In these dangerous times, any trip to the mall (or anywhere there are crowds) could be a ticket to an active shooter event. In our recent article on what to do in these circumstances, we specifically mentioned that you shouldn’t attend the wounded until the threat is abolished, and that is still your best strategy; you aren’t doing anyone any good by becoming the next casualty. Even law enforcement won’t treat the injured until the gunman is neutralized.
ABCDE vs. CABDE
It stands to reason that those sustaining wounds are going to be bleeding. If emergency medical personnel are not on the way, you will have to take action.
The initial field assessment of a victim usually involves the mnemonic ABCDE:
• Airway: Is the airway open?
• Breathing: Is the victim breathing?
• Circulation: Is the victim bleeding?
• Disability: Can the victim feel and move extremities? Can they respond appropriately to questions?
• Expose: Can you see the full extent of the injury or injuries?
This sequence changes in the actively bleeding wound to CABDE. In these circumstances, the cause of death is more often hemorrhage, which must be abated quickly. The determination of airway, breathing, and mental status can often be done simultaneously with bleeding control, as many patients will be conscious and talking.
Direct pressure with a gloved hand is still the most successful method of bleeding control. However, there are many instances where pressure alone won’t deal with the issue. More aggressive methods such as tourniquets were, however, discouraged due to the risk of “necrosis” (tissue death due to lack of blood flow), nerve damage, and more.
Despite the legitimacy of these issues, the military, through its experience in the Middle East, began to change its thinking. They found that a percentage of preventable deaths were related to inadequate measures to control bleeding. As such, the Tactical Combat Casualty Care (TC3) guidelines for our armed forces now actively promote the use of tourniquets as the first step to stop severe hemorrhage.
This has carried over to civilian emergency care, especially in events like the Boston Marathon bombings and the San Bernardino shootings. Injuries at remote locations, like homesteads where rapid transport is difficult, make tourniquets a required item in the family medical kit.
We’ve talked about tourniquets in the past, but we haven’t mentioned what might be an ideal tourniquet for the average citizen: the SWAT-T. SWAT-T stands for Stretch, Wrap, and Tuck Tourniquet, and the instructions are, essentially, all in the name. You can see the simplicity of application in the video below:
The SWAT tourniquet is a wide elastic band that can serve as a compact, lightweight, and inexpensive tourniquet or pressure dressing. It’s very simple to use, especially with two hands: Stretch it, wrap (at least 2 inches) above the area of bleeding on the extremity, and tuck the end into itself. That’s pretty much all there is to it.
Some tourniquets are difficult or impossible to place effectively around the thin arms of children, but the SWAT-T gives you the ability to apply it on just about anyone’s extremities, regardless of size.
The SWAT-T is often carried as a backup to other tourniquets due to its versatility: It can be used as a pressure dressing as well as a tourniquet, or even just as a covering for other dressings without any significant pressure at all. Other non-tourniquet uses include stabilizing a splint or ice pack for orthopedic injuries, holding an abdominal dressing in place, and even as a sling for an injured arm or shoulder.
For the medic, having a supply of tourniquets is important to save lives that would otherwise be lost due to bleeding. Even if you have other tourniquets, consider adding the versatile and lightweight SWAT-T to your medical storage.
Joe Alton, MD
Learn more about controlling hemorrhage (or just about any other issue you’ll face in times of trouble) by getting a copy of our 3 category #1 Amazon Bestseller The Survival Medicine Handbook.