I think it's cold war thinking - in a LSCO environment you may not be able to get a casualty to a hospital right away - so they will lose that limb. COIN flipped the script, but we were still fighting the last war.
The fear is that we will use COIN rules in a LSCO environment.
I could be wrong, but I'm pretty sure it was because of how quickly wounded could be transported to a hospital, coupled with updated medical practices.
I remember learning first aid as a boy scout before 9/11. We were told that if a tourniquet was applied the limb is considered a loss. This still holds true except we are getting the patient to a hospital way quicker.
Was also told only a doctor can take off a tourniquet. With advancements in medical practices soldiers are surviving injuries that in previous wars were fatal.
Modern "stop the bleed" training says that it takes several hours to do permanent injury to a limb with a tourniquet, and even longer to do enough injury to make the limb a total loss. I think some of the medical science regarding tourniquets was just wrong before.
Part of it was because it was believed that the deoxygenated "dead" blood would make its way back into the bloodstream once the tourniquet was removed which could then cause toxic shock. IDK if its still practiced but we were taught to write on the patient's forehead the time the tourniquet was applied so surgical teams would know how long the circulation had been cut off.
Yes the time is good to know. Many (most?) tourniquets have labels to write the time, but I suppose that's dependent on having a sharpie (which you should have in your medical bag).
Toxic chemical release is a real thing and among other things, the potassium can cause arrhythmia and the myglobin will cause kidney damage. Beyond the obvious bleeding risk, this is why tourniquets that have been left on for many hours should only be released in a medical environment.
As a Boy Scout I also learned that a tourniquet means you're loosing the limb. What the data seems to say though is under 2 hours there is little risk of permanent damage, within 2-4 hours you have a high chance of a good recovery, and after 6 hours you have a high chance of significant permanent damage. Data from Afghanistan (where medivacs could often respond quickly) shows there were virtually no limb loses due to a tourniquet.
The reason we are always fighting the last War is you cannot learn from a lesson until it is taught...
I think the trick is to not only learn faster, but apply it every bit as fast... It should not have taken them 6 yrs to realize the regular way wasn't working as intended in Iraq/Afghanistan...
Thanks, Ryan - Another great post. And another factor affected by 'fighting the last war'. I'm surprised at the organizational inertia in the military medical community. I thought they would be the foremost sector where data is collected and disseminated with regularity. Silly me.
Re: TBI. With personal anecdotal usage and some really cool research have you heard of Q-collars? I'm imagining those would be very useful in arty threat regions. Oh, and you can totally do combat with it on even though my white ass head turns more tomatoey colored. $250 ain't cheap, but I also have grown fond of my brain even with it's disfunction. https://q30.com/products/q-collar-tactical?gad=1&gclid=EAIaIQobChMIofaF8J36_gIV4cbjBx2ElAZLEAAYASACEgIJU_D_BwE
Finally subscribed! Great first article to read! Very informative. I often wondered why you didn’t see more tourniquets used in the early afghan/Iraq days. Thanks for clarifying.
Thank you. So many things I had not considered. The war in Ukraine is so incredibly different that Afghanistan. I am also so thankful you did your original video about almost losing your arm, and why a tourniquet is so important. It made me pick up a new First Aid course, to un learn all the things I had learned that are now disproven. The big difference between regular medicine and pseudo science, is that real medicine changes and improves. I'll respect anyone that chooses homeopathic medicine for themself, but know that it basically has little changed from first invented long ago. Updating is good, and applying what we learn quickly is so important!
Served from 2010-2014. Definitely a part of the COIN generation. This conflict in Ukraine is completely different from what us US service members are trained and accustomed to from the last 20+ years. Our military definitely has a long way to go to bringing our forces up to par for the next LSCO.
The note about "Universal TBI from Artillery fire" is interesting. I would love if you could expand on that. To me, TBI is brain damage, which is very serious. Are you saying that soliders that are hunkering down but getting shelled are all developing TBI? Even if they are otherwise unscathed?
Why was a tourniquet ever deemed an only last resort option to begin with when it seems like an obvious life saving measure?
I think it's cold war thinking - in a LSCO environment you may not be able to get a casualty to a hospital right away - so they will lose that limb. COIN flipped the script, but we were still fighting the last war.
The fear is that we will use COIN rules in a LSCO environment.
I could be wrong, but I'm pretty sure it was because of how quickly wounded could be transported to a hospital, coupled with updated medical practices.
I remember learning first aid as a boy scout before 9/11. We were told that if a tourniquet was applied the limb is considered a loss. This still holds true except we are getting the patient to a hospital way quicker.
Was also told only a doctor can take off a tourniquet. With advancements in medical practices soldiers are surviving injuries that in previous wars were fatal.
Modern "stop the bleed" training says that it takes several hours to do permanent injury to a limb with a tourniquet, and even longer to do enough injury to make the limb a total loss. I think some of the medical science regarding tourniquets was just wrong before.
Part of it was because it was believed that the deoxygenated "dead" blood would make its way back into the bloodstream once the tourniquet was removed which could then cause toxic shock. IDK if its still practiced but we were taught to write on the patient's forehead the time the tourniquet was applied so surgical teams would know how long the circulation had been cut off.
Yes the time is good to know. Many (most?) tourniquets have labels to write the time, but I suppose that's dependent on having a sharpie (which you should have in your medical bag).
Toxic chemical release is a real thing and among other things, the potassium can cause arrhythmia and the myglobin will cause kidney damage. Beyond the obvious bleeding risk, this is why tourniquets that have been left on for many hours should only be released in a medical environment.
As a Boy Scout I also learned that a tourniquet means you're loosing the limb. What the data seems to say though is under 2 hours there is little risk of permanent damage, within 2-4 hours you have a high chance of a good recovery, and after 6 hours you have a high chance of significant permanent damage. Data from Afghanistan (where medivacs could often respond quickly) shows there were virtually no limb loses due to a tourniquet.
The reason we are always fighting the last War is you cannot learn from a lesson until it is taught...
I think the trick is to not only learn faster, but apply it every bit as fast... It should not have taken them 6 yrs to realize the regular way wasn't working as intended in Iraq/Afghanistan...
Thanks, Ryan - Another great post. And another factor affected by 'fighting the last war'. I'm surprised at the organizational inertia in the military medical community. I thought they would be the foremost sector where data is collected and disseminated with regularity. Silly me.
Isn't targeting the unarmed medical services of an army against the laws of war or something?
Re: TBI. With personal anecdotal usage and some really cool research have you heard of Q-collars? I'm imagining those would be very useful in arty threat regions. Oh, and you can totally do combat with it on even though my white ass head turns more tomatoey colored. $250 ain't cheap, but I also have grown fond of my brain even with it's disfunction. https://q30.com/products/q-collar-tactical?gad=1&gclid=EAIaIQobChMIofaF8J36_gIV4cbjBx2ElAZLEAAYASACEgIJU_D_BwE
Finally subscribed! Great first article to read! Very informative. I often wondered why you didn’t see more tourniquets used in the early afghan/Iraq days. Thanks for clarifying.
Thank you. So many things I had not considered. The war in Ukraine is so incredibly different that Afghanistan. I am also so thankful you did your original video about almost losing your arm, and why a tourniquet is so important. It made me pick up a new First Aid course, to un learn all the things I had learned that are now disproven. The big difference between regular medicine and pseudo science, is that real medicine changes and improves. I'll respect anyone that chooses homeopathic medicine for themself, but know that it basically has little changed from first invented long ago. Updating is good, and applying what we learn quickly is so important!
Served from 2010-2014. Definitely a part of the COIN generation. This conflict in Ukraine is completely different from what us US service members are trained and accustomed to from the last 20+ years. Our military definitely has a long way to go to bringing our forces up to par for the next LSCO.
The note about "Universal TBI from Artillery fire" is interesting. I would love if you could expand on that. To me, TBI is brain damage, which is very serious. Are you saying that soliders that are hunkering down but getting shelled are all developing TBI? Even if they are otherwise unscathed?
It’s that artillery explosions are causing multiple injuries and unarmored areas as well as TBI. It’s almost universal.