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Discussion in 'First Aid Station' started by Weko, Feb 16, 2016.
VinnyP Joelski 1++
Well, I personally don't practice this method either since it's not on my protocol.
I just mentioning it's used in military, and on Tactical Paramedic texts.
There are actually other practices they do in military that differ from civilians,
such as trauma triage instead of START triage, use hemostatic agents in the abdomen region, or cleaning and replacing intestine for evisceration.
I was originally trained by the military, I refresh every year with the military, they do have some differences but there has been a lot of convergence over the last few years. I am represented at a lot of the policy boards and in the past have sat on them. They don't teach this and as far as I know never have as part of any curriculum. Page 24 of the Tactical Paramedic Manual you refer to says under the direct pressure heading:
"Push a fist or knee INTO a wound as a "Stop gap" prior to applying a dressing or a tourniquet".
Which I am entirely comfortable with in some cases. But nothing about proximal application.
Trainers can go off, piste despite our best efforts, so I am not saying this hasn't been taught in the military, just that it had no place being taught.
Ok here you go. I just took homeland security ems special ops course over the weekend. Technique with a knee drop was discussed, demonstrated and encouraged there. Same as many I never heard of it plus I voiced my concerns about possible complications few posts above. I also mentioned it to the instructors. It is reserved for special situations such as mci where you are treating multiple victims with limited resources. We are not talking about one patient being tended to by a dedicated crew. We are talking about an active shooter situation when you go in and need to prevent unknown number of people from dying. Start traige to the full effect. Obviously you drop a knee on miss jones who lacerated her femoral by falling on the rake you are going to have problems. You drop the knee on 15 people in the subway after ied goes off you are a hero.
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A few points from a lay instructor-
1. For typical lay responders, pressure points and elevation are no longer taught for the reasons discussed above
2. Tourniquets and chemical means are taught differently by different programs and instructors. Most lay programs barely mention them.
3. Teaching pressure points to a lay responder was always a bit tricky. There is no way to effectively teach the locations and techniques, much less provide effective practice, in the time allowed. Thus, in a real emergency, they rarely know how to respond effectively.
4. Most of us, especially in a typical urban or semi-urban lifestyle, will never encounter a wound that cannot be controlled by direct pressure well enough to help until better help arrives. I've carried a darn good EMS kit for years and never needed my 'big ouchie' stuff.
5. A BIG AMEN to the idea that instructors can go 'off script'. I have heard instructors say some of the most outlandish things in class- things WAY OUTSIDE anything 'The Book' has to say on a topic. This applies just as much to first aid as it does to pretty much any other topic.
Bottom line- tennis balls? I've got better things to do with the space they would take.
I am an EMT and we do not even have pressure points in our protocol any more. This is the flow chart from our protocol:
So I would basically follow that. Don't have a TQ? Improvise one. Studies are showing that limbs are still viable after 4-6 hours IIRC. I would only use direct pressure as a last ditch effort.