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Discussion in 'First Aid Station' started by jeremiahak, Apr 25, 2013.
here here! A good belt, a bandana etc IS better than nothing
I carry one with me on my hip next to my radio and keep some 2 in my EDC Bag.
I'm interested in reading about it. Please forward me what you have. Thanks!
That's old medicine. Evidence based medicine (the new standard) shows that it is not actually damaging.
It is second line therapy for uncontrolled bleeding. Direct pressure then tourniquet.
Standard of care these days. I fear that if you don't use one in your service then the burden will soon be on your service to explain why they have not adopted this as a practice.
And it is a very basic skill - not at all to be reserved for advanced providers. Non medically trained combatants are doing it every single day all around the world.
Just my 2cents
I know what you are saying and sure a tourniquet has its use. I also agree it doesn't take a high degree of skill to apply one. My point was knowing when it's proper to use a tourniquet and the issues that can arise from applying one. I've only had to apply a tourniquet one time ( once is enough ) it was used after every other attempt to control bleeding...elevation, direct pressure, squeezing involved artery...didn't produce sufficient results.
I dont carry one but I have 2 in my FAK.
One stays in the car, one stays in my travel/range bag, one stay on me at all times.
Got two in the FAK large size i carry only when hiking or camping.
Being not skilled in the argument, think this could be the right place where to ask for comments and suggests about my kit...
Detailed pics of my FAK here Nick4305's personal EDC
Not sure if it's been mentioned in here yet or not, I could've overlooked it, but I think an important thing to remember when talking about tourniquets is that you should have a good understanding of when one would be clinically recommended (i.e., called for). Like a few guys have pointed out, they can cause more damage if used incorrectly. Know that, for a major arterial bleed you'll have literally seconds, if you're lucky, to make something happen. Traumatic amputations and large, uncontrolled bleeding issues are about the only time one is recommended and then it's important to note when you applied it. A MCI like the Boston Marathon, where limbs are blown off is a good example of when one is called for. A big gash on the lower leg of a hiker, probably not. I'd suggest a good combat gauze there. Also remember you can use arterial pressure points above the wound to control bleeding long enough for it to start clotting.
Yes, and yes.
Don't forget, Ninja, that they used to teach tourniquets for snake bites, a horrible idea. If you watch too many movies you'll be cutting it open and sucking at the wound, too -- even worse.
It has been wrong in both directions -- when to use, and when not to. Does a tourniquet take a lot of training to apply? No. Should you have some basic knowledge of when it is or isn't appropriate? Absolutely.
0 excuse for increasing injury because someone is carrying gear they aren't checked out on.
For anyone without any formal training, go to your local community collage, most of them offer some sort of EMT-B course for relatively little money.
Its worth the time to learn how to use this stuff.
I keep either keep two CATs or Softt-ws in all my med kits.
I do not carry a med kit on me, because I really dont have pocket room and I dont need to look like bat man.
I wouldn't make a blanket statement suggesting they do not cause damage. They have their place but they also have theirs risks, whether or not the risk is justified depends on the severity of the injury.
The two Level 1 trauma centers I cover (one PEDs and one adult) does not routinely employ them nor do the EMS services in the city.
The skill set required for applying a tourniquet is very basic, must like a pneumo dart. The skill in correctly determining when to apply varies and I will say virtually every layman on the street and a near majority of first responders will incorrectly use either.
Of the injuries I've treated in the hospital, from traumatic amputations to open bilateral femur fractures, there is only one that needed a tourniquet and it was a little girl who cut three of her digital arteries in her hand with a hedge trimmer.
That is not to say "don't use them," but you had better KNOW it is necessary and damned near exhausted yourself applying pressureto a wound.
Elevation and "Squeezing involved artery" (Indirect pressure) are 2 more examples of old medicine.
From the current PHTLS guidance:
"elevation of an extremity and compression on a pressure point proximal to the injured site are not proven methods of hemorrhage control and are not endorsed by PHTLS"
And from the summary:
Prehospital tourniquets are indicated if direct pressure or a pressure dressing fails to control hemorrhage.
The tourniquet should be placed prior to extrication and prior to transport. There is a clear survival advantage if placement is done prior to the onset of shock.
The tourniquet is tightened until hemorrhage ceases. An additional tourniquet can be placed next to the first tourniquet if bleeding control is inadequate following placement of the first tourniquet.
The patient should be transported to a hospital with immediate surgical capabilities whenever possible.
The time of tourniquet application should be documented and relayed to the trauma team upon arrival at the hospital.
There are few, if any, significant complications attributed to tourniquet use. It is a safe procedure, should be performed by all EMS personnel, and saves lives.
PHTLS recommends the placement of tourniquets by EMS personnel if direct pressure fails to control extremity hemorrhage.
The old routines regarding tourniquets is a dark chapter in medicine, what "we" did was that we accepted old truths as a good basis for policies instead of looking at the available evidence or getting proper evidence if there's a lack of it (which there was). It's unacceptable and there's no doubt in my mind that "use tourniquets only as a last resort" have killed quite a few people.
And to answer the OP, no I do not carry a tourniquet on my person.
I would also like to review the swat-t vs cat material someone mentioned above.
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Im also interested in reading the research. If you could post a link or send it to me I would appreciate it. The swat t just looks like theraband. In a pinch would it be appropriate to use it?
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The PHTLS guidelines are based on treatment practices in Iraq and Afghanistan. That doesn't mean they aren't valid, but they but they have been observed in a very narrow setting and a small subset of patients that succumb to injuries generally limited to high energy gunshot wounds or blast injuiries, both of which occur in a setting where the patient and treating personnel have to evacuate immediately.
I have no doubt they have found dramatic increases in survival rates of their patients, but I don't think it is clear that same improvement will he seen in patients here.
Again, that doesn't mean they don't have their place or that they shouldn't be used, but make sure you truly can't stop the bleeding and aren't simply getting lazy, failing to assess your patient, or succumbing to otherwise poor technique.
PHTLS are the teaching syllabus for the civilian NAEMT under the American College of Surgeons' Committee on Trauma it forms the syllabus for over 30 other countries around the world. No one is (Hopefully) still teaching elevation and indirect pressure.
I don't carry one physically on me, and I am an active medic. I do have ones in my trauma bags in my vehicles.
I agree with the other medical folks here. For those of you that haven't done much medicine, it is very uncommon to need one. In fact, I've been a medic on rescue squads and ambulances for 28 years now and I haven't needed one yet outside of training. If all else fails you definitely need one, but direct pressure and pressure dressings usually do the trick.
Valuable reading regarding civilian prehospital use of the tourniquet.
It is not the end all method of hemorrhage control but it is an extremely valuable tool. As with any tool proper handling is vital. But the risks of using a tourniquet is quite low as far as we know from the limited research we have. This should hold especially true in civilian settings where advanced medical help is readily available most of the time.
Yes, its a scan from military medicine which i have to digg out from my computer.. I have not forgotten my promise.. Just have to find it first -.-
I think theraband is more elastic than the swat which is very rigid.. Also the swat has a kind of surface texture which does that it transfers alot of energy the the lower layers each time you wrap.. The amount of pressure you get with a few wraps is very high, and it kind of grips so its going nowhere when tugged in. You should get a few and train with one of them.. I was very surpriced in its performance