North American Rescue Combat Application Tourniquet (C-A-T) Last week I got into a discussion with a friend of mine who’s an EMT about the type of gear that you should have for emergencies where a victim is severely bleeding, and we spent a fair amount of time discussing the importance of tourniquets. Because the data (especially the data from the US military in Iraq and Afghanistan where IEDs were prevalent and body armor decreased the number of immediate deaths) shows that using tourniquets can have a significant impact on saving the lives of wounded people, I thought that I would lay out the facts in this blog. For years the approach to treating people in trauma situations was ABC (Airway, Breathing, and Circulation), but over the past 20 years the priority order for lifesaving treatments in emergency situations has transitioned to MARCH (Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head Injury). So these days, upon arrival as you evaluate the person for trauma, the most notable, life-threatening condition is massive hemorrhage. Massive hemorrhage can kill people faster than an airway complication, because we don’t have much blood in our bodies in the first place (~5 liters is the average). Depending on the location of the wound, direct pressure, pressure dressing, wound packing (with or without a hemostatic agent) or tourniquets are the immediate field solutions to the problem. “The breakthrough paper that resulted was published in a 1996 issue of Military Medicine and ushered in the dawn of Tactical Combat Casualty Care (TCCC). TCCC launched a total reassessment of best practices in casualty management on the battlefield because of the penetrating wounding patterns found there. With 60 percent of preventable combat deaths identified as extremity hemorrhage, 33 percent as tension pneumothorax—a life-threatening chest injury— and 6 percent as airway obstruction, TCCC shifted the treatment priority from the standard prehospital protocol of airway management first to controlling the massive hemorrhage due to extremity trauma. This change meant that something as simple as applying a tourniquet could potentially save many lives on the battlefield. Military research began to focus on identifying a standard-issue tourniquet that was safe, effective, easy-to-apply and ruggedized for austere environments.” - North American Rescue - Winter 2012-2013 by Ricardo Flores Following the discussion with my friend I happened to have another similar discussion with a Navy Pararescue specialist. He reiterated the points covered in my previous discussion and emphasized that at the shooting range and in the back country it is imperative that you carry a tourniquet; and the only one that he recommended was the Combat Application Tourniquet (C-A-T) by North American Rescue - which is now the standard in the US military based on years of studies. “In 2004, the U.S. Army Institute of Surgical Research (USAISR) conducted a study of seven commercially available, off-the-shelf tourniquets for their effectiveness in stopping blood flow with the least amount of pain during application. Three of the seven were 100 percent clinically effective in occluding blood flow. However, USAISR recommended the C-A-T as the primary battlefield tourniquet based on its overall performance—less painful, easier to use, as well as smaller and lighter than the other tourniquets evaluated. In 2008, a study of battlefield data from a combat support hospital in Baghdad published in the Journal of Trauma validated the earlier USAIR conclusions. The C-A-T was identified as “the best combat tourniquet” In 2011, another study published in Military Medicine further validated the earlier studies and continued to hail the U.S. military’s primary tourniquet, the C-A-T, as the safest and most effective combat tourniquet requiring 30 percent less pressure to achieve success.” - North American Rescue - Winter 2012-2013 by Ricardo Flores Because of this discussion we updated our gear by purchasing a C-A-T tourniquet to replace our older gear. The CAT currently on the market is the 7th generation of the tourniquet and is recognized as the fastest, safest, and most effective prehospital field tourniquet available. It has proven to be 100% effective in occluding blood flow in both upper & lower extremities by the U.S. Army’s Institute of Surgical Research. The C-A-T comes in both black and orange. We purchased the orange version so that we can very easily locate it in our kit in an emergency situation.  As with all tourniquets the main thing to remember if you have to apply one to a victim is to place it “high and tight” – high above the wound to stop the circulation above the point of bleeding and tight enough that you cannot put your fingers under the band; even if this is painful to the victim. Once in place do not ever remove the tourniquet unless you absolutely have to so that you can make it tighter because the bleeding restarts and you don’t have a second tourniquet to place adjacent to the initial tourniquet. With respect the C-A-T, “The Gen 7 CAT utilizes a durable windlass system with a patented free-moving internal band providing true circumferential pressure to the extremity. Once adequately tightened, bleeding will cease and the windlass is locked into place. A hook and loop windlass retention strap is then applied, securing the windlass to maintain pressure during casualty evacuation”. Here are the high level instructions for using the C-A-T tourniquet.  It should be noted that tourniquets should normally only used for extremities (arms and legs) when the bleeding cannot be stopped by the use of direct pressure alone, if direct pressure cannot be effectively applied for any reason, or if it is clear that the injury is so massive that attempting to use direct pressure will fail and only waste valuable time. There is an intermediate option of “wound packing” that can be used if applying direct pressure is not sufficient to stop the bleeding and the wound is on the neck, armpit, shoulder or groin. Because of the critical internal organs - the only viable field solution to wounds to the chest, abdomen, lower back, pelvis and skull is applying direct pressure. The nominal order of the steps that you should take to “stop the bleed” is:
If you want more details about the C-A-T Combat Application Tourniquet you can find it here: https://www.narescue.com/combat-application-tourniquet-c-a-t.html Here’s a great presentation by North American Rescue on “Small Limb Hemorrhage Control” that covers all this material in detail: https://www.narescue.com/education/cat-tourniquet-education/small-limb-hemorrhage-training-ppt.html In addition, other CAT Tourniquet Educational Materials can be found here: https://www.narescue.com/education/cat-tourniquet-education.html Just remember – with respect to traumatic bleeding – If it won’t quit - - - Tourniquet! 
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Latest Side-by-Side Comparison from Sport Fitness Advisor Well today’s the first day of Spring here in North America – so I guess it’s time to get ready to get back outside in the great outdoors; and we all know what that means – Gear Preparation. To get ready for the Hiking and Camping season everyone has their own routine. What we do is take out all our gear, check it over for usability, clean up anything that needs a little tender care and evaluate what we have against the newest gear available to see if our gear has either “aged out” or if there are new products on the market that are significantly better than what we have. This allows us to make sure that the gear we take with us works when we need it in the outback, and keeps us up to date on the latest items on the market. Checking over all of your gear at the beginning of the season doesn’t’ sound like a lot of fun – but trust us – it’s better to find out now that you need a new piece of gear rather than the day before a trip, or even worse, on the trip. To compare our gear against what is currently on the market we always head to our local outdoor stores (to see as many items as possible in person) and to the internet to read the great gear reviews that are online. Of course, many items don’t change that much from year to year (we doubt that we’re ever going to replace our Council Tool Woodcraft 24" Pack Axe, Gerber E-Tool Folding Spade, Buck 110 or Army Survival Knife), but we always like to keep current with what’s out there “just in case”. While we were checking our gear for the 2022 Spring/Summer/Fall season we were contacted by Jillian, an editor from Sport Fitness Advisor about a comprehensive guide that they had just published about the "Best Backpacking Stove".  Since our site focuses on the specific gear selections that work for us, and our specific situation, and provides our evaluation criteria and rationale for selecting our gear, we don’t provide detailed side-by-side comparisons of products. That doesn’t’ mean that we don’t read a lot of the websites that provide side-by-side product comparisons – because we most certainly do – we just find that many of these sites do this better than we would (because of the size of their staff and budget). So our HCS site has direct links to many of the sites that do specialize in detailed gear reviews, just in case you want to see the side-by-side comparisons. Of course, we love it even more when a site that has evaluated the latest gear reaches out to us to let us know about a comparison our readers would be interested in; like Sport Fitness Advisor did. We really liked the "Best Backpacking Stove" article because it was comprehensive in covering what features you need and why you need them. And, as all of our readers know, we think that providing you the most important evaluation criteria is vital since it allows you to assess if your situation equates to the evaluators when you make your gear selection decision. If it does – fine. If it doesn’t - then you can use the detailed information to make a gear selection that better fits your specific situation. Here’s what the Sport Fitness Advisor article covers:
For comparison’s sake our evaluation criteria for compact hiking/camping stoves include:
The 10 stoves that Sport Fitness Advisor covers in their article include:
We don’t want to give away their conclusions, so you should go read the "Best Backpacking Stove" article for yourself; it’s worth a few minutes of your time. In addition to their recent article about the “Best Backpacking Stove” Sport Fitness Advisor has numerous other articles related to Hiking and Camping. You should go take a look. https://www.sport-fitness-advisor.com/?s=hiking https://www.sport-fitness-advisor.com/?s=camping If you would like to see another expert opinion on what the best backpacking stoves currently on the market are - you should check out Clever Hiker’s latest list of “Best Backpacking Stoves”; he’s always got great insight into the gear you need. Great Article from loveholidays.comSince we’ve had a considerable amount of snow here in New England over the past two weeks, we’ve been thinking about our next outdoor adventure – and for us that means heading to a National Park if possible since they contain so many beautiful sights to see. Coincidentally, this week we were contacted by Liam, from loveholidays.com, a travel agency in the UK, about a detailed article he had written titled “An Essential Guide to Enjoying US National Parks Responsibly”. Since we were relaxing inside (after shoveling all that snow) we read Liam’s article. That got us even more motivated to think about planning a trip, so we decided to take a look at where all the US National Parks are located and compare that to the list of those that we have already visited. As always, the internet is a wonderful source of information. So here’s what our research found. There are actually 424 locations that fall under the National Park Service; 63 National Parks, 85 National Monuments, 76 National Historic sites, 58 National Historic Parks and 142 other locations categorized in a variety of different ways.  Here’s a good map of where the 63 US National Parks are located (from morethanjustparks.com) and another showing all 424 locations under the National Park Service (from nationalparkobsessed.com) – which is marvelously interactive on their website:
Part of our problem is that we’ve been so many places (admittedly a good problem to have), and the vast majority of the US National Parks are located West of the Mississippi (although there are lots of other NPS sites in the East) – so we have to travel a good distance to get there. Here’s our list of what we’ve visited so far looks like. So I guess that we really need to head back to the Northwest US next.  So, back to the article that started all of our research. Liam’s article is quite extensive, covering the value of spending time outdoors in US National Parks (including a look at why we feel so good outside), why US National Parks are some of the most amazing outdoor spaces and how to enjoy them safely.  Since there’s so much information included in the article it’s been structured into four main sections, each with a wide variety of facts, details and links to other online sources.
 Some of the detailed information in Liam’s article that we appreciated was:
 As an aside, Liam’s article cites the statistic that the average American spends 87% of their time indoors, 6% of it in a car and just 7% of their life outdoors. Thankfully we are nowhere close to that……... Because Liam’s article has some great information, we thought that we would pass it on to all of you. Hopefully you enjoy it, and find its content as useful as we did. Here's the link again: https://www.loveholidays.com/holidays/enjoying-us-national-parks-responsibly/ Last Year We Had More Readers Than Ever BeforeLike most websites, ever since we launched our Hiking, Camping and Shooting (HCS) website we’ve tracked the statistics to see who our readers are, where they’re located and what they read. Since 2021 recently finished we thought that we would share some of our latest statistics from the year with all of you. In 2021 our readership increased by 32% and came from 112 different Countries from around the world. We had an increase of 10% of our readers coming from countries outside of the US, but 77% or our readers still came from the United States. The largest concentrations outside the US were from the following 20 Countries:
  We have readers from all 50 of the United States - with the largest concentrations being in the following 20 States:
  The 35 pages and blog posts that people read the most during 2021 were: Like 2020, in 2021 we had more page views on our "Shooting" pages than either our "Hiking" or "Camping" pages. Probably because of the craziness of 2021, and the fact that approximately 38.9 million new firearms were sold in the United States during the year. The majority of our users look at our website between the hours of 10:00 AM and 1:00 AM.  Most of our readers find us either by searching on Google (82%) or by previously having been to our website and coming directly to us (13%). A much smaller percentage (5%), find us through other sources to include our Hiking, Camping and Shooting Facebook page.  The majority of our users view our website from either their mobile device (55%) or their desktop computer (43%) using either Chrome (51%) or Safari (37%) browsers.
Since we launched our website back in April 2016 we've had people from 143 different countries stop by with 79% coming from the US and the other 21% from all over the World. The top 25 international countries and the top 25 US States are:
Hopefully this data shows you that in 2021 you were in good company as you read through our Hiking, Camping and Shooting gear write-ups and blog posts. We hope that they gave you some information that made all of your adventures a little more fun. Wherever you’re from, we’re glad that you stopped by to look over our HCS website and look forward to seeing you again in 2022. Great "Outdoor Hiking for Beginners" ArticleOne of the main reasons that we started our HCS website back in 2016 was to share the knowledge that we had acquired during our many years of Hiking, Camping and Shooting. So we’re always gratified when someone reaches out to us to say that they found our gear evaluation criteria, product information, blogs, adventure photos, "Useful Apps", and "Other Helpful Information Sources" links to additional websites to be helpful. In that vein, this week, Lily and her son Logan (who is in the process of earning his Boy Scout Hiking badge), dropped us a note to say that they had found our site to be really helpful. And, as with many contacts that we receive, Logan wanted us to know about another great online resource that he had found; an article on "Outdoor Hiking for Beginners" by Kim Hart on the AAA State of Play website.  So at Logan’s request, and because we agree with what Kim’s article has to say, we thought that adding this information to our HCS site and sharing it with all of our readers made sense. In her article Kim hits the nail directly on the head in her opening paragraph when she says: “For many people, their workdays are filled with busy office spaces, crowded highways, and lengthy commutes. Hiking is an activity that provides an escape from the hectic nature of everyday life and is enjoyed by people across the country. Hikers are not only subject to the fresh outdoor air, open skies, and scenic beauty of nature, but they're also participating in an excellent form of exercise that works out their bodies and relaxes and soothes their minds. Provided that they are in decent physical condition, almost anyone can participate in hiking, but beginners must know what to expect and how to prepare for the experience. Hiking with a more experienced partner and following helpful hiking tips can make one's experience safer and more enjoyable.” Kim then goes on to give her top-10 hiking tips to get new hikers on the trails:
Finally, Kim wraps it all up by providing links to 27 other hiking reference sources to include topics like:
To check out all the details, and to access the links that she includes, here’s the direct link to Kim Hart’s "Outdoor Hiking for Beginners" article: https://www.aaastateofplay.com/outdoor-hiking-for-beginners/ The Beauty of the Desert in Winter As mentioned in the previous blog post, on our 11-day road trip to the Southwestern part of the US we visited New Mexico, Arizona, Nevada and California. Here are a few photos from the 1,600 mile trip aggregated by State (click on any photo to start the slideshow):
You can see all the photos of our trip to the Southwestern US on the Adventures/North America page. Road Trip to the Southwestern USWe just returned from an 11-day road trip to the Southwestern part of the US; specifically New Mexico, Arizona, Nevada and California. During our trip we drove almost 1,600 miles, hiked lots of great locations and saw all sorts of interesting sights to include: - Petroglyph National Monument - Albuquerque BioPark Botanic Garden - Museum of Nuclear Science & History - Painted Desert - Petrified National Forest - Lowell Observatory - Sedona Rock Formations - Chapel of the Holy Cross - Grand Canyon - Hoover Dam - Las Vegas Strip - Titanic Artifact Exhibition - The Neon Boneyard - The Mob Museum - Fremont Street Experience - Mojave Desert National Preserve - Joshua Tree National Park - Santa Monica Pier - Palisades Park - Venice Beach - San Luis Rey Mission - Balboa Park - San Diego Museum of Us As always I took far too many photos - so I'll start posting them in the next day or two. If you can't wait to see some of the photos the we took each day of our trip, you can always check out our Facebook page at: www.facebook.com/HikingCampingandShooting  There’s Lots to See on the Plains of Middle AmericaAs mentioned in the previous blog post, on our 11-day road trip from Chicago to Colorado and back we visited Illinois, Missouri, Kansas, Colorado, Nebraska and Iowa. Here are a few photos from the 2,750 mile trip aggregated by State (click on any photo to start the slideshow):
You can see all the photos of our trip to the Plains States on the Adventures/North America page. Seeing the Sights Along I-70 and I-80We just returned from an 11-day road trip from Chicago to Colorado and back - driving 2,750 miles - on I-70 going out and on I-80 coming back. As always we hiked lots of great locations and saw all sorts of interesting sights to include: - Mid America Motor Works - Cross at the Crossroads: America’s Largest Cross - Kaskaskia Dragon - Combat Air Museum - Kansas Cosmosphere - Monument Rocks - World's Largest Easel - Cripple Creek and Victor Gold Mining Areas - Garden of the Gods - United States Air Force Academy - Wings of Change Statue - Statue of Liberty Replica - Heartland Museum of Military Vehicles - Strategic Air Command and Aerospace Museum - Iowa 80 – World’s Largest Truck Stop - Retro Rocket Ship - Moai Dude - Rock Island Arsenal Atomic Cannon, National Cemetery and Confederate Cemetery As always I took far too many photos - so I'll start posting them in the next day or two. If you can't wait to see some of the photos the we took during our trip, you can always check out our Facebook page at: www.facebook.com/HikingCampingandShooting  The Sights Along the Danube Are Stunning As mentioned in the previous blog post, on our 14-day trip from Budapest to Prague we visited Hungary, Slovakia, Austria, Germany and the Czech Republic. Here are a few photos from the 560 mile trip aggregated by Country (click on any photo to start the slideshow):
You can see all the photos of our trip up the Danube on the Adventures/Europe page. |
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