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No Israeli dressing, no compressed gauze...No problem!




 

“Doc!  I don't have an Israeli dressing or compressed gauze! She's bleeding out! What do I do?!” 


Don't worry buddy, I don't even use that stuff.  

 

It may seem hard to believe that a medic would say something like this.  Most of you are bombarded every day with “special opps medical kits” for sale that are loaded with items like compressed gauze, the Israeli dressing and lots of other “sexy” items.  It almost seems like sacrilege for a battlefield medic to say he doesn’t prefer these items, but, stay with me and I’ll tell you why.  



The hallmark of someone who has mastered their craft is when they can do more with less.  Most people think of high-level Tactical Combat Casualty Care, (TCCC), courses as special operations personnel teaching others how to use the newest and greatest equipment.  That is a part of the training, but it’s not the main goal.  The main purpose of these courses is to build confidence with advanced and high-level instruction. This often means spending countless hours practicing very basic techniques that could still be effective when you don't have your "sexy" equipment.


The origins of advanced TCCC courses does draw it's roots from the special operations forces community.  Their emphasis is not on having the most advanced equipment, it’s on having the most advanced skill set when that equipment is not available.  One thing I learned while spending time with the cadre in these courses is that they prided themselves on being masters of the most basic tools and techniques, while having the knowledge on how to use the cool stuff when it was available.  You could take all their cool equipment away and they would still get the job done. 


This is true for many professions.  Look at your BJJ professor for example.  Do they need the most expensive gi, rash guard, finger tape or mouthpiece to submit everyone in the class?  How about the firefighter who’s been on the job for decades?  Do they need the whole station with them to save the day in a vehicle crash?  There’s a general idea happening here; Top performers are not people with the best tools, they are the people with the best skills.  Stay with me and let's go down the rabbit hole on this one.





 

To put it plainly, I don’t need the most expensive or advanced items to control a hemorrhage.  I’ve had years of training and real-world experience.  Some of my training was at the SOF TCCC level and all of my experience I draw from comes from combat in Iraq and Afghanistan.  I found myself in a position in the 2009/2010-time frame when I became completely obsessed with being the best I could be with the most basic equipment at my disposal.  As a result, I became very proficient and developed a high level of confidence with some very simple items. I even had the opportunity to put those minimalist techniques to the test in one particular contact in Afghanistan.  CAT tourniquets and the "cool guy" pressure dressing saved the day and I had a brief lived moment of greatness.

 

The technique I’m about to show you IS NOT for instructional purposes.   This is just a story of how I used the "cool guy" pressure dressing in "the stan”.  This technique was originally taught to me in an advanced TCCC course that was a part of my pre deployment workup.  It’s literally so simple a caveman can do it.  The instructors were all much higher-tier individuals in the world of battlefield medicine and gave us very in-depth instruction on some very basic techniques.  This is the exact moment when I stepped away from compressed gauze and the Israeli dressing forever and became obsessed with idea of “doing more with less” to be prepared for unseen situations.  This very underwhelming technique is done with very easy to find, easy to afford and easy to use supplies. Not only that, it's the most effective pressure dressing I've ever been taught or used in a real situation.



My "cool guy" pressure dressing set up


  1. CAT tourniquet (not needed for the pressure dressing technique, but always with me and part of my kit)

  2. 1 six-inch roll of ace wrap prepped with a knot at the end

  3. Rolls of sterile kerlix

  4. (not pictured) 1.5 inch medical tape

 

In the 2010-2011 time frame I was on a winding road on the side of a mountain in Afghanistan.  We were in the middle of a trip back to Jalalabad when I heard our driver, Tony, yell out, “hey, doc!  We got someone shot out here!”  My vehicle TC, Jobe, and I ripped off the velcro from ours headsets, jumped out of the vehicle and got to work.  I ended up treating three wounded local national partners who had just been shot.  My first patient was shot in the thigh and just right above the hip. He had a shattered femur, full hemorrhage, was bleeding out and knocking on deaths door.  He was sitting down in the dirt with his back  leaned up against the tire of his vehicle and had the signature “pool of blood” around him.  His face was ghost white, lips and eyelids were blue and he could barely respond to me shouting at him.  My next patient was shot in the testicles and respectably bleeding from his million-dollar wound.  He was fully alert and completely terrified about me getting ready to treat him, (understandably).  My third patient was another gunshot wound to the leg with a very respectable hemorrhage.  This wasn’t quite as bad as the first patient, but, definitely a fatal wound without intervention.  The 7.62 round is a pretty devastating thing in case you haven’t caught on by now. Both leg hemorrhage patients received proper tourniquets and all three had wounds that were packed and secured using the pressure dressing technique I'm about to show you. For my million-dollar man the wrapping and ratcheting was much more interesting and involved his hips, thighs and torso. Picture an emergency medical pressure diaper. I'm sure my fellow medics can figure that one out.

 

To say my casualties were fucked up would be an understatement.  I don’t think Jobe really expected to see someone going blue in the eyes and lips from blood loss or to hear a man screaming in Arabic while I cranked down to stop his hemorrhaging.  Completely serious, I always hear people say they love doc, but ya’ll have no idea how much we love you when you level a weapon or sling lead so we can do our job.  Thank you to all my guys who ever walked that walk with me.  I always tell people I’m not really a “warfighter”.  I’m there, I’m armed and I'm hot in the contact, but, killing people isn’t my task or purpose.  Lucky for me, I had a solid teammate named Jobe who was with me every step of the way, weapon levelled and a head on a swivel to fill in that “combatant” role while I played captain save the day.  He even assisted a few times during treatment. Much appreciated sir.  Thank you.   

 

Now, let me show you a pressure dressing I learned from some “cool” people. 




 

I hope that was most amazing thing you’ve ever seen in your life.  Just kidding, it’s very underwhelming, I know.  It is effective though. 

 

Final thoughts…you’re not wrong for having sexy items and equipment, you're only wrong if you can't be effective with them. Would it hurt you to get proficient without all the cool gear, though? You might not always have it.

 

 


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