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.

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.

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.

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.

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.

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.

Exactly

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. 

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. 

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

use tourniquets as a LAST resort to save a life...you can use whatever available at the moment (belt, tie, rope, clothing, sling, etc)

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.

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.

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!

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!

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  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   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   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   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

But if he is, he might be a good 2a supporting physician.

Hey sliver u taking patients?

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.

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.

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.