Training tourniquets

The tourniquet is something I’ve tried quite hard to avoid in my life- Not just in the “avoiding a massive haemorrhage” sense, but in the “avoiding tactical medicine” sense.

Recently I spent nearly £2500 of other peoples donations on CAT tourniquets, and shipped them into Kyiv for civilian prehospital providers. After doing that, I think it’s time to think differently about tourniquets in UK trainings and protocols.

I work in situations where massive haemorrhages are an if, not a when- I’ve not dealt with them, but people in queercare have.

But I’ve chosen not to emphaise tourniquets, or put a lot of infrastructure into making sure people have them.

I carry one, sometimes, on spikier demos and similar, and I know some other people have bought them for themselves.

But we don’t focus on them, and tell people not to focus on them- They’re just the thing that comes after direct pressure when you’re dealing with a massive haemorrhage. You can make one with a triangular bandage and your shears.

This runs counter to a lot of the noise you’ll hear, especially from Americans. Americans love tourniquets- The more the better, and if you can have chest seals and hemostatic gauze too, that’s great. What do you mean activated charcoal and something to help with blood sugar?

Carrying tourniquets is dominant in the aesthetics and discourse of layperson prehospital care, as much as carrying milk for tear gas is.

But the focus on an object rather than a technique has always been a problem- People obsess over them, and avoid learning the skills they need to deal with most dangerous situations they encounter- Which is probably deescalation.

For the last 50 years in UK street medicine, and community care, even adjusting for our updated knowledge on their efficacy and reduced risks, keeping them tucked away was the right call.

I think it’s time to bring them out a bit more- Not make them the core part of our training they are in military medicine, but train with dedicated tourniquets.

Why?

Because that makes sense in warzones and other dangerous areas, and it’s becoming more likely that people we train will end up there. Probably the uk will become more of one.

There are a lot of uk civilians all around ukraine right now.

Some of whom are leftists, many of whom are working unaffiliated and without proper medical training for the situation. The fact that Ukraine isn’t surrounded by a set of hostile states(like syria) and you don’t need to get in an aircraft to get there(with it’s attendant “why are you carrying so much outdoors gear”1) makes this a bigger problem. Couple it with large Ukrainian diasporas and a sense of solidarity among the eastern European community, and you have a recipe for a lot of people from our communities in dangerous places without training.

(There are racial effects at play here: I think I’m adjusting for them, and obv people from the UK have been fighting and doing aid elsewhere forever- Across the Middle Aast and Africa to start with, I suspect a chunk of SE Asia, but I don’t know the conflicts there as well. But all of them have a lot more friction to enter than Ukraine. )

Warzones like this will get more logistically proximate, and our protests and riots will get spikier.

The gay bashing will get worse and so will white supremacist violence.

We need to be ahead of events when we’re building infrastructure to deal with those events.

We train now not so the people will be able to deploy a CAT on a protest tomorrow.

We train now so in 10 years they’ll be able to open a box of them we’ve left above a shop somewhere, or whom someone fundraised for entirely independently, and be able to tell their friends how to use them.

We train now so the buddy pair that’s traveling as a walking manifest and trainer with a #QCWR shipment knows what to do when the very NGO aid convoy gets hit by an IED from some proxy who doesn’t really listen to their imperial trainers.

We train now so in ten years it’s not new and scary, but instinctive and normal.

So yeah. This isn’t a post about whether you should carry a tourniquet. If you do it’s almost certainly a sign you’ve got either misplaced priorities or a fetish. The latter is fine, the former is dangerous.

It’s a post about whether we should build an infrastructure that has, at it’s endpoints far from here and now, people using tourniquets.

We should do that. We’ll be grateful.

1. Assumes basic levels of competence. For many it will be “why are you carrying so much tactical gear”? ↩