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.

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

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.

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://firstaid.about.com/od/bleedingcontrol/ss/bleedingsteps_4.htm
http://www.tpub.com/seabee/6-1.htm
http://www.combattourniquet.com/

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.

You serious? You sure thats not just for amputation type injuries?

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.

Ah. That more detailed explanation makes more sense. Just making sure, sometimes the army does some stupid stuff lol

Quote from: pj_benn on January 20, 2011, 10:08:52 PM

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 =)

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.......

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 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.   

Got my CAT tourniquet in yesterday....bought a bunch for work stuff and this one's mine......

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.

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.

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.

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.

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.

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

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