Tccc

[d3653je]

If this a dupe I am sorry, a search yielded nothing.

I called it TCCC since that is my source. I am a big fan of the CAT and Combat Gauze. 14 years in EMS can think of 2 times where a CAT could have made a difference... Combat Gauze less than 5 times. Still I think these two things everyone should have and should be a BLS Skill. As it stands the protocol doesn't not include the gauze and the CAT is a few words at the end of the bleeding protocol.

My question is who would be the best person to go to, to be able to use these? Is it as simple as talking to the Med Director for that county? In theory the Med Control can overrule the state but can they really?

Thoughts on how I should go about trying to get these two items into use in the county I am in?

 

[reaper]

We use the CAT. It should not be hard to convince MD or state. Since it is second choice in standards. Getting a service to purchase them is a whole other question!

 

[JJR512]

What are TCCC, CAT, and Combat Gauze?

 

[Adz]

I think CAT is combat application tourniquet, not sure about combat gauze but I'm assuming its something like QuikClot?

 

[citizensoldierny]

What are TCCC, CAT, and Combat Gauze?

I'm thinking the original poster might have spent some time in the military. TCCC is tactical combat casualty care, also called TEMS for tactical ems. CAT as mentioned is a combat application tourniquet that can be applied with one hand to oneself if the need arises. If my memory is correct and nothing new came down the pike the combat gauze is what the Army was calling an Israeli bandage a few years ago, it is an abd pad size gauze with a lot of muslin for wrapping like the previous wound dressing that every soldier carried with the addition of a D handle that allows it to be a pressure dressing or a tourniquet. We used the terms combat dressing and Israeli bandage interchangeably when I took CLS but was cautioned that Israeli bandage was frowned on by some of our allies and intended recipients of our services

 

[Wild_Weasel]

Combat Gauze is kaolin impregnated gauze that when packed into a penetrating injury such as gunshot wound promotes clotting. While some civilian protocols skip pressure points and go directly to a tourniquet such as the CAT, after applying direct pressure and elevation, I have seen nothing allowing wound packing even with standard untreated gauze. I have trained with it here I Afghanistan but have never used it in the field.

Cheers,
W-W

 

[JJR512]

What a coincidence, I just learned in class tonight that Howard County has ordered 70 CATs to be deployed on all front-line rigs (including engines and rescue squads).

Maryland's protocols do not permit using pressure points. They are as Wild_Weasel said, direct pressure and elevation, followed by a tourniquet if necessary.

 

[JJR512]

Combat Gauze is kaolin impregnated gauze that when packed into a penetrating injury such as gunshot wound promotes clotting. While some civilian protocols skip pressure points and go directly to a tourniquet such as the CAT, after applying direct pressure and elevation, I have seen nothing allowing wound packing even with standard untreated gauze. I have trained with it here I Afghanistan but have never used it in the field.

Cheers,
W-W

Interestingly, the current 11th edition of Emergency Care (by Limmer & O'Keefe, published by Brady) does present the use of hemostatic agents (primarily as hemostatic dressings, alternatively as powder or granules) as a primary method of bleeding control, along with direct pressure and elevation, and tourniquets.

I am not sure if Maryland uses them, though. I'll have to check into that.

 

[jjesusfreak01]

Maryland's protocols do not permit using pressure points. They are as Wild_Weasel said, direct pressure and elevation, followed by a tourniquet if necessary.

Why do you think that is? I know they probably do work well, but do they figure that if bleeding is that bad then a tourniquet is probably just a better choice, allowing you to move on to other injuries rather than sitting there with a thumb on a pressure point?

 

[JJR512]

Why do you think that is? I know they probably do work well, but do they figure that if bleeding is that bad then a tourniquet is probably just a better choice, allowing you to move on to other injuries rather than sitting there with a thumb on a pressure point?

I do not know. What you said about using a tourniquet and moving on does seem to make sense, but I'm not sure if that's the reason why our protocols are that way or not. I'll have to check into that.

 

[usafmedic45]

If this a dupe I am sorry, a search yielded nothing.

I called it TCCC since that is my source. I am a big fan of the CAT and Combat Gauze. 14 years in EMS can think of 2 times where a CAT could have made a difference... Combat Gauze less than 5 times. Still I think these two things everyone should have and should be a BLS Skill. As it stands the protocol doesn't not include the gauze and the CAT is a few words at the end of the bleeding protocol.

My question is who would be the best person to go to, to be able to use these? Is it as simple as talking to the Med Director for that county? In theory the Med Control can overrule the state but can they really?

Thoughts on how I should go about trying to get these two items into use in the county I am in?

IF you need help with the tourniquet issue, feel free to PM me. I wrote a paper on the subject that was cited in the most recent TCCC revisions.

but I'm not sure if that's the reason why our protocols are that way or not

Outdated beliefs about the "risks" associated with tourniquet use.

Combat Gauze is kaolin impregnated gauze that when packed into a penetrating injury such as gunshot wound promotes clotting.

LOL Good luck packing it into most of the gunshot wounds we see in civilian life. LOL It's ok for bigger wounds, but you'll have a hard time getting it into even the exit wounds of most handgun injuries.

 

[reaper]

Your alive!!!!!!!!

 

[usafmedic45]

Your alive!!!!!!!!

Yup. I just had to take a break for a while due to some stuff going on in my life.

 

[dixie_flatline]

Interestingly, the current 11th edition of Emergency Care (by Limmer & O'Keefe, published by Brady) does present the use of hemostatic agents (primarily as hemostatic dressings, alternatively as powder or granules) as a primary method of bleeding control, along with direct pressure and elevation, and tourniquets.

I am not sure if Maryland uses them, though. I'll have to check into that.

It doesn't apply to the OP's question, since neither CAT or Combat Gauze are hemostatic (afaik), but we were told that hemostatic agents (quikclot, celox) are taboo in MD. They cause thermal tissue injuries (burns) and aren't really suited to the demographic of injuries we see. Uncontrolled hemorrhage is the #1 cause of death on the battlefield. It is NOT the #1 cause of death in Maryland.

However, I have heard that Maryland might be bringing back the PASGs, so I wouldn't necessarily count QuikClot out forever. Battlefield medicine isn't usually pretty, but it is effective. Just takes civilian programs a little while to clean it up and adopt it themselves.

 

[JJR512]

It doesn't apply to the OP's question, since neither CAT or Combat Gauze are hemostatic (afaik), but we were told that hemostatic agents (quikclot, celox) are taboo in MD. They cause thermal tissue injuries (burns) and aren't really suited to the demographic of injuries we see. Uncontrolled hemorrhage is the #1 cause of death on the battlefield. It is NOT the #1 cause of death in Maryland.

However, I have heard that Maryland might be bringing back the PASGs, so I wouldn't necessarily count QuikClot out forever. Battlefield medicine isn't usually pretty, but it is effective. Just takes civilian programs a little while to clean it up and adopt it themselves.

Bringing them back? We just got rid of them in 2008! And from what I could tell, nobody was sorry to see them go...