Dave

Like you have seen some real nasties, although not a bomb aftermath. but I have not had a bleed I could not control with direct pressure, including, like you, partial amputations (never a full one, but had a few bikers over the years with just a few threads of flesh holding their foot on). Worst I can think of is a glass injury to a guy's leg many years ago, 67 stitches. In those days it was a 9 or 15. I think it was 9s I used - probably about six of them. Elevated the leg. Job's a good 'un.

I suppose it depends on the potential for exposure to such injuries and also some clinicians are just plain unlucky when it comes to seeing high volume nasty trauma.

I've seen a fair few serious trauma patients - not sure if TXA, CATs, Celox, Israeli Dressing etc would have improved survival - but it is always difficult to determine this in hindsight.

With the exception of one patient a couple of years ago, most isolated amputations or severe leg wounds I've come across have not bled out too much really so a CAT wouldn't have been of much use with the others.

Polytrauma patients are different kettle of fish though. The last chap I treated (July last year) with all of the 'fashionable' treatment plans above survived despite having severe legs and chest injuries.

Also we are now looking at internal haemorrhage treatments as an indication for some of the new interventions - not just external trauma.

I can count dozens of times I could have used one or a combination of these interventions over the years. I discussed TXA with a trainer last week and he said that according to the ED docs and clinical reviews this drug could have been used 3 times in the past few months in my geographical location.

I absolutely agree - there have been incidents of personnel placing CATs onto venous bleeds. So agree they shouldn't be taught to FAs.

I have been a medic for 40 yrs and have only used a CAT type tourniquet no more than 4-5 times and these were in war zones and in NI
Just spent the last 8 months in Angola working with a good mate who I served with in the Marines for 20 years we taught nationals the use of CAT,s and the usual blood stopping tricks. It is unusual to have to use one but its correct application and recognition as the most effective way to stem blood loss is equaly as important,particularly when an injury is in extremis.
As one viewer rightly states it has been used on venous haemorrhage because of lack of basic first aid knowledge and the desire to be "different" as seen in some overseas CP courses.