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So you carry a gun, but are you prepared?

Whether you’re a newly permitted gun owner or a cop who’s been toting the ‘ol brick around for years on the job, I’d be willing to bet that there’s a significant portion of you, dear readers, who I would classify as “unprepared”.

No, it’s not a shot at you personally, your training (although I’m sure we both acknowledge we could both benefit from more training, perpetually, but that’s another discussion), your mindset, or anything like that, but it’s a frequently-overlooked but much-harped-upon component of people’s carry that is regularly overlooked.

Yup, you got me, I’m a medic, and I’m here to tell you to carry medical gear. In fact, I’m a civilian paramedic who serves on a SWAT team, and also works as an instructor… but I’m not just here to say “go buy a tourniquet” and run off into my station giggling. Although if that worked, cool.

For those of you who remain unconvinced, I will give you three actionable steps that you can take as any kind of lawfully armed citizen or gun-toting professional to improve your medical gear capability as well as your medical training, without spending hundreds of dollars, and without carrying an ambulance on your back. Stay with me, and you’ll see what I mean – all this trauma medicine is not as much voodoo magic or forbidden knowledge as some of the paramagicians or paragods would have you believe. 

Now, we can all acknowledge that the best case scenario is to go to some kind of formal schooling, whether that’s your local EMT/paramedic program at a tech or community college, or a class by the likes of Caleb at Lone Star Medics, Kerry at Dark Angel Medical, or another competent, educated, and tactically aware medical trainer. I realize this is not possible for everyone, and that is why I’m writing this article – I just don’t want anybody thinking this replaces or supersedes any actual (ideally in person, but y’know, COVID-19 is still a thing, at least as of this writing) training.

Alright, with that out of the way – let’s move along to step one: buy the tourniquet, and how to carry it.

First step, go buy a tourniquet. Without going all the way down the proverbial rabbit hole, you should be aware that there are a bunch of tourniquets on the market, and they’re not all the same, or even effective. I have two personal favorites, but I want to make you aware of why they’re my favorites – they’re the two that have lasted the longest on the list published by a group of people you may be familiar with – the Committee on Tactical Combat Casualty Care, or CoTCCC (sometimes pronounced “cot-see”). They’re a US Army committee who looks at all aspects of trauma care and works to improve it – in short, they are the experts on the forefront of trauma care. CoTCCC doesn’t “approve” tourniquets, but they do publish a list of tourniquets they feel comfortable recommending. That list is as follows:

  • Combat Application Tourniquet Gen 6, Gen 7 (CAT)
  • Ratcheting Medical Tourniquet-Tactical (RMT-T)
  • SAM Extremity Tourniquet (SAM-XT)
  • SOF Tactical Tourniquet – Wide (SOFTT-W)
  • Tactical Mechanical Tourniquet (TMT)
  • TX2” Tourniquet, TX3” Tourniquet (TX2, TX3)

The two longest-standing occupants of this list are the CAT and the SOFTT-W, and they are my personal preferences for tourniquets, and what I recommend to whoever asks for my opinion. If that’s all you’re here for, jump to the next section – if you want to learn why, keep reading.

All of the tourniquets on the list have some kind of mechanical advantage to tighten them and shut off (occlude) the arteries in the injured limb. If the tourniquet you’re looking at does not have a mechanical advantage feature, avoid it – don’t bet your life or someone else’s on an un-vetted product.

The two I prefer (as well as the SAM-XT and the TMT) possess a windlass – in simple terms, a stick you spin. Windlass based tourniquets allow you to apply a tight band (with Velcro or a buckle, generally) and then tighten that band even further than “hand tight” by spinning the windlass. 

This creates something often referred to as a “cone of pressure”, compressing the arteries responsible for carrying your blood – generally to your body, but if you’re applying a tourniquet, they’re probably carrying that same blood to the outside world. As many in EMS like to say, “air goes in and out, blood goes round and round, any variation is bad”. A sidebar on this – if you’re going to apply a second tourniquet because the first one was ineffective, apply it immediately next to the existing one – proximal (closer to the heart) to the existing one where possible – this will allow the cones of pressure to work together, rather than creating two separate and distinct cones, allowing for improved effectiveness.

Some others, like the RMT-T, use a ratcheting system to apply additional pressure once the strap is applied “hand tight”. I have some, but not a lot, of hands-on experience with these systems, and my biggest complaints are that the mechanical advantage provided by the ratchet is fairly minimal in comparison to most windlass methods, and that the ratchet method introduces more moving parts, and thereby introduces bulk and additional points of failure if grit or mud gets into the mechanism.

Admittedly, mud and blood can clog the Velcro in the CAT, which is why I generally, when pressed, state my preference for the SOFTT-W over the CAT. Incidentally, as of this writing, Tactical Medical Solutions just released a new generation of the SOFTT-W in March of 2021, which I have not gotten my hands on yet but which looks to have improved even further on the design especially as it relates to one-handed application. I look forward to seeing what upgrades have been made once I get hands-on.

For those of you who skipped forward, start reading again here. Once you’ve got your hands on a SOFTT-W or a CAT, I’d encourage you to look at ankle kits if you like, or something like the PHLster Flatpack, whatever fits your carry methods and makes you willing to carry your newfound companion regularly – incidentally, if you’re really cheap and want to ankle carry it, just (gently) attach it to your ankle – not perfectly ideal because its loop won’t be open very wide if you need to deploy it, but far better than not carrying it at all.

Incidentally, the reason I (and others) harp so hard on carrying a commercially produced tourniquet is twofold – firstly, because improvised tourniquets suck:

“Without a windlass, improvised tourniquets failed to stop bleeding in 99% of tests (79 of 80 tests). With a windlass, improvised tourniquets failed to stop bleeding in 32% of tests (p < .0001)”

(Altamirano et al, (2015). Role of the Windlass in Improvised Tourniquet Use on a Manikin Hemorrhage Model. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 15(2), 42–46.

Perhaps even more importantly, the second reason to carry a commercial solution is when you need a tourniquet for massive hemorrhage, literally nothing else will do the job in the time you have. The first letter in the care under fire acronym “MARCH” is “M” for Massive hemorrhage, and tourniquets are the only intervention used in the “hot zone care” portion of the TECC guidelines because when an arterial bleed is present, the casualty has minutes to live, and likely seconds of “useful consciousness”, the time in which the casualty retains the mental fortitude to help themselves, generally by application of a tourniquet.

blankNow, I won’t sit here and tell you the end all be all of medical preparedness is carrying a tourniquet, but as a medic myself, the minimum amount of gear I would feel comfortable with is a pair of gloves and a tourniquet, especially if I was carrying a firearm, professionally or otherwise.

Second step, train – I would encourage you to buy a second, identical tourniquet and train with that one. Buy a blue one if you like, buy a black one and write “training” on the strap, I don’t care. Don’t, if you can at all help it, train with the tourniquet you carry. All quality tourniquets I am aware of are at least partially a fabric or nonwoven of some kind, which will degrade with the application of tension, friction, and more generally, use. 

This leads into my second recommendation for training – train like you fight. Apply it tightly and wind the windlass two or three times – this will be uncomfortable, but it will show you what works and what does not. If you’re really feeling squirrely, get up and walk with the tourniquet on your leg – it’ll show you what you can really work through (pro tip: straighten your leg and shift your weight to your heel. Your inclination will be to walk on tiptoe, but this is actually more uncomfortable. Yes, I’m speaking from experience).

Now, go take a class. I recommended some specifically up above, but a community Stop the Bleed class is far better than nothing at all. You might find you want additional equipment to compliment the tourniquet. I’ll write some more about that soon, keep an eye out here for more information on that front.

Have you signed up for a class yet? I’ll be here when you get back. Go on.

Third, and final step – actually carry your tourniquet when you carry your gun. In fact, carry it when you don’t carry your gun. Have one in your garage, out when you use your chainsaw in the back forty. Take one when you go hunting, ATVing or snowmobiling. Throw one in your glove box. Doesn’t do you any good in your medkit that’s stuffed under your bed if you’re out front and need one, or in your truck if you’re out with the chainsaw.

Stay safe out there.

Until next time.