[chacham15]

Ha, the locations of all our equipment was boiled down to a science in my unit. For example, the tourniquet was in the left side because the left was more difficult to access in prone because we cant remove our right hands from the gun and we need the left elbow for stability. (For non-military people, the tourniquet that a person carries is used on him in case of emergency so he himself should rarely need to access it).

[rdl]

Yeah, I saw a wide variety of unit effort put into things like that. At one level, standardization is good, but at another level, treating a 6'7 300# Samoan guy the same as a 5'3" female might not make sense for layout of equipment...

The ultra-badass thing to do was to pre-apply CAT tourniquets (loose) to all 4 limbs, so the operator could then tighten them when hit and continue in the fight. An 18D would then periodically loosen them, keeping the limb from being lost, and monitoring/timing for sepsis (which is the risk of leaving a tourniquet tight, letting tissue die, and then loosening outside of a hospital setting -- I think it's hyperkalemia and some other stuff too. I think the rule is 30 minutes of blood flow per 2 hours for up to 24h, but this was evolving at the time. It worked better for immediate response than relying just on direct pressure (israeli bandage, etc.), since it could be accomplished in 5 seconds directly by the operator (it's hard to even FIND where entrance and exit wounds are under a uniform, and sometimes there are multiple per patient per incident, although usually on the same limb).

It was fine when OCF-I, etc. people did it, but then utterly hilarious when random people copied them without understanding (not even infantry, but supply guys going on outside the wire road trips between bases returning from R&R...).

It was a lot like startups -- people learning as they went, in a rapidly evolving environment. The big fail, IMO, was rotating whole units out ever 4, 7, 12, or 15 months to have to re-learn everything again, and then sending them to an entirely different place when they returned. The British Empire system of rotating individual battalions or brigades through a unit which was permanently stationed in the occupied territory made a lot more sense I think.

[chacham15]

> treating a 6'7 300# Samoan guy the same as a 5'3" female might not make sense for layout of equipment...

Well, my situation was a bit different as I was in a special forces unit. For one, we had no women.

>The ultra-badass thing to do was to pre-apply CAT tourniquets (loose) to all 4 limbs, so the operator could then tighten them when hit and continue in the fight.

We've had this practice, but when you have a tourniquet(properly tied, cutting off all flow) on a limb, you have little to no control over it (to test this, tie a tourniquet just above your bicep and try to open and close your hand when it has no pulse). The only thing you can do is use other limbs to make up for the lost one. Furthermore, if that limb is a leg (the thigh in particular), in order to fully cut off the flow, it is necessary to apply so much pressure so as to break the bone (which sucks, but is better than dying). Lastly, even if the situation were dire enough to warrant these measures, where would you place the tourniquet on the limb? This is a problem for a few reasons. For example, I dont know about your unit but in mine, anything on us gets beaten up a lot for various reasons; damage to the tourniquet would be likely and problematic. Furthermore, during an exercise, the amount of blood that flows through your muscles increases thereby expanding the size of the limb. This would cut off blood flow and inhibit performance if you had a loosely tied tourniquet on it. If you resize it to be larger, then it would slip and fall in times of inactivity. Lastly, and this might also be a difference between units, we arent allowed to wear any bright colors, reflective mattes, sharp contracting colores, or have anything on us which identifiably changes our shape so as to mitigate detection. As I said, when it comes to the equipment (especially the medical equipment) everything is boiled down to a science.

>It worked better for immediate response than relying just on direct pressure

This is true, but the problem is the loss of use of the limb. If you are in a situation where you absolutely need to move quickly, a direct pressure solution to slow the bleeding until you are in a relatively safe area where you can then apply a tourniquet is better. A lot of the decisions you have to make are a balancing act of speed versus safety.

>but then utterly hilarious when random people copied them without understanding

This is very true. The number one mistake I see people who havent been trained to use a tourniquet make is they tie it (however poorly) on the injury. You are supposed to tie it 4 fingers above the injury because veins are elastic and when severed they jump back into the body, so you need to account for that and tie it higher.

Sorry if I went on too much, I just really like that so much thought has been put into every decision that we take for granted; if only we knew.

[rdl]

(I was just a contractor for a few tiny companies, but got to work closely with people from various units ranging from "other" people to line infantry/MPs to CS/CSS to medical to allies to host nation, so I got to see a wide spectrum of great to defective for everything and then try to do whatever the people I was with did, or what made the most sense for me. I confess to having been one of the "empty plate carrier" wearers on some big bases, but I think it was an educated decision...)

The most interesting thing I saw in 8 years was working with the guys from the Institute for Surgical Research (ISR), making sure they got x-rays and CTs of all injuries, so they could have a team of doctors go through and figure out which equipment and weapons worked, which didn't, and how various pre and in-hospital interventions ended up over a statistically significant number of patients. I'd still rather have USA/USN/USAF trauma surgeons than anything I've seen in the civilian world)