Do not use a tourniquet???

[Bennettjh]

I know absolutely nothing medical but I've always thought a tourniquet should be used.

 

[Tanfodude]

The paramedic is hot

Two shark attacks have people on edge in North Carolina - KernGoldenEmpire

 

[Trigger Time]

Carry two

 

[rhino]

I carry this guy (SOF-T) next to the IBD in my cargo pants pocket:



It's pretty easy to apply with one hand. If you have to use it on yourself, that could be very important.

 

[JeremiahJohnson]

I carry this guy (SOF-T) next to the IBD in my cargo pants pocket:

View attachment 39309

It's pretty easy to apply with one hand. If you have to use it on yourself, that could be very important.

Same one in my go bag! Good rig!

 

[Reno316]

Not a medic here.

My understanding is that a tourniquet pretty much guarantees the loss of a limb because of the severe nerve and tissue damage they cause by cutting off all blood flow. They should only be used when direct pressure has no chance to stop bleeding and severe blood loss poses a risk of death.

They are basically a last resort.

First: I do not mean any disrespect.
Second: My bona fides... 15 years as a paramedic, 9-1-1 in inner city Atlanta and Critical Care Flight Medic in Arizona.

Your information/understanding is not quite accurate. A tourniquet, when properly applied and patient is promptly evacuated to a surgeon, is a acceptable medical treatment for severe arterial bleeding (spurting across the room type bleeding) or extensive and continuous venous bleeding. Mind you, they are not for the "cut my finger on a pocket knife, and it's seeping a little bit" type of injury.


The anecdotal evidence of them causing loss of limb stems from, believe it or not, US Civil War. Battlefield injuries would get a tourniquet to the affected extremity, then the patient would be stacked up along with dozens or hundreds others, waiting days to have a surgeon treat them. And, given the state of medicine in the 1860s, it was unsurprising that the end result of this would be the loss of a limb.

Dr. John Kragh, US Army Institute of Surgical Research, has done some pretty extensive data on tourniquets. To the best of my knowledge, none of the studies he's done show negative outcomes to tourniquet use.

Some "light" reading if you wish:

Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma; Journal of Trauma-Injury Infection & Critical Care:
February 2008. Kragh, et al


Prehospital Tourniquet Use in Operation Iraqi Freedom: Effect on Hemorrhage Control and Outcomes; Journal of Trauma-Injury Infection & Critical Care:
February 2008. Beekley, et al


Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma; Annals of Surgery
January 2009. Kragh, et al


Battle Casualty Survival with Emergency Tourniquet Use to Stop Limb Bleeding; Journal of Emergency Medicine.
December 2011. Kragh, et al.


I have a tourniquet in my range bag. Wouldn't go shooting without it.

 

[NathanJefferson]

I asked my neighbor who is an ER doctor - who cut his teeth in rice paddys - and he agreed with what I've heard in training sessions from Patriot Nurse and Wetsu: There might be a small percentage of times a tourniquet is not the right course of action, but the number of times it will help more than hurt makes it the best course of action in pretty much every instance you think it might be necessary. IMHO and not to be taken as advice, I'd rather have the chance of having an amputation after having a tourniquet on for HOURS (it takes several hours of application to cause cell death from my understanding) than bleed to death in minutes...

 

[mbills2223]

Wowza...way out of that 911 operators scope to offer advice like that

 

[SMiller]

TACMED™ ANKLE MEDICAL KIT is my go to for EDC, throw some gloves and other supplies in it as well.

SOF® Tactical Tourniquet is in that kit, also have one in my BUG as well as BOB.

Not pushing the product, in all the research I did it seemed the best of what is available.

Ancle carrying a G43 (as a BUG) on one ancle and a ankle med kit on the other ancle works out pretty well (balances out).

 

[FreeFAL]

Incorrect. Tourniquets are viable, and the extremity can be too after their use if done correctly. That said usually tourniquets are applied in the absence of major bleeding. People show up to my shock room all the time not bleeding with loose tourniquets. Even with amputations, the artery will often spasm down. Warm the patient up, restore his blood volume and the artery will eventually start bleeding again.

Qualifications: Chief resident for trauma surgery, Methodist and Eskenazi.

Not a medic here.

My understanding is that a tourniquet pretty much guarantees the loss of a limb because of the severe nerve and tissue damage they cause by cutting off all blood flow. They should only be used when direct pressure has no chance to stop bleeding and severe blood loss poses a risk of death.

They are basically a last resort.

Considering that both shark attack victims ended up losing limbs anyway, a tourniquet was probably the right call. Because the dispatcher was not there, they were likely being cautious.

 

[FreeFAL]

I asked my neighbor who is an ER doctor - who cut his teeth in rice paddys - and he agreed with what I've heard in training sessions from Patriot Nurse and Wetsu: There might be a small percentage of times a tourniquet is not the right course of action, but the number of times it will help more than hurt makes it the best course of action in pretty much every instance you think it might be necessary. IMHO and not to be taken as advice, I'd rather have the chance of having an amputation after having a tourniquet on for HOURS (it takes several hours of application to cause cell death from my understanding) than bleed to death in minutes...

In my experience, you are better off not asking docs questions outside their field of expertise. He can't fix the problem? Then he doesn't know when to use that tourniquet or not-- or the real kicker, which is how longtime keep it applied without reperfusing.

 

[The Bubba Effect]

Incorrect. Tourniquets are viable, and the extremity can be too after their use if done correctly. That said usually tourniquets are applied in the absence of major bleeding. People show up to my shock room all the time not bleeding with loose tourniquets. Even with amputations, the artery will often spasm down. Warm the patient up, restore his blood volume and the artery will eventually start bleeding again.

Qualifications: Chief resident for trauma surgery, Methodist and Eskenazi.

If I encounter an amputation that is not bleeding, should I put a tourniquet on it anyway? My concern is that something might change and bleeding might start, then any action might be too little too late. Am I really risking anything by putting a (properly applied) tourniquet on an amputation, even if it is not bleeding?).

Qualifications: Uneducated hillbilly making the most of the free professional knowledge on INGO

 

[SMiller]

If I encounter an amputation that is not bleeding, should I put a tourniquet on it anyway? My concern is that something might change and bleeding might start, then any action might be too little too late. Am I really risking anything by putting a (properly applied) tourniquet on an amputation, even if it is not bleeding?).

Qualifications: Uneducated hillbilly making the most of the free professional knowledge on INGO

If blood isn't shooting across the room there is no need...

There are other things that could be done that would be a better use of time.

 

[Reno316]

If I encounter an amputation that is not bleeding, should I put a tourniquet on it anyway?

Why would you? The point of applying a tourniquet is to stop massive, life-threatening hemorrhage.

If they are not bleeding, then there's nothing for the tourniquet to stop, is there?

Don't over-think things...

 

[freekforge]

I bet the dispatcher hasn't stayed on top of emergency medical science. Up until very recently tournequets were frowned upon by civilians because they think if it on for five minutes stuff starts to die. It wasn't until recently with the wars that it was proved that you can actually safely use them. Even when its a textbook case too many people are scared to use them.

 

[mbills2223]

I bet the dispatcher hasn't stayed on top of emergency medical science. Up until very recently tournequets were frowned upon by civilians because they think if it on for five minutes stuff starts to die. It wasn't until recently with the wars that it was proved that you can actually safely use them. Even when its a textbook case too many people are scared to use them.

I think the dispatcher also probably was totally clueless as to the nature of the wound (and as a result probably shouldn't have stepped out of his scope of practice to provide faulty advice).

 

[in_betts]

First I would like to say "Great Thread" as this is a topic where everything from wives-tales to comparing an urban ER or dangerous industrial accident frequency scenario often gets confused with the guy who stubbed his toe and has seven drops a minute coming from the disgorged nail. Yes the disgorged nail hurts like hell but he won't die from blood loss.

Knowledge Base: just the average guy who has a brain and taken the Red Cross / Industrial Safety / Gunshot Wound type classes from everything between dip-noggle and awesome real world experience instructors.

I claim to know nothing but firmly believe I will always act to the best of my ability and hope the Good Samaritan laws will cover me if my teaching is outdated. Thanks for all those with depth of knowledge chiming in.

 

[CavMedic]

As a Combat Medic and someone who works on an Ambulance now, I can say this, ALWAYS use a TQ to stop any large amount of extremity bleeding. Whether it is arterial or not. One way or another all bleeding stops, lets stop it under our terms. The damage to the limb is minimal compared to the threat of loss of life. If you are concerned about damage the TQ can be left on for 6-8 hours before muscle death becomes a concern, and hopefully by that time that are in a surgery suite.

Edt: The dispatchers are often bound and restricted to going off of cards that tell them what to do. Most of the time they are not trained in EMS by preference so they do not add anything that can further complicate the run. I can't blame dispatch on this.

 

[CountryBoy19]

I carry this guy (SOF-T) next to the IBD in my cargo pants pocket:

View attachment 39309

It's pretty easy to apply with one hand. If you have to use it on yourself, that could be very important.

Not trying to be nit-picky, just want to clarify so people buy the TQ they think they are buying: that is a SOF-TTW, which is the one with a quick-disconnect buckle. The SOF-T is the older version that does not have the quick disconnect buckle...

 

[rhino]

Not trying to be nit-picky, just want to clarify so people buy the TQ they think they are buying: that is a SOF-TTW, which is the one with a quick-disconnect buckle. The SOF-T is the older version that does not have the quick disconnect buckle...

Sorry for the inaccuracy! Mine has the quick disconnect buckle.