The propensity to carry a tourniquet, especially among civilians is on the rise which is great. Massive hemorrhage is the most commonly found preventable death on the battlefield which means it’s crucial to carry the equipment to control it.
While many civilians, LE personnel and military personnel are carrying tourniquets, they often don’t have the training to properly apply it in a timely manner. There are no set application time limits like we have in the shooting world where a certain draw speed, reload speed or split times have become standard for departments, courses or in challenges. So here is our standard:
Reach your stored tourniquet with either hand, apply it only using one hand, in under 15 seconds.
This means if you are carrying a tourniquet you should be able to grab it with either hand and apply to any extremity, to completion, in under 15 seconds. This may seem easy but when you try it you will be amazed at how difficult it can actually be to accomplish the above in under 15 seconds. After you have applied the tourniquet you should check your pulse either using a standard finger test method or using a pulse oximeter. While both methods won’t guarantee you that you have applied the tourniquet 100% correctly it’s a fairly good measurement of how well you applied the tourniquet in under 15 seconds. This standard exists no matter what kit you’re carrying, your physical or mental state, available ambient light or any other outside factor.
Below is a video we shot awhile back of applying the RATs Tourniquet. (Yes we know it wasn’t from a stored position, yes we know we didn’t show how well it did or didn’t work and yes we know the “injured” extremity was moving.) We will work on getting a better video but in the meantime it should get an idea of the standard across.
The reason we chose 15 seconds as our standard is because: 1. it’s an achievable standard that anyone can reach with some practice 2. if you have a massive hemorrhage you can lose consciousness in 15-20 seconds which means if you can get the tourniquet on in under 15 seconds you should (hopefully) apply it before going unconscious.
While it’s important to train with a tourniquet, it’s equally as important to not use a tourniquet that you train with as the tourniquet you trust your life with. IF YOU USE A TOURNIQUET FOR TRAINING DO NOT USE IT AS YOUR PRIMARY TOURNIQUET. Simply paint the tourniquet blue, red, pink or whatever color you need to help you remember it’s a training tourniquet only. This is because when you use a tourniquet for training you begin to stress it; this coupled with environmental factors can drastically reduce your tourniquet’s efficacy or cause it to fail when it counts.
As far as what tourniquet to use we don’t care if you use a RATs, CAT, SOFT-T, SWAT-T or any other tourniquet on the market. This isn’t a post to determine what tourniquet is the best, you can leave that for the millions of other forums out there. As far as how to store/carry your tourniquet that is up to you as long as you can meet the standard above. While we offer a number of carrying solutions for a number of types of tourniquets we suggest you use the one that allows you to quickly apply it as well as carry it securely.
If you can matched or beat the standard we want to see it! Please feel free to upload your video of you getting your tourniquet on as set above and either tag us (@refactortactical on IG, reftactical on Twitter RE Factor Tactical on Facebook) or use #REFTTQSTANDARD.
Unfortunately, in today’s military, the chances of using a 9-line MEDEVAC format in combat is high and many operational personnel are not receiving the training required to call it into medical personnel correctly. If a MEDEVAC is improperly requested in, the patient may not receive medical care promptly, possibly resulting in catastrophic consequences. All personnel, civilian or military should be trained to calmly and collectively call in a 9-Line MEDEVAC under stress. Additionally, training should include stressful scenarios where personnel, from privates to senior officers, practice calling in MEDEVACS to training cadre.
When calling in a MEDEVAC, there are several steps that the individual must take to ensure the 9 Line is properly called in and dispatched units are given the necessary information required to reach the patient’s location.
Step 1: Return fire/render the scene safe- Before attempting to call in a 9Line MEDEVAC the scene must be rendered safe. Personnel should not reduce the overall efficacy of the force’s firepower to call in a 9Line. If the unit under fire reduces the overall aggression and violence of action against the enemy force it could result in a greater loss of personnel. At all costs, the firefight must be won before moving towards rendering aid to the wounded.
Step 2: Care under fire- Once fire superiority has been established medical personnel can begin care under fire. In this step medical personnel and medically trained operators can start to tend to life-threatening wounds while maintaining security.
Step 3: Determine number of patients by type- this is not only valuable information to have when calling in the 9line but it will also allow medical personnel to accurately triage patients based on their medical condition and chances of living. In this step critically wounded personnel is identified and consolidated in the event, there is limited space on incoming MEDEVAC platforms.
Step 4: Contact MEDEVAC channel- while ensuring the scene safe is important, getting the MEDEVAC out is also critical. MEDEVAC units will have varied response times but giving them notification of the situation as soon as possible will help reduce their time to the station. If the operating element has a BFT, this should be hit as quickly as possible to let supporting units know of the emergency taking place. Again, operating personnel should practice radioing for help as part of their response to attack.
Step 5: Using 9 Line MEDEVAC format to call in MEDEVAC- The first five lines are most important when calling in a MEDEVAC, the other four can be relayed when birds are in the air. Ensure you have a safe LZ for the landing party.
Important: no matter what the situation on the ground the radio operator should remain calm and collected at all costs. Personnel calling in a MEDEVAC while in a state of panic may relay incorrect information or speak in a manner that is incomprehensible over the radio. Remember, responding units will not come any faster if the RTO is calling the 9Line in a sensitive manner.
To ensure the 9Line is called in properly the Operator should consider writing down the information to ensure all pertinent information is passed.
The 9-line MEDEVAC format can vary based on the operational element. Some items use the U.S. military 9line MEDEVAC while others use NATO 9Line or internally generated 9Lines with the unique information required for supporting units. All leadership and medical personnel should get with local MEDEVAC elements to ensure they have proper radio frequencies and 9Line formats readily available. Also, every person on the ground should have a 9Line MEDEVAC on his or her persons at all times. This can be a card placed in an IFAK, on a radio or kept in a pocket. We recommend using the RE Factor Tactical 9Line MEDEVAC reference guide which can adhere to the back of radio, buttstock of a weapon or inside of a vehicle.
Line 1: Location of pickup site- this is given in an MGRS 6-8 digit grid.
Line 2: Frequency and call-sign at pickup site- this is the frequency and callsign that you will be talking to the incoming MEDEVAC aircraft on. In most cases, this is a predetermined, non-encrypted channel that is set-aside for MEDEVAC. If possible write this on all 9Line cards before the mission.
Line 3: Number of patients by precedence-
A- Urgent (surgical)- i.e. requires the in-flight surgeon to perform surgery while en route to the hospital.
B- Urgent (non-surgical)- the i.e. patient has an arterial bleed that can be stabilized until arriving at the hospital.
C- Priority- i.e. injuries that are not immediately life threatening but could become fatal eventually.
D- Routine- i.e. patient requires regular medical care, but the unit cannot transport them by their means.
E- Convenience- i.e. nonlife-threatening care provided to personnel in a combat zone.
Line 4: Special Equipment required-
C- Extraction Equipment- i.e. jungle penetrator
Line 5: Number of Patients by type:
A- Litter- cannot walk on their own
B- Ambulatory- able to self-move to MEDEVAC platform
Line 6: Security of Pickup area-
N- No enemy troops in area
P- Possible enemy troops in area (approach with caution)
E- Enemy troops in area (approach with caution)
X-Enemy troops in area (armed escort required)
Line 7: Method of Marking at pickup site (important: always ensure marking equipment is available to the marking personnel. If you are going to throw purple smoke, ensure you have purple smoke on hand)
A- Panels- i.e. VF-17 panel
B- Pyrotechnical equipment- i.e. pen flare, red star cluster
C- Smoke Signal- (provide smoke color)
E- Other- i.e. IR flash or beacon
Line 8: Patient Nationality and Status
A- US Military
B- US Civilian
C- Non-US Military
D- Non-US Citizen
Line 9: NBC Contamination
*During peacetime provide terrain of pickup site
M.I.S.T. Report– The M.I.S.T. Report has recently been incorporated into the 9Line MEDEVAC format and traditionally comes after the 9Line Format. The M.I.S.T. Report stands for:
M – Mechanism of injury (mine, GSW, RPG, RTA, etc.given)
I – Type of Injury (found and or suspected)
S – Signs (pulse rate, blood pressure, respiratory rate)
T – Treatment is given (morphine, tourniquet, etc.Example)
“Line one, one eight Sierra whiskey papa one two tree one four five one seven”
“Line two, two seven zero zero Bravo Five”
“Line tree, alpha one, bravo tree”
“line four, alpha”
“line five, alpha four”
“How to copy over?”
At this point, the MEDEVAC line will repeat all given and initiate movement for MEDEVAC. Once in the air, the operator will relay final four lines in the same manner provided.
Remember, training to send in a 9Line is necessary for all personnel on the ground. You never know when YOU may be calling in a MEDEVAC and you never want to wait until the situation to take place to figure out that you are unable to call it incorrectly.
A simple way to keep a 9Line on you at all times to carry the RE Factor Tactical 9 Line MEDEVAC format which is available on our website. Made in the USA of tough marine grade vinyl, they are precisely cut to fit on the back of a PRC-148 radio or the buttstock of a rifle.