2aHawaii
General Topics => Health, Fitness, and First Aid => Topic started by: tonsofguns on January 08, 2011, 12:44:11 AM
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I know we have some medical professionals here; can anyone give some solid advice on tourniquets. As in what to buy, when to apply.
I'm aware of the debate surrounding the use of tourniquets, so anyone against the use of them please speak up as well.
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When to apply - only if all else fails (pressure dressing, elevate the wound above heart, etc., there is no way help will get there in time and they will die if you dont do it) write a t on their forehead and put the time it was applied
Im a little rusty. i think someone here said theyre an emt-p, im sure theyll chime in
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Last time I took a Red Cross FA cert course (2008?) They did away with the elevation thing. Not sure why. According to the classes anyway I'd have to chime in with pj in that it's a last ditch effort. It's either die or tie off the limb.
As the saying goes, better to have and not need then to need and not have.
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Like many things in medicine, techniques and procedures fall in and out of favor, hopefully based on research supporting those decisions. In regards to tourniquets, they were used for a long time, then some studies found that they didn't perform as well in terms of saving lives, and now, to come full circle, additional reserch has been showing that they are beneficial.
They have become part of the "standard of care" for both EMS and battlefield situations. Statewide, Hawaii EMS rigs were supplied with the "CAT" tourniquet system in early 2010.
The standards for when to apply a tourniquet is evolving, so there may be some variance in when you "should" use one. As a general rule, a tourniquet is applied when standard pressure dressing do not work to control significant bleeding from an extremity and there is a concern about loss of life secondary to uncontrolled bleeding. All standards agree that once on, a tourniquet should only be removed at a medical facility with the ability to provide definitive care. The time a tourniquet is applied should be documented. If there is a chance that a patient may be transported by someone other than who applied the tourniquet, the application time should be made very prominant on the patient, either with a disaster tag, or some similar fashion, or as mentioned, written on the forehead or chest of the patient.
A couple of links:
http://www.armystudyguide.com/content/Prep_For_Basic_Training/Prep_for_basic_first_aid/apply-a-tourniquet.shtml (http://www.armystudyguide.com/content/Prep_For_Basic_Training/Prep_for_basic_first_aid/apply-a-tourniquet.shtml)
http://firstaid.about.com/od/bleedingcontrol/ss/bleedingsteps_4.htm (http://firstaid.about.com/od/bleedingcontrol/ss/bleedingsteps_4.htm)
http://www.tpub.com/seabee/6-1.htm (http://www.tpub.com/seabee/6-1.htm)
http://www.combattourniquet.com/ (http://www.combattourniquet.com/)
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The Army has gone away from the dressing/manual pressure/pressure dressing/torniquet routine to just applying the torniquet. Keep it simple, take note of the time applied, youve got roughly 6 hours for medical personnel to remove it. CAT for the win.
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You serious? You sure thats not just for amputation type injuries?
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You serious? You sure thats not just for amputation type injuries?
It may be a bit dated (summer 08') but that is what was being taught by our Bde medics and the instructors at Ft Irwin the last time I went to NTC. This is from lessons learned over the last 10 years or so of GWOT, goes along with not stopping to render buddy aid until the firefight is over. Application of a torniquet does not mean automatically someone is going to lose a limb, and common sense dictates you wouldnt use it on anything other than profuse arterial or venous bleeding. As stated above, you have approx. 6 hours to have it removed which most battlefield injuries are addressed at a CASH well within that timeframe.
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Ah. That more detailed explanation makes more sense. Just making sure, sometimes the army does some stupid stuff lol
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You serious? You sure thats not just for amputation type injuries?
It may be a bit dated (summer 08') but that is what was being taught by our Bde medics and the instructors at Ft Irwin the last time I went to NTC. This is from lessons learned over the last 10 years or so of GWOT, goes along with not stopping to render buddy aid until the firefight is over. Application of a torniquet does not mean automatically someone is going to lose a limb, and common sense dictates you wouldnt use it on anything other than profuse arterial or venous bleeding. As stated above, you have approx. 6 hours to have it removed which most battlefield injuries are addressed at a CASH well within that timeframe.
This is what we have been advised too (Army).. Go straight for it, heck they were issuing us tourniquet kits to us with that white handle LOL. Tourniquets have there association that once you put it on you are losing the limb but you know that isnt always true . In essence you are doing what you can to stop the bleeding immediately. Now Im going to throw out the general "situation dictates" here.....
If you have time to properly asses the wound and apply proper first Aid, I dont think a Tourniquet will be the first thing you will jump for. But if you are in an immediate situation were time is not in your favor an you see that applying a simple pressure dressing is not going to stop the bleeding and risking a bleed out......that tourniquet is going on......that 6 hour thing seems long...but I dont have an argument against it. But I wouldnt want one for more than a couple hours if I have a chance to keep that limb LOL
so tough direct question, but if my guy says I cant stop the bleeding. Im going to throw one on to make sure he/she doesnt bleed out before they can get direct medical attention =) :shaka:
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tourniquet in a combat situation is first... situational awareness of course depending on damage....and applied to absolutely stop the blood flow....
only the user may be allowed to loosen the tourniquet themselves.......
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I just went through CERT (Community Emergency Response Team) training about a month ago (also did the training in 1992) which included the Red Cross First Aid course and was told that tourniquets are not recommended. Direct pressure is still the best procedure. Also, traumatic amputation does not call for a tourniquet because the blood vessels typically restrict the flow of blood and again direct pressure is suggested. I still carry one just as a precaution but also carry QuikClot for added insurance.
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I just went through CERT (Community Emergency Response Team) training about a month ago (also did the training in 1992) which included the Red Cross First Aid course and was told that tourniquets are not recommended. Direct pressure is still the best procedure. Also, traumatic amputation does not call for a tourniquet because the blood vessels typically restrict the flow of blood and again direct pressure is suggested. I still carry one just as a precaution but also carry QuikClot for added insurance.
I don't think the Red Cross training is quite as up-to-date as some more "professional" curricula. Tourniquets fell out of favor for a while, but over the last several years several studies and practical use have stimulated a re-evaluation of that dicta. Currently the recommendations from National trauma and surgical organizations recommend tourniquets.
And, not all traumatic amputations are the same. Those with a sharp amputation are more likely to bleed versus an amputation in which the limb is torn off. The reason is that in the latter instance the blood vessels are "stretched" as the limb is torn off and that in turn causes the vessels to "retract" on themselves. That same physiological reaction is not associated with a "sharp" amputation. A crushing amputation could have either. But, the bottom line, regardless of how the amputation occured is to control the bleeding. If direct pressure does so, great. If not consider rapidly moving to a tourniquet.
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Got my CAT tourniquet in yesterday....bought a bunch for work stuff and this one's mine......
(http://i451.photobucket.com/albums/qq232/billr2979/IMG_20110811_142804.jpg)
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Been through a Red Cross FA training in '11 along with pre-deployment training in '08. I asked about tourniquets to our Red Cross FA instructors and they informed me that the Red Cross does not approve tourniquets with the exception that since the GWOT and use of tourniquets has helped save a substantial amount of lives and that each trainee could take that knowledge for what its worth.
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The Red Cross cirriculum is dated the moment it comes out....not unlike most programs. In reality medicine is, and probably always will be, rapidly evolving. It is not unusual to hear instructors using standardized cirriculum (from any source) tell their students that the content is "dated" even if it is only a year or two old. The other issue with Red Cross training is that it is centered around the fact that advanced help is usually close at hand. So, in that context, direct pressure, under most circumstances, will suffice. But, if medical aid is not close, or you need to evac to a safer destination and cannot maintain constant direct pressure, then a tourniquet is the best choice. Despite the attempt to teach FA in a "cook book" manner, each situation needs to be evaluated individually based on the current circumstances (available resources, time until advanced help arrives, your level of training, scene safety) and decisions made on the basis of what you can do to provide the best possible outcome for the patient while not endagering yourself or other crew members.
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The Red Cross cirriculum is dated the moment it comes out....not unlike most programs. In reality medicine is, and probably always will be, rapidly evolving. It is not unusual to hear instructors using standardized cirriculum (from any source) tell their students that the content is "dated" even if it is only a year or two old. The other issue with Red Cross training is that it is centered around the fact that advanced help is usually close at hand. So, in that context, direct pressure, under most circumstances, will suffice. But, if medical aid is not close, or you need to evac to a safer destination and cannot maintain constant direct pressure, then a tourniquet is the best choice. Despite the attempt to teach FA in a "cook book" manner, each situation needs to be evaluated individually based on the current circumstances (available resources, time until advanced help arrives, your level of training, scene safety) and decisions made on the basis of what you can do to provide the best possible outcome for the patient while not endagering yourself or other crew members.
good advice.
My take on it, if i cant stop it with pressure and elevation and blood is still being lost, tourney time. Better a missing limb than dead.
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good advice.
My take on it, if i cant stop it with pressure and elevation and blood is still being lost, tourney time. Better a missing limb than dead.
Back in the day (and like HiCarry is saying the classes are always changing), they used to teach tourniquets (say around 1994) and say release pressure every X minutes. A little later it was tourniquets, but expect that the limb is going to be lost, never release pressure. Now they don't even teach tourniquets.
The issue is one of litigation and its generally felt that tourniquets go well beyond what is 1st Aid and as such would place the general laymen into a situation where the Good Samaritan laws would not cover them.
With quick clot now readily available I'm not sure if there wouldn't be a push to use that instead of tourniquets (as taught) in 1st Aid curriculum.
GZ <--------------- not in the health care profession, but taken a crap load of 1st Aid/CPR classes over the years.
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GZ - the issue with tourniquets, or at least their fall from grace, was not necessarily focused on liability so much as it was on studies that seemed to indicate they were not beneficial. Some of that research found that limb salvage rates were sometimes low and used that criteria (wrongly, IMHO) to determine that tourniquets were "ineffective." In light of this research, tourniquets faded from the arsenels of care providers. However, the protracted military actions in the ME and Afganistan gave rise to more practical research and in that context, the effectiveness of tourniquets was re-established. Along with the hemostatic agents being concurrently developed for battlefield use, the medical establishment re-evaluated their thinking and conducted more studies. That being said, those hemostatic agents, despite their proven efficacy, have not made it into the civillian hospital and EMS providers at the same rate as the use of tourniquets. Not sure why....
As for Good Samaritan laws, they generally cover the provider as long as they are not grossly negligent and act within their training. So, it wasn't that they thought the tourniquets were beyond the level of training for general first aid (remember, there was a time they were rountinely taught...) it was just that they thought they didn't work as well as originally thought.
Hope that helps....didn't mean to ramble.
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That's a hard call, really depends on the wound. I'm sure the civilian world is pretty ANTI-tourniquet unless it's a complete amputation( Shark bite, Car wreck, etc.) In the ARMY we're taught TQ first, then asses once you're in a safer spot.
-J
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so i have a question-
how many on this board carry a first aid kit or even an IFAK at the range?
and would you use it on a stranger?
me personally, i have an IFAK supplemented with extra anti-coagulants in my range bag
i'm not a real doctor, but i would use it if i had to on a stranger
aloha
steve
That's a hard call, really depends on the wound. I'm sure the civilian world is pretty ANTI-tourniquet unless it's a complete amputation( Shark bite, Car wreck, etc.) In the ARMY we're taught TQ first, then asses once you're in a safer spot.
-J
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so i have a question-
how many on this board carry a first aid kit or even an IFAK at the range?
and would you use it on a stranger?
me personally, i have an IFAK supplemented with extra anti-coagulants in my range bag
i'm not a real doctor, but i would use it if i had to on a stranger
aloha
steve
I don't carry a 1st Aid/Trauma kit...........my friend does sometimes.
I haven't had any training in clotting agents, so personally I'd never use it on someone I didn't know personally and even then only if they wanted to use it.
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sorry
it was pointed out tome that i said anti-coagulants
i meant coagulants :(
eg- quik-clot, etc
aloha
steve
so i have a question-
how many on this board carry a first aid kit or even an IFAK at the range?
and would you use it on a stranger?
me personally, i have an IFAK supplemented with extra anti-coagulants in my range bag
i'm not a real doctor, but i would use it if i had to on a stranger
aloha
steve
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When I'm at work I keep one I'm my bag and when I go hiking I bring one along too. Just a basic one from red cross.
When I took first aid from red cross we never learned tourniquets. She said its not needed and extremely dangerous. When I took the wilderness and first aid training they taught us how to do it. I guess a lot depends on how advance of the class is.
I also want to expand my kits. Where do you guys buy your gear from?
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In my SUV I have a C-collar, a couple pressure bandages, a SAM splint, compressed gauze,a sharpie pen, and an IV kit. It all fits in a gallon ziploc. And Yes if i'm the first on the scene i'm gonna start working on them.
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Direct pressure is definitely the way to go. Anyone in the military is going to endorse the tourniquet because the whole point of combat medicine is to get good guys back into the fight as fast as possible. While bullets are flying, you can't have a few guys surrounding a patient giving direct pressure and elevating limbs in the open. It's much better to have a guy throw a tourniquet on himself or have a buddy assist, and have one or two guns out of the fight for <30 seconds or so. Personally, if it was ME somehow injured at the range, I'd throw a tourniquet on myself. I'm less than 30 minutes from a good medical facility here, so I'm definitely below the 6 hour amount of time where I'd start to risk losing a limb.
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Direct pressure is definitely the way to go. Anyone in the military is going to endorse the tourniquet because the whole point of combat medicine is to get good guys back into the fight as fast as possible. While bullets are flying, you can't have a few guys surrounding a patient giving direct pressure and elevating limbs in the open. It's much better to have a guy throw a tourniquet on himself or have a buddy assist, and have one or two guns out of the fight for <30 seconds or so. Personally, if it was ME somehow injured at the range, I'd throw a tourniquet on myself. I'm less than 30 minutes from a good medical facility here, so I'm definitely below the 6 hour amount of time where I'd start to risk losing a limb.
Your training for tourniquets goes way beyond what is (not) taught in 1st Aid/CPR courses. Tourniquets are just not taught.
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Direct pressure is definitely the way to go. Anyone in the military is going to endorse the tourniquet because the whole point of combat medicine is to get good guys back into the fight as fast as possible. While bullets are flying, you can't have a few guys surrounding a patient giving direct pressure and elevating limbs in the open. It's much better to have a guy throw a tourniquet on himself or have a buddy assist, and have one or two guns out of the fight for <30 seconds or so. Personally, if it was ME somehow injured at the range, I'd throw a tourniquet on myself. I'm less than 30 minutes from a good medical facility here, so I'm definitely below the 6 hour amount of time where I'd start to risk losing a limb.
If you are at the range and within 30 minutes of advanced care, why forgo direct pressure and move immediately to a tourniquet? Direct pressure is frequently effective, you don't have to worry about "bullets flying" or getting back into the fight.....and the 6 hour limit for tourniquet is not some magic number...cellular damage due to tissue ischemia (lack of oxygen) starts almost immediately on application of the tourniquet. Why risk it?
That type of thinking is why "cookbook" medicine can be problematic to teach....it removes some of the critical thinking behind the process of weighing the risks versus the benefits of treatment options. I'm not saying a tourniquet would never be the right answer in the situation of a GSW or traumatic amputation in the urban setting where medical care is close at hand, it just wouldn't be my first choice.
Oh, and my car kit has IVs, bulky dressings, SAM splints, CAT, and hemostatic agents....and gloves.....used to carry meds but got expensive replacing them. And I have been first at many scenes, and yes I start treatment. I also have an extensive background in emergency medicine and carry a million dollars in malpractice insurance....When EMS shows up, I can usually get them to replace my stuff, especially the IV fluids, tubing, and IV catheters.
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i bought my IFAK from chinook medical
got clotting stuff from amazon.com
i think you should be able to get the one-handed tourniquets from amazon too
aloha
steve
When I'm at work I keep one I'm my bag and when I go hiking I bring one along too. Just a basic one from red cross.
When I took first aid from red cross we never learned tourniquets. She said its not needed and extremely dangerous. When I took the wilderness and first aid training they taught us how to do it. I guess a lot depends on how advance of the class is.
I also want to expand my kits. Where do you guys buy your gear from?
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If you are at the range and within 30 minutes of advanced care, why forgo direct pressure and move immediately to a tourniquet? Direct pressure is frequently effective, you don't have to worry about "bullets flying" or getting back into the fight.....and the 6 hour limit for tourniquet is not some magic number...cellular damage due to tissue ischemia (lack of oxygen) starts almost immediately on application of the tourniquet. Why risk it?
That type of thinking is why "cookbook" medicine can be problematic to teach....it removes some of the critical thinking behind the process of weighing the risks versus the benefits of treatment options. I'm not saying a tourniquet would never be the right answer in the situation of a GSW or traumatic amputation in the urban setting where medical care is close at hand, it just wouldn't be my first choice....................
Pretty much sums up why tourniquets are not taught in 1st Aid/CPR.........
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The short answer.....
Conscious injured person: I'd explain the dangers of not letting me help you, and wait for a yes or no.
Unconscious: Yes, no questions asked.
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The short answer.....
Conscious injured person: I'd explain the dangers of not letting me help you, and wait for a yes or no.
Unconscious: Yes, no questions asked.
Implied consent works with the CPR thing and I guess is arguable if you've had training with a tourniquet. If you do not have training, then Good Samaritan will not cover you.
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so i have a question-
how many on this board carry a first aid kit or even an IFAK at the range?
and would you use it on a stranger?
me personally, i have an IFAK supplemented with extra anti-coagulants in my range bag
i'm not a real doctor, but i would use it if i had to on a stranger
aloha
steve
I have all the standard gun wound care stuff in my bag. I do need to get some sheers though. I would not hesitate, one minute, to put a TQ on someone.
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just got this email from chinook medical that is appropriate to this discussion:
I want to apologize and correct for a proofreading error published in our company newsletter yesterday regarding the use of tourniquets. We shared a WebMD quiz with you that recommended against the use of tourniquets for wound care in the home, and I want to address our position around this subject.
This statement contradicts current EMS protocol which advocates for the use of tourniquets for life threatening extremity hemorrhage that cannot be controlled by other means. When used properly, the tourniquet is a proven life-saving device used to control traumatic and severe bleeding when applying direct pressure and hemostatic bandages fail.
aloha
steve
i bought my IFAK from chinook medical
got clotting stuff from amazon.com
i think you should be able to get the one-handed tourniquets from amazon too
aloha
steve
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I have all the standard gun wound care stuff in my bag. I do need to get some sheers though. I would not hesitate, one minute, to put a TQ on someone.
I have a few extras, remind me and I'll give you one. As for hesitating to use a tourniquet, as before, in a battlefield situation, don't hesitate. If, however, you are close to medical care, one could argue, successfully IMHO, that not using direct pressure and hemostatics (if available) would be negligence. Add to that any real or perceived vascular or nerve damage from the tourniquet, and you might find yourself on the wrong side of a legal action without the benefit of any good Samaritan protections.
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Currently American Red Cross does not teach tourniquet use, however American Heart Association, American Safety & Health Institute, and Emergency Care & Safety Institute all support their use and train how to properly use them in desperate situations in their First Aid and Advanced First Aid, and Wilderness First Aid classes.
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Tourniquets should not remain in place longer than 10 minutes at a time. If the source of the bleeding cannot immediately be identified and ligated, the tourniquet should be loosened momentarily every 10 minutes.
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Tourniquets should not remain in place longer than 10 minutes at a time. If the source of the bleeding cannot immediately be identified and ligated, the tourniquet should be loosened momentarily every 10 minutes.
Ehhhhhhhhhhhhhhhh...Personally, if it was MY leg squirting ARTERIAL bleeding, I'm gonna crank that bitch down, and I'm fine with keeping it there for a couple hours till I can get CASEVAC'd to a medical facility. Definitely not loosening a tourniquet over an arterial wound after 10 minutes.
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Ehhhhhhhhhhhhhhhh...Personally, if it was MY leg squirting ARTERIAL bleeding, I'm gonna crank that bitch down, and I'm fine with keeping it there for a couple hours till I can get CASEVAC'd to a medical facility. Definitely not loosening a tourniquet over an arterial wound after 10 minutes.
if you wanna keep that limb you will. I'm not saying to let yourself bleed out but you gotta loosen it for just a bit every 10 mins or that limb is gonna die. after about 5 mins and some muscle will start to die. longer then 10 mins and your gonna lose that limb!
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if you wanna keep that limb you will. I'm not saying to let yourself bleed out but you gotta loosen it for just a bit every 10 mins or that limb is gonna die. after about 5 mins and some muscle will start to die. longer then 10 mins and your gonna lose that limb!
Guys blown up in Iraq and Afghanistan have tourniquets on for over an hour and keep the limb. I go by my training and experience.
Granted, it's not Iraq or Afghanistan, but we have amazing hospitals here and I don't have to wait an hour for a helicopter to pick me up. I have full faith in doc patching me up.
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Tourniquets should not remain in place longer than 10 minutes at a time. If the source of the bleeding cannot immediately be identified and ligated, the tourniquet should be loosened momentarily every 10 minutes.
Disagree. Please identify your source of information as I believe it is probably dated and not standard of care.
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if you wanna keep that limb you will. I'm not saying to let yourself bleed out but you gotta loosen it for just a bit every 10 mins or that limb is gonna die. after about 5 mins and some muscle will start to die. longer then 10 mins and your gonna lose that limb!
Again, your information is dated. Most current research and recommendations do not advocate the intermittent loosening that had been taught many years ago.
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if you wanna keep that limb you will. I'm not saying to let yourself bleed out but you gotta loosen it for just a bit every 10 mins or that limb is gonna die. after about 5 mins and some muscle will start to die. longer then 10 mins and your gonna lose that limb!
You can leave it on for atleast an hour before tissue starts to permanently deteriorate.
It all comes down to how badly you want to live. Worst case scenario, you survive but you now have an amputated limb.
p.s. If you remove a tourniquet before 10 minutes then you aren't letting it actually clot, any decent arterial bleed will just seep through your bandage or past your tourniquet. hopefully body will automatically kick into survival mode and your muscles around the wound site will spasm creating a natural pressure block.
Moral of the story is if you are trained to use a tourniquet, then use one. Strap it down tighter than you think you need to, and leave it there till you find someone who has more medical knowledge than you do.
-J
68W
Combat Medic.
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You can leave it on for atleast an hour before tissue starts to permanently deteriorate.
It all comes down to how badly you want to live. Worst case scenario, you survive but you now have an amputated limb.
p.s. If you remove a tourniquet before 10 minutes then you aren't letting it actually clot, any decent arterial bleed will just seep through your bandage or past your tourniquet. hopefully body will automatically kick into survival mode and your muscles around the wound site will spasm creating a natural pressure block.
Moral of the story is if you are trained to use a tourniquet, then use one. Strap it down tighter than you think you need to, and leave it there till you find someone who has more medical knowledge than you do.
-J
68W
Combat Medic.
Good advice. If you put a tourniquet on, leave it there. Loosening it only serves to restore the intraarterial pressure and dislodge any clot that may have started to form.
In terms of cellular damage due to hypoxia (lack of oxygen) and actual muscle damage, there isn't really a magic number (eg, 10 minutes, one hour) before there is demonstrable "permanent damage" to a limb. One of the most current concepts in trauma care is that of "permissible hypotension" meaning that field care shouldn't attempt to restore a "normal" blood pressure and instead focus on immediate treatable interventions, like airway (although there is some controversy in that as well...). So, if the current medical thinking is that it is ok, even preferable, to have a low b/p (meaning decreased blood flow, and therefore hypoxia, to the entire body) then the issue of hypoxia to a single limb from a tourniquet become almost moot.
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That's a hard call, really depends on the wound. I'm sure the civilian world is pretty ANTI-tourniquet unless it's a complete amputation( Shark bite, Car wreck, etc.) In the ARMY we're taught TQ first, then asses once you're in a safer spot.
-J
This...
Add to it the fact that the CAT and the other military tourniquets are designed for a soldier to apply themselves if needed. Eliminating/reducing the time another soldier is needed "off the gun" to attend to a wounded teammate. The direct pressure and pressure dressing method, while very effective requires someone to aid the person bleeding.
This being said, I keep a CAT in my IFAK, (I also keep a pair of ACSes in there... but that is a different ball of wax)
Red cross doesnt like the tourniquet option, as in a Samaritan situation direct pressure (should) be adaquate - and the red cross doesnt want to be responsable for well meaning (but over zealous) rescuers slapping on a tourniquet when direct pressure would have been adaquate.
Use of a CAT does not automatically mean you are sacrificing a limb if properly applied and attended to - those of you who choose to use them should seek guidance (unless you already were trained in their use by uncle sam)
I feel the CAT is an essential piece of kit for hikers, hunters, fishermen, etc. I've even sent one to my dad who works with metal alone in his shop to keep in his first aid kit.
It's kinda like owning a defensive carbine... you may never need it for it's intended purpose, but if you ever do it'll save your ass.
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Tourniquets should not remain in place longer than 10 minutes at a time. If the source of the bleeding cannot immediately be identified and ligated, the tourniquet should be loosened momentarily every 10 minutes.
Tourniquets do NOT need to be released every 10 minutes. A tourniquet can be left in place for up to 6 hours depending on temperature and other factors, to control bleeding and still be able to save the affected limb. The important fact then becomes delivering medication to overcome the toxins that have built up in the affected limb before the tourniquet is released and they rush into the body.
I have been a medic for over 25 years, and am also a Diving Medical Technician (DMT) and have used tourniquets successfully many times for long term bleeding control for several hours.
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Tourniquets do NOT need to be released every 10 minutes. A tourniquet can be left in place for up to 6 hours depending on temperature and other factors, to control bleeding and still be able to save the affected limb. The important fact then becomes delivering medication to overcome the toxins that have built up in the affected limb before the tourniquet is released and they rush into the body.
This is the same reason why I was trained to not allow a fall arrest casualty to remove their harness and move about after a rescue
Deoxygenated blood full of CO2 pooling in the legs can cause cardiac arrest if allowed to return to the body without treatment.
We refer to it as suspension trauma, we issue special stirrups to clip to the waist of the fall harness to stand in while awaiting rescue, allows circulation of the blood in the legs.
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Exactly
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This is the same reason why I was trained to not allow a fall arrest casualty to remove their harness and move about after a rescue
Deoxygenated blood full of CO2 pooling in the legs can cause cardiac arrest if allowed to return to the body without treatment.
We refer to it as suspension trauma, we issue special stirrups to clip to the waist of the fall harness to stand in while awaiting rescue, allows circulation of the blood in the legs.
The blood in a limb with a tourniquet develops a decreased pH and oxygen (PO2 or partial pressure of oxygen) and a build up of lactic acid, potassium and carbon dioxide (PCO2). The sudden release of a tourniquet releases these metabolites into the general blood system. It is not the PCO2 that causes the concern or physiologic impacts, but rather the lactic acid and potassium. Lactic acidosis reduces the ability of the body (at the cellular level) to produce "energy" (refer to the Kreb cycle) and the influx of potassium can cause heart dysrhythmias, up to and including cardiac standstill.
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I am definitely not an expert here but I did attend the Army Combat Medic / Advanced Life Support Live Tissue course a couple of times before getting hosed by PETA. this was in the 07'-08' time frame. I also sat in on a basic cert course about 3 weeks ago administered by C&C instructor for our unit who has now issued the CAT. Some things I took from all of this, mostly the live tissue training.... Use only as a last resort for preservation of life, as mentioned when other methods like direct pressure and clotting agents fail, or are not practical to apply given the situation, such as an ongoing gunfight, battle, etc... Use of the tourniquet is a great tool, sometimes the only or most practical option for self application to save your own life. Use of some clotting agents like the granular Quik Clot cannot be applied successfully by one person. 4 people are ideal. Of course there are much better bandage clotting agents currently on the market, but if you have the granular type and no practical application practice, do not expect to be successful trying to use it. Gauze and direct pressure is your friend. Correctly packing certain wounds is your friend. Stopping a major bleeder like a femoral, even retracted can be highly effective with a finger or two. Of course under fire would be another story to try and maintain it. Allowing the clot to take is time consuming and frustrating at times especially under fire and in transport, but that clot is your friend. Certain wounds require so much pressure with a tourniquet to stop or control the bleeding that if you have never done it before you might not be successful. For myself, when applying a tourniquet to several different bleeders, I needed to use far more pressure than I would have thought. We actually tested the original CAT tourniquets in these courses and many of the original prototypes could not take the torque and broke. NOT ALL CAT tourniquets are created equal. Many are still made to cheap or flimsy IMO. When applying a tough location / bleeder you can literally see the bruising happening in front of you as it is applied. Some say the application may be more painful to the person than the wound itself and I can believe it. 6 hours for application with the time of initial application denoted.
I carry an IFAK plus I have a more extensive KIT in my vehicle. I keep a couple of CAT tourniquets readily accessible on my gear for self application. The idea is that your kit is to be used on you. Maintain the ABC's and get them to an ER and surgery ASAP. One huge thing I took away from the live tissue training is that the body can take huge amounts of damage and still survive with good early intervention.
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I have a fairly well stocked A bag and it does have CATs in it. They are generally speaking something that you can say "yay or nay" to. Some wounds require them, some wounds you can use quick clot, pressure dressings, etc. Speaking only about tourniquets, Surf was dead on, they are not all created equal. Though I have them in my A bag, but I also have my own homemade version that I prefer, because they won't break and you don't have to waste valuable seconds messing with the Velcro..just my two cents
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use tourniquets as a LAST resort to save a life...you can use whatever available at the moment (belt, tie, rope, clothing, sling, etc)
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use tourniquets as a LAST resort to save a life...you can use whatever available at the moment (belt, tie, rope, clothing, sling, etc)
Unfortunately, it is not quite that simple.
If you are in a firefight and sustain significant trauma to an extremity, and you need to stay in the fight or definitive treatment is delayed, use a tourniquet right away.
If you are in an urban environment, and medical care is minutes away, it is doubtful a tourniquet would provide any significant advantage to direct pressure and rapid transport to definitive care.
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Unfortunately, it is not quite that simple.
If you are in a firefight and sustain significant trauma to an extremity, and you need to stay in the fight or definitive treatment is delayed, use a tourniquet right away.
If you are in an urban environment, and medical care is minutes away, it is doubtful a tourniquet would provide any significant advantage to direct pressure and rapid transport to definitive care.
You are right..depends on the situation...I was just thinking of the training on self-buddy aid in a combat (military) scenario....Thus I said last resort.
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Again, your information is dated. Most current research and recommendations do not advocate the intermittent loosening that had been taught many years ago.
hahahahaha, everyone which has a medical licenses please raise their hand. (I can raise mines) if not, stfu!
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You can leave it on for atleast an hour before tissue starts to permanently deteriorate.
that is bull shit! see this is why a medic or a paramedic/emt is not a real doctor. You might want to play one but you do not have a medical licenses!
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hahahahaha, everyone which has a medical licenses please raise their hand. (I can raise mines) if not, stfu!
Hey "doc" (if you are one) I've worked with lot's of folks that had medical licenses that were complete idiots, so how about you STFU if you can't play nice in the sandbox. If you have empirical evidence, such as peer reviewed literature that backs up your contention, then please provide it.
Here's some that contradicts your premise:
http://www.ncbi.nlm.nih.gov/pubmed/19106667 (http://www.ncbi.nlm.nih.gov/pubmed/19106667) Conclusions: Tourniquet use when shock was absent was strongly associated with saved lives, and prehospital use was also strongly associated with lifesaving. No limbs were lost due to tourniquet use. Education and fielding of prehospital tourniquets in the military environment should continue.
http://journals.lww.com/jtrauma/Abstract/2008/02001/Practical_Use_of_Emergency_Tourniquets_to_Stop.8.aspx (http://journals.lww.com/jtrauma/Abstract/2008/02001/Practical_Use_of_Emergency_Tourniquets_to_Stop.8.aspx) Conclusions: Morbidity risk was low, and there was a positive risk benefit ratio in light of the survival benefit. No limbs were lost because of tourniquet use, and tourniquet duration was not associated with increased morbidity. Education for early military tourniquet use should continue.
http://journals.lww.com/jtrauma/Abstract/2003/05001/Tourniquets_for_Hemorrhage_Control_on_the.38.aspx (http://journals.lww.com/jtrauma/Abstract/2003/05001/Tourniquets_for_Hemorrhage_Control_on_the.38.aspx) Conclusion : Tourniquet application is an effective and easily applied (by medical and nonmedical personnel) method for prevention of exsanguination in the military prehospital setting.
http://journals.lww.com/jorthotrauma/Abstract/2007/04000/Extended__16_Hour__Tourniquet_Application_After.9.aspx (http://journals.lww.com/jorthotrauma/Abstract/2007/04000/Extended__16_Hour__Tourniquet_Application_After.9.aspx) We present a case of emergency tourniquet use of unusually long duration. The patient was wounded during combat operations, and the subsequent battle and evacuation caused a significant delay in surgical treatment of his wounds. Emergency tourniquets can be lifesaving, but are not benign interventions. In general, the extent of tourniquet injury increases with increasing time of application. Despite having a tourniquet in place for 16 hours, the limb was salvaged and significant functional recovery was accomplished. We conducted a search of the published literature including the Medline database, and present a review of the relevant articles concerning emergency tourniquet use, tourniquet injury, and mitigating treatments. Given the widespread use of tourniquets in ongoing military operations, it seems likely that tourniquets will transition to civilian use. Thus it is important for physicians to understand tourniquet injury and appreciate that even extended tourniquet application times does not necessarily doom the affected limb.
I'm betting you aren't even a physician.....just saying
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But if he is, he might be a good 2a supporting physician.
Hey sliver u taking patients?
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But if he is, he might be a good 2a supporting physician.
Hey sliver u taking patients?
The articles I posted are from peer reviewed journals dating back to 2004. The last one was from April 2007. The issue of tourniquets, hemorrhage control and limb damage/salvage is not new, cutting edge medicine. If indeed he is a physician, he is woefully ignorant of the subject at hand, which, considering the ease of researching it, is completely unacceptable and shows an unwillingness to keep updated on current practices. I personally would be unwilling to go to someone who is so adamant about being right in light of overwhelming evidence to the contrary. Furthermore, his inability to research readily available material relevant to medical decision making is, to say the least, alarming. I wouldn't trust my life to someone demonstrating this type of behavior, pro 2A or not.
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not to mention his grammar and subject/verb agreement difficulties
The articles I posted are from peer reviewed journals dating back to 2004. The last one was from April 2007. The issue of tourniquets, hemorrhage control and limb damage/salvage is not new, cutting edge medicine. If indeed he is a physician, he is woefully ignorant of the subject at hand, which, considering the ease of researching it, is completely unacceptable and shows an unwillingness to keep updated on current practices. I personally would be unwilling to go to someone who is so adamant about being right in light of overwhelming evidence to the contrary. Furthermore, his inability to research readily available material relevant to medical decision making is, to say the least, alarming. I wouldn't trust my life to someone demonstrating this type of behavior, pro 2A or not.
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He could be a podiatrist...
I remember a call with a cardiac pt, her son showed up and we explained-- in layman's terms-- what was happening. He goes, "I'm a doctor, just tell me what's up." So, we show him the 12-lead EKG and say "check out the elevations in five & six". Right away he goes, "um, I'm a actually a psychologist, sorry."
Back to the tourniquet issue... I can't speak for what a PA or MD would do, but current practice (for arterial bleeding) is direct pressure and then straight to tourniquet if that doesn't work. I could care less what Silver thinks of EMT/paramedics-- if someone gets shot outside of an ER, then it's prehospital and therefore our turf. Not trying to start a pissing contest here, but being a good ER doc doesn't necessarily translate to providing good prehospital care. What the average Joe at Koko Head will have in his IFAK is closer to what we carry on the rig, and any advice that any HM/68W/MICT has to offer is completely relevant.
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He could be a podiatrist...
I remember a call with a cardiac pt, her son showed up and we explained-- in layman's terms-- what was happening. He goes, "I'm a doctor, just tell me what's up." So, we show him the 12-lead EKG and say "check out the elevations in five & six". Right away he goes, "um, I'm a actually a psychologist, sorry."
Back to the tourniquet issue... I can't speak for what a PA or MD would do, but current practice (for arterial bleeding) is direct pressure and then straight to tourniquet if that doesn't work. I could care less what Silver thinks of EMT/paramedics-- if someone gets shot outside of an ER, then it's prehospital and therefore our turf. Not trying to start a pissing contest here, but being a good ER doc doesn't necessarily translate to providing good prehospital care. What the average Joe at Koko Head will have in his IFAK is closer to what we carry on the rig, and any advice that any HM/68W/MICT has to offer is completely relevant.
I can't tell you the number of calls where I'd have some person come up and say "I'm a doctor" and start giving orders. Occasionally, it would be someone with some relevant experience, but I always found that it was those guys that "offered" to help rather than tried to commandeer the scene. Most of the folks that tried that were completely out of their element (optometrist, third year medical resident, dermatologist, etc.). I'd usually tell them we were alright and operating off our protocols, but with the extra pushy ones I'd simply ask for their name and proof of professional licensure, and then explain that they could, if they wanted, assume full and complete responsibility for the scene, including associated liability if they wanted. None ever took me up on the offer. I have even had the cops remove these self-professed "doctors" from the scene for me if they continued to be a PIA. I love it when you watch them drug away by the cops screaming "...but I'm a doctor...."
As for his grammar and syntax, that and his completely dated advice pegged him immediately as someone who didn't have the background he claimed....hey, maybe he can be our very own version of the mall ninja. You know, the ninja doc.....wonder when he'll start advocating for intra-cardiac epinephrine and massive bicarb administration for arrests?
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Yup, the offer of "transferring care" to them usually makes them leave. Years ago I had a code at Arizona Memorial, and this Italian woman kept hovering around, stating that she was a doctor and that she could intubate the pt for us. I was on internship then and there was no way in Hell I was going to give up a tube and miss my criteria!
wonder when he'll start advocating for intra-cardiac epinephrine... for arrests
Reminds me of that scene from Pulp Fiction. We just got these epi preloads in (the Luer-Jet ones), and for whatever reason, they come with this huge (like spinal tap) needle at the end. Showed my friend, and he asked if that was for drug overdoses, like Uma Thurman's character. He's not a medical guy... I told them they were prostate injections.
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We just got these epi preloads in (the Luer-Jet ones), and for whatever reason, they come with this huge (like spinal tap) needle at the end. Showed my friend, and he asked if that was for drug overdoses, like Uma Thurman's character. He's not a medical guy... I told them they were prostate injections.
Yep, I remember those well. Those are the 3.5 inch intra-cardiac needles.....Those were in vogue back when I first started. Actually did many, many IC epi's during codes. That and Isuprel drips.....
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Which TQs are you guys carrying?
Picked up a few CATs from Mojo Tactical (thanks, Dave!).
For those who carry CATs, do you guys have them prepared for one-handed or two-handed application?
CATs, but you have to be careful. The market is full of knock-offs made in China and they are poorly constructed.
You should carry the CAT with a single routing of the end through the friction adapter (one handed set-up) so that YOU can apply to YOUR upper extremity. If you are applying to YOUR lower extremity, or to someone else's upper or lower extremity, you will need to loop the end through both slots of the friction adapter.
A good review of the CAT and other tourniquets: https://www.youtube.com/watch?v=yaxJmhh3-0w