, this was performed by a resident doctor who has confidence and a medical degree even before their residency. That being said, they were also an intern, so they had only been a resident a few months at the time, and this was their second time doing such an intervention.

I would imagine the considerations are something like:
1) Can medics and soldiers be taught to start with something else before reaching for the tourniquet, and can they be taught when to make the call to tourniquet
2) Can this technique be taught not just to medics, but to the average infantryman
3) Would this intervention be effective in reducing unnecessary amputations without risking an intolerable increase in battlefield mortality due to poor decision making

Or something like that. I am confident that it is achievable, but I do not know if item 3 is fulfilled. I would imagine doctrine will change in the coming years, there have already been big steps taken to prepare for LSCO and the death of the Golden Hour and dependence on total air superiority and medevac via helicopter.

>>64178678
>>64178518
Noting that I forgot to answer the primary question, I am not certain that loosening tourniquets is the correct option here. Reperfusion injury is very serious and can be equally limb-threatening (see: compartment syndrome). I would imagine that, instead, focus will be on improving the hemorrhage control reaction from tourniquet to starting with other methods.

Do what it takes to keep the person alive long enough to get them to advanced care

>>64178518
It depends on the situation. In the absence of US style helicopter medivac, whether or not a tq related amputation is “unnecessary” is not a judgment I’d expect an American military surgeon to be qualified to make. Americans don’t need their walking wounded to help defend a trench until sundown allows ground based evacuation, Americans call in CAS and then CASEVAC.

OTOH, I am willing to bet that a better solution exists than whatever current Ukrainian training is. They were trained by westerners to use westerner tourniquet doctrine (aka >>64178633) reguardless of whether it was optimal because that was what western trainers knew, and who knows if they are considering their outcomes good enough or if they are experimenting to discover a better way.

I know my wilderness medical training instructs that the TQ is for self-rescue use only (unless the limb is otherwise irrecoverable). TQ to prevent exsanguination until you can get to stable ground and then you remove it and apply direct pressure and dressings until you bring the bleeding under control that way. I imagine that combat complicates this.

>>64178518
Theoretically it could be, the issue is that if the tourniquet is on for a damn good reason that may not be easy to tell through blood and grime, loosen it and now you killed a guy. I'd think the best answer would be better trained and stocked 2nd line treatment of casualties aimed at better triaging and categorizing wounded with aggressive application of hemostatic agents, packing, wrapping, and the removing the TQ if they're quite sure there won't be a catastrophic bleed. Pretty much stop off points between the front and the real medical attention at the rear specializing in this sort of thing. If you reduce unnecessary amputations by 20k but increase deaths by 5-10k then the math doesn't work out. Those guys could've pushed paper, trained others, or operated a HATO super weapon like a forklift.

if you have knowledge of how to clamp blood vessels and the locations of collateral arteries it would make sense i suppose

>>64178708
>I know my wilderness medical training instructs that the TQ is for self-rescue use only (unless the limb is otherwise irrecoverable). TQ to prevent exsanguination until you can get to stable ground and then you remove it and apply direct pressure and dressings until you bring the bleeding under control that way. I imagine that combat complicates this.
Forgot to mention that this is on a timer. If it takes too long, leave it on and just accept limb death.

>>64178518
The tourniquet has become popular because it requires minimal education to use.

>>64178648
Your greentext has nothing to do with anything implied by the OP or post made before you. Projective greentexting is an atrocious form of posting and you should be punished for it along with projective avatar posters.

>>64178518
The problem with the US military is that they always assume everyone else have the same American style logistics system. The US has superlative logistics. No other country even comes close. They can medivac a soldier from the frontline to a proper field hospital within minutes to a few hours. If the field hospital can't fix it, they can transfer the soldier back to the States in 24 hours. The Ukies are the poorest European nation and don't have such luxuries. The fact they're holding on this long at all is a credit to them.

>>64178518
>Is loosening tourniquets and applying hemostatic hours before evacuation is possible a viable solution here?
If by loosening the tq you mean removing it completely because you've had the time to carefully dress the wound and think it may no longer be necessary (or you think it might not have been necessary in the first place), then yes, that is absolutely a viable solution and doctrine is changing in that direction.
If by loosening the tq, you mean periodically loosening it to let some blood into the limb then reapplying it, no, that's just letting the patient bleed out in stages. Risk of death is too high and you're not going to meaningfully protect the limb.

The reason tqs are causing so many unnecessary amputations in Ukraine is because their forces were trained by Western partners teaching a doctrine built on our experiences in the GWOT. Our soldiers were essentially being taught to apply tqs to any serious bleed and not touch it until the casualty arrived at the battalion aid station. We were probably applying just as many unnecessary tqs but we could get away with it because we were fighting a COIN war with total air dominance and a well-polished MEDEVAC system.

Doctine, both ours and what we're teaching to the Ukrainians, is starting to change.
We're still pretty gung-ho about applying tqs (which is appropriate, a catastrophic haemorrhage can kill you in seconds and recognising what bleeds truly require a tq during care under fire is difficult) but there is increasing recognition of the importance of tourniquet conversion (i.e. deescalating from tq to wound dressing and direct pressure) and tourniquet replacement (replacing a hasty tq with one placed closer to the wound after dressing/packing have proven inadequate).
AFAIK tourniquet conversion/tourniquet replacement is currently CMC level under the TCCC but in Ukraine they're teaching it to everyone.
>t. Dr, emergency physician, former MSF volunteer in Ukraine.

>>64178696
>I am not certain that loosening tourniquets is the correct option here.
It is. Current recommendations are that tqs should be deescalated if the following criteria are met
>Casualty is not in shock
>You are able to monitor the wound for rebleeding
>The wound is not an amputation
>The tq has not been in place for >6h (at which point the risk of reperfusion injury becomes too great, obviously sooner is better)
>Other tactical or medical considerations preclude conversion

>>64179508
Sure, under the stipulation that additional training is provided, makes good sense

>>64178518
You're not supposed to jump straight to torniquets, this is military retardation. Torniquets are the last resort unless the bleeding is so bad it's obvious other methods won't work (artery shooting blood) or you need to evac quickly and don't have time for other means. It's always been this way until lazy military retards started getting into EMS training positions and fucked up what doctors and surgeons who actually went to real medical school have told us for decades, which is what I told you above.

>>64179734
A good rule of thumb, it's the last resort unless it needs to be the first. The reason being is if you plug it up, the rest of the leg still has circulation. If you cut circulation to the entire leg, the entire leg suffers and may end up with dead tissue.

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The assumption being “being medically discharged” is something the soldiers sought to avoid..

>improper use of tourniquets
>hurr durr you should just send a chopper to evacuate a wounded guy, we did this in afghanistan and iraq, it totally works in a real war
Sometimes the western military is delusional to a high degree

>>64178633
>picrel are superior for this exact reason
This shit is what russians tried to use for decades and it never worked in the field, people would just bleed out while trying to use it

>>64178678
You sound like an insufferable faggot.

Trauma resident here.

I have nothing more to add to what has been said, you have less than 6 hours before hemostatic surgery is performed to ATTEMP to save a limb. A tq is good to stop death, not to save a limb.
When to use one and when to pack a wound? Good luck figuring that out with bullets flying mortars shells falling around, drones watching you etc.

Ideally in a city when a GS to a limb comes it goes to the CT scan with a contrast solution. You see where the hemorrhage is you take the patient to the OP room if your hospital has hemodynamics team. Full time from GS to op room can be as fast as 30-45 minutes in my city.
In the middle of a fucking trench in bumfuck Ukraine Russian border? Well there you go sometimes 2 days....

>>64179421
>They can medivac a soldier from the frontline to a proper field hospital within minutes to a few hours
because the US never fought a real war in the last 50+ years, yeah

>>64178633
I have a few of these for if someone gets a serious gash.. but not something that is going to immediately threaten their life, cut off/lower bloodflow to the area and apply pressure so the wound can coagulate a little, wrap the bandage tightly but not like you would a TQ, and then remove the band

but like if someone has catastrophic damage to their limb where the bloodloss is high and they could die literally in minutes, a real CAT that lets you use way more torque much quicker then you could fumbling around with a sharpie and a single use band or something... just bring both.. the single use bands are so easy to carry like 10 of

>>64179809
The biggest issue is that you can use a normal tourniquet with a single hand, while this rubber bullshit it unusable in the field, under fire and doubly so on yourself.

>>64179797
>I'm sure to win because my dying from treatable injuries is superior

>>64179881
Why the strawman, Martinez?

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>>64179797
We started doing it in 1944.

>>64179894
I know

>>64179898
Whats a real war?

>>64179902
The one I’m having with your mother’s ass tonight

>>64179902
Where you don't play around in a sandbox with a non-factor enemy and where you don't go in after an enemy on its last legs after it fought for 5 years with others.

>>64179477
Now I know. Thanks Doc.

>>64178518
I-I'm gonna toorn

>>64178678
68W’s are useless insufferable faggots and you are too

>>64178678
>and the death of the Golden Hour and dependence on total air superiority and medevac via helicopter.
We need single person medivac drones l.
Its 21st century ffs.

>>64179421
Ukrainian problem is frontline evacuation, outside that they literally can straight drive ambulance to Kiev major hospitals.

>>64179991
>We need single person medivac drones l.
ukies are trying this, basically a RC buggy to drive up to a soldier, hook him in and pull away, but it's all too primitive, slow, non-versatile and not available in enough numbers

>>64179910
like the gulf war?

>>64180001
I mean flying drones of course, that can quickly in one go pass 20 km "great zone" of death filled with enemy drones.

>>64179797
Why do wars suddenly stop counting when America skullfucks the opponent in less than a year or in some cases months?

>>64180009
Let's be real for a moment: compared to the US at the tail end of the cold war (and the coalition overall), Iraq after its disastrous Iran-Iraq war as a pushover.

>>64180019
Because the US learned its painful lesson from Vietnam and stopped engaging in real wars.

>>64178518
t. medfag
Tourniquets are overused in field medicine, especially with the advancement of things like hemostatic wound spray and less use of pain meds that lead to arteriolar dilation and venous relaxation.

That said, a combat medic's job is to take a stable or declining patient and keep them from declining more until they can make it to a medical facility. Their job is to essentially stop the patient from dying, then record vitals and times of every procedure and medication used and how those are affecting vitals. If a patient has a tourniquet on for longer than a few hours, that is a direct failure of the medic or somebody through the train of treatment.
A. They should see written on a chart or even the patient's forehead something like "HC LEFT JUNCTIONAL 0400", reminding themselves or future facilitators that this patient has a tourniquet on their leg and how much time it has been in place.
B. Advanced treatment options should be in use by the time the patient has cleared the field and the very first thing med should be doing is running a drip/blood bag and isolating the area of treatment by immediately addressing hemostasis to prepare for surgical intervention.


The ONLY reasons a medical team wouldn't catch something as simple as hemorrhage control is a fault in protocol, not using their treatment plan or SBAR, not doing proper hand-offs and a lack of qualified medical personnel.

>>64180083
>If a patient has a tourniquet on for longer than a few hours, that is a direct failure of the medic or somebody through the train of treatment.
This is a conflict where casualties often don't even see a medic for several hours. You're making judgements based on your experiences working in a first-world, civilian context (or maybe a first world military where time to definitive care isn't significantly prolonged either). Attitudes like that are directly responsible for the adverse outcomes we've been seeing.

>>64178648
Who's "we", zigger?

>>64180118
Well I'll make a correction, the longest I've seen a tourniquet in place is 12 hours without need for amputation. But a trained medic should automatically be gearing up for a tourniquet conversion around the 3 hour mark and have a treatment plan in place to prevent reperfusion. You're speculating as if we aren't trained to encounter a situation in which the patient can't be immediately evac'd, and that's very much part of the training. You're not just risking amputation, there's a dozen other complications that happen when you keep a wound in stasis for that long, and your job is still to prevent any decline possible. Modern western forces though, it is extremely rare where you have a patient stuck in the field longer than a few hours, and even more rare that even a basic infantryman isn't going to know how to convert to another form of hemostasis.

>>64179796
Not him but I guess my question would be why are people leaving these TQs on for days on end in so many cases where it appears unnecessary? I understand just throwing a TQ on a limb in the heat of the moment, but once things have calmed down why aren't medics reassessing their patients wounds?

>>64179809
> a real CAT
This is also a problem Ukraine has. There’s a shitload of fake and/or expired medical gear floating around.

>>64178518
Was in the military issued and trained on a tourniquet. Always on the assumption that 3rd line care was less than 6 hour away, never remove a tourniquet. 2 hours was the old limit before high risk of losing the limb, advances in medication and chemical treatment pushed that out to 8 to 10 hours.

If you can stop a bleed by another method do so, if not use a tourniquet, if you can stop the bleed and it's not something you can use a tourniquet on use QuikClot to burn it closed.

>>64180233
They were starting to change it around the time I got out because they were seeing more and more casualties come back from junctional wounds with high survivability well after the typical 2 hours, but from my understanding now there's a lot more tech around wound seal and foam that negates the need for long term manual hemorrhage care with tourniquets or gauze. I'm sure that by our next major conflict, tourniquets will be seen as archaic. There a lot of really cool wound seal sprays that even penetrative arterial bleeding and seal this shut, but immediately dissolve upon contract with saline.

>>64178633
>I've heard a doctor say that picrel are superior for this exact reason.
Lol fuck no
>My training says to use a cat7 and put it on tight or they'll die but the doctor I mentioned says differently.
Things are different in a combat environment, far from hospital beds and blood infusions
>wound packing and/or hemostatic wouldn't completely cut off blood flow to the limb I guess
It can, actually, if packed and wrapped correctly. But that is a huge "if" and not all bleeds are going to be able to be handled that way.
>but if it's a day before the patient gets to an OR, is the limb still going to survive that?
Probably not, and your high and tight cat-7 isn't really to blame.
>>64178708
>TQ is for self-rescue use only (unless the limb is otherwise irrecoverable). TQ to prevent exsanguination until you can get to stable ground and then you remove it and apply direct pressure and dressings
Depends on the wound and in many cases it's better to just leave the tourniquet on. "Oh no my limb is ouchie" yeah ok buddy now you've packed some non hemostatic gauze in there and are hemorrhaging right through it regardless of pressure, and you fucking die. FAFO
>>64180216
>> a real CAT
>This is also a problem Ukraine has. There’s a shitload of fake and/or expired medical gear floating around.
Correct. I once bought some cheap amazon tqs to use as training aids, and the quality was shockingly bad. They weren't able to cut off blood flow at all, making them unusable even for training purposes. If anyone got treated with that knockoff for a real injury, it'd be fatal
>>64178678
>1)
Doctrine says apply tq first, pack wound and remove tq later (when not under fire)
>2)
Originally the answer was 'yes' but consensus has shifted over time to favor just medics for many interventions, this included
>3)
The answer is dubious even for the USA. For Ukraine, the answer is 'fuck no'

>>64179796
>trauma resident
Right, okay :) I too am applying to trauma medicine to be a trauma doctor

>>64178518
>Ukrainians take care of their wounded
>russians blow themselves up because they know nobody will help them
>Visajeet posts an article about it thinking he'll demoralise white little this way
It ain't easy being brown.

>>64180136
I don't know I'm not there. You need to understand cardiovascular surgery is made by surgeons and specialists. Trauma surgeons are not the best for that . So my guess is you have a time frame, where say from tourniquet application to field hospital, minimum 2-3 hours, and you are not the only casualty so the triage would go first to the critically wounded to save them, then to you and your precious limb. So add another 2 hours. And IF that field hospital is minimally good equiped. If not add 2 more hours until someone looks at you. So there you are already out of that nice 6-8 hour safe window.
I'm not very versed in the techniques to do those kind of surgeries but you need equipment.
So my guess is that is what is happening, plus the American doctrine, and well even in a city you lose a limb many times from GSW.
I'm a civilian MD resident with a military degree. So I'm not a field medic. We work on hospital and stations. We are officers 2nd Lts but with a very basic idea of army life and 0 experience in war zones

>>64181307
To add to that 6 hour window we had patients in a city wait from GSW to surgery 8 hours before we could find a hemodynamics team available bringing him there and so on. No tourniquet was applied of any kind just packed the wound, got compartiment syndrome guy lost the leg in 4 separate surgeries in 2 weeks. A puny 22 lr round to the common tibial artery and bad luck

>>64180015
Most drones don't have that much lift.

>>64178648
Jesus Christ can you nerds stop your online rivalry shit for a second so we can have a thread about something interesting?

>>64181307
>2LT
>Resident
Come on son

>>64181701
Exactly you finish the residency after 4 ys as a 1st LT. I'm not in the us.

>>64183549
Oh oof

>>64180942
yet they have been on the offensive for 2 years straight since 2023.

>>64180123
> muh "zigger" again

>>64187535
Russians have been offensive for much longer than that.

>>64178678
This just makes me think only combat medics should have the torniquets.

>>64178648
You ever tried to stop trying so hard to fit in?

>>64189949
>This just makes me think only combat medics should have the torniquets.
Why? Seriously, what about that dude's post makes you think that?
The fact of every soldier carrying a tourniquet is one of the reasons deaths were became so rare during the GWOT.

>>64179991
I mean, if you have the industrial capacity to make something like that at scale, why even have soldiers at all? Why not deploy a 100% mechanical force of autonomous kill-bots that just move forwards towards the enemy border and fire on anything that moves in their field of view until no targets remain? It's not a very complex task to identify a man-sized or vehicle-sized target and point a turreted weapon at that target. A cellphone from the later 2010s has enough compute power to do that.

And I'm only partially memeing here. What do human infantrymen really do in a total war scenario like the Ukraine War that either couldn't be done better by robots or couldn't just be removed from doctrine? I feel like 50 years of counterinsurgency from Vietnam to Afghanistan have led militaries to overvalue the human element, causing us to cling to an outmoded idea of "boots on the ground" that doesn't really serve a useful purpose in an attritional war that's just about destroying enemy assets until the economy of the other country folds under the pressure of replacing losses.

god i hate when the EMS gun nerds start trying to fight over who is correct. the entire field is nothing but anecdotal evidence and tribal station knowledge.

>>64180083
Torniquets aren't just done by combat medics anymore...

>>64180942
Why did you post twice

>>64190007
Because if they're not capable of using it correctly or need specialized training than it's not worth the limb problem.

>>64190372
My retarded friend, the best things about a modern tourniquet is specifically that a person can use it on himself and thus don't bleed out in 5 minutes, which would happen if the tourniquet wouldn't be used.

>>64190372
the issue isn't misuse, it's that they are left on for too long.

Probably, very simply, because they don't have the resources or manpower to take it off and bandage.
They Ukies are probably sticking with TQs because, even with an amputation, those are guys who're going to live. They might not fight militarily, but they can go home, participate in the economy with rehab, and have kids.

>>64190051
>What do human infantrymen really do in a total war scenario like the Ukraine War
They build and maintain holes in the ground from these holes specialists infantrymen launch drones to fuck everybody's shit up.

>>64190051
>What do human infantrymen really do in a total war scenario like the Ukraine War that either couldn't be done better by robots or couldn't just be removed from doctrine?
being very, very cheap

>>64178708
DARPA has been toying with the concept of quadcopters large enough to do CASEVAC for years, but it's never gotten past .ppt stage because they don't trust soldiers to pilot drones with passengers inside and drone autopilot tech doesn't have enough 9s of reliability yet. Ukraine, however, has a large body of trained drone pilots and constantly-evolving doctrines while lacking CASEVAC altogether, so there's an opportunity there...

>>64178518
I know I'm dating myself here but when I was trained I was taught that tourniquets were obsolete and to always use other methods to stop bleeding. Still bizarre to me how things reversed themselves.

>>64190051
>What do human infantrymen really do in a total war scenario like the Ukraine War
The bulk of the work. Drones are completely blocked from the battlefield 2/3rds of the time due to jammers and crippled supplies makes stopping Russian attacks with artillery harder.

If you only watch drone compilations on reddit you're missing most of the war, especially post 2023 when artillery started running low. In the gray zone it's an infantry-squad centric war fought by men in holes with shovels and rifles repelling small teams of other men with rifles in small unit engagements similar to Vietnam or Afghanistan. This is part of why it's static in areas like Povrosk. A mechanized battalion would have counterattacked and cut off the russian advance in 2023 but drones can't do it and dismounted infantry move too slow so the russians can trickle in more fire team size mobik groups.

>I feel like 50 years of counterinsurgency from Vietnam to Afghanistan
This was a common narrative between WW2 and the Korean War. Atomic bombs (and if you didn't want them mass carpet bombing) had made the stupid monkey with a gun obsolete. Real civilized nations had no need for such crude modes of warfare, particularly in attritional wars about destroying the enemy until their economy folds. Just bomb them haha. You know what actually happened. Bombing raids dropping more HE than WW2 raids weren't enough. Flattening every village in the land wasn't enough.

Perhaps it's a military lesson which has to be re-learned every few generations. The human element isn't overvalued. Quite the opposite: it tends to be undervalued by the professional institutions themselves; and undervalued to an absurdly wrong level by everyone else.

>>64180678
> It can, actually, if packed and wrapped correctly. But that is a huge "if" and not all bleeds
Hey retard, first off you dont pack limbs. Second off direct pressure is the best way of stopping a non SHTF bleed. Third off direct pressure isnt supposed to cut off circulation in the first place not even sure how you’d do that

>>64191018
But they aren't cheap. Every soldier you deploy costs ~20 years of food, housing, education, etc. to create, and if he's lost in battle, he costs on top of that all the economic output he'd have had in his whole career had he not been sent to die in a trench.

In terms of long-term economic impact, infantry have the highest cost to combat effectiveness ratio of any form of military asset. They only appear cheap in the short term because the cost of creating potential soldiers has already be paid before the war starts and the cost of their lost economic output is spread out over successive years. But as the war in Ukraine is dragging on, both sides are starting to run into the problem of having exhausted the preexisting fighting-age men, and are starting to feel the consequences of those men not being in the workforce.