Tourniquets, Misuse

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  • 2A_Tom

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    It seems that we are placing a lot of emphasis on tourniquets these days. That can be a very good thing, but there are many more situations where a T is not necessary than when it is.

    Most times an IZZY, gauze or improvised bandages is all you need.

    Always remember that in STOP the BLEED situations direct pressure is usually your FIRST and most times the only recourse necessary.

    Here are two video's where, in my opinion tourniquets are unnecessarily applied.


    1. In this one it seems officer is panicky, he has not practiced with his tourniquet, does not know that the child's extermity is too small, does not have knowledge of anatomy and the circulatory system.[video=youtube_share;uNe_Ulr3txs]https://youtu.be/uNe_Ulr3txs[/video]
    2. In this one we have basically the same lack of knowlwdge and the presence of a wound that would be much better served with bandaging and direct pressure.[video=youtube;j8zHYvprES8]https://www.youtube.com/watch?v=j8zHYvprES8[/video]

    I am not wanting to discuss the police action in this one that thread already exists.


    STOP The BLEED

    FIRST:
    1. Apply direct pressure.
    2. unless there is arterial bleeding/ lots of blood flowing fast.

    Next:
    1. Apply tourniquet.
    2. Do not allow anyone except a doctor to loosen the it.
    3. Protect the wound.

    Then treat for shock:
    1. Raise the feet and affected extremity above the heart.
    2. Keep the victim warm.
    3. Keep the victim as calm as possible.

    We all need practice and training.



     

    Wolfhound

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    In the military we were taught when using a tourniquet the rule is "lose a limb but save a life." So, the idea was to use them only when necessary and since you aren't minutes from an Emergency Room the patient will quite possibly lose the limb to which the tourniquet is applied.
     

    Sylvain

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    Here's another video (also from Skinny Medic) of a cop applying a tourniquet on a suspect.

    While I agree that direct pressure is usually all you need it also means that you will get glued to your patient for the next 5 or 10 minutes if you don't have a pressure bandage.

    In the case of a police officer having to deal with a suspect and a chaotic scene a tourniquet that will only take 10 seconds to apply might be the best solution.
    Keeping both his hands free to use his radio, gun, and do other tasks, dealing with additional suspects etc.



    [video=youtube;dZxTz51iUyQ]https://www.youtube.com/watch?v=dZxTz51iUyQ[/video]
    watch
     

    cedartop

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    In the military we were taught when using a tourniquet the rule is "lose a limb but save a life." So, the idea was to use them only when necessary and since you aren't minutes from an Emergency Room the patient will quite possibly lose the limb to which the tourniquet is applied.

    How long ago was that?
     

    2A_Tom

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    I cannot speak for Wolfhound, but mine was 45 years ago. I realize that now doctors can save a limb up 8 hours, maybe more. When I was in they taught the same, I was a basic Infantry man and they did not go into anything further than saving a life. I believe what they were emphasizing was that the soldiers life was more important than the limb.
     

    fullmetaljesus

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    Any one have suggestions on a good first aid / CPR class?
    I had my cert in both back in the 7th grade but didn't keep up with it.
     

    Wolfhound

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    How long ago was that?

    My combat lifesaver training was in 1988. I realize that emergency medicine has come a long way since then. We didn't have quick clot or anything like that back then.
    Anytime you cut off blood flow to a limb it is simply a matter of time until tissue death (necrosis) occurs. I am sure that limb loss due to a tourniquet is much less common in first world countries where trauma care is easily accessible like the USA.

    Tourniquet_poster.jpg
     

    cedartop

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    My combat lifesaver training was in 1988. I realize that emergency medicine has come a long way since then. We didn't have quick clot or anything like that back then.
    Anytime you cut off blood flow to a limb it is simply a matter of time until tissue death (necrosis) occurs. I am sure that limb loss due to a tourniquet is much less common in first world countries where trauma care is easily accessible like the USA.

    Tourniquet_poster.jpg
    That was during my era as well. TQ use has increased exponentially since then.
     

    2A_Tom

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    Oh, I knew that, This is [STRIKE]snark city[/STRIKE] INGO.

    Thank you, both, for your service.
     

    2A_Tom

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    Here's another video (also from Skinny Medic) of a cop applying a tourniquet on a suspect.

    While I agree that direct pressure is usually all you need it also means that you will get glued to your patient for the next 5 or 10 minutes if you don't have a pressure bandage.

    In the case of a police officer having to deal with a suspect and a chaotic scene a tourniquet that will only take 10 seconds to apply might be the best solution.
    Keeping both his hands free to use his radio, gun, and do other tasks, dealing with additional suspects etc.
    watch

    In this case there was definitely a lot of blood and a tourniquet was indicated.

    In the video of the child the officer was in no danger. In the video with the lower leg there was no large bleeding, and the officer put himself in close proximity with someone who had been threatening with a sharp object and was said to have more weapons on their person.

    Kudos to the officer in your video for shot placement, Had the truck been a bit slower or the officer been a bit quicker, discussion of the use of s tourniquet would have been moot.
     

    rhino

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    There are some other things to do between the first application of direct pressure and the need to apply a tourniquet. One is simple elevation of the injured part above the heart (if possible).

    Israeli Battle Dressings (IBD) and similar pressure bandage work really, really well in most cases. They have the advantage that once you apply, you are no longer attached to that injury (whether it's on yourself or someone else).

    I've had two situations in which I was injured and I needed an IBD. The first time I didn't have one and I had to apply pressure with a bandana and then a second after it soaked through while waiting for EMS. I actually achieved hemostasis until the paramedics wanted to look at the wound and pulled the bandanas and the forming clot off. That injury was on my head (post-cleaning of wound photos are in a topic on INGO from I think 2009). No way to use a tourniquet on that.

    The other was the now infamous karambit to the lower leg incident. Having an IBD handy allowed me use of my hands and enough mobility to clean-up a huge pool of blood before I drove myself to the ER. Given the rate of flow and that it was on my lower leg, I know that some people who are "tourniquet-centric" would have used one on me, but application of pressure was sufficient. Even if the initial application of the IBD doesn't stem the flow, you can apply a lot more pressure using the clip and it will generally do the trick.

    When I completed "Tactical Treatment of Gunshot Wounds" the first time with Doc Gunn, he had never had to use a tourniquet in his entire career. He'd always been able get pressure to work and the dude has seen a lot of trauma. During my second or third time in the class, he actually had a case where he applied a tourniquet to a traumatic amputation.

    When you really need a tourniquet, nothing else will do, which is why we have them and know how and when to use them. When you don't really need it, direct pressure is a much better choice. It's important to know when to use a tourniquet and just as important to know when you don't.
     

    2A_Tom

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    I agree with the use of an IBD earlier I referred to it as an IZZY.

    Another that I skipped was pressure points.

    Hopefully there will be others around to help.

    I do not ever believe that I will be working on someone that may be hostile.
     

    VUPDblue

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    IBDs and 4x4s have been my go-to in most shooting situations I have found myself a part of. I carry a TQ on my belt with several more in the car, and two IBDs in my BDU pocket. I have had the very obvious need for a TQ a couple times and, again, it was very obvious that is what was needed. Beyond that, being able to seal wounds to the chest cavity is important and an IBD nor TQ will work for that. I also keep a couple chest seals in my grab-bag, knowing that one will probably be enough to use to seal holes, especially if cut in half, then using the wrapper itself to seal multiples if there are a lot. The knowledge and calm ability to choose the right one, in a situation like that, is arguably more valuable than the gear itself.
     
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