What if you get shot??

[2A_Tom]

It is funny that my training was in 1973. Apply the tourniquet until the flow is staunched and do not release it. I have evolved to adding the time.

 

[rhino]

Really? I have yet to find a trauma doctor here in Indy to say anything negative about them. Many taught our 1700 officers about them when they were issued their gunshot trauma kits. We've had members of our SWAT team use them on themselves after being shot. We've used them on many citizens in the field with great success.

You kind of answered your own question. "Trauma doctors" are a small part of the community of medical professionals. There are plenty of MDs, DOs, and RNs whose first reaction is never going to be tourniquet because it's contrary to their training and their emergency medicine paradigm. A dermatologist or an internal med specialist is going to seek continuing ed in their specialty, but why would they also seek updates in trauma medicine or emergency medicine. They may never be in a situation where a tourniquet is an appropriate tool, but that won't stop some of them from discouraging a non-medical professional who raises the subject. The example cited to which my message was a response is evidence of that.

 

[Jackson]

Speaking from the perspective of the layman, isn't a tourniquet one of those things where, when you actually need one, nothing else will do? Your options are bleed out or tourniquet.

So the real argument is whether they should be applied first or last in the procedure to stop blood loss. This is probably hard to determine with a high degree certainty without real field experience. Because I don't have that experience I have to error on the side of "most likely to survive". If it looks like a life-threatening flow... Tourniquet. If I understand correctly, the military takes a similar approach to training the average soldier. If so, I'm assuming the reasons are similar.

As for whether I carry a med kit, I don't keep one on my person. I keep a few things in my car and my range bag. They probably need to be refreshed.

 

[Double T]

You kind of answered your own question. "Trauma doctors" are a small part of the community of medical professionals. There are plenty of MDs, DOs, and RNs whose first reaction is never going to be tourniquet because it's contrary to their training and their emergency medicine paradigm. A dermatologist or an internal med specialist is going to seek continuing ed in their specialty, but why would they also seek updates in trauma medicine or emergency medicine. They may never be in a situation where a tourniquet is an appropriate tool, but that won't stop some of them from discouraging a non-medical professional who raises the subject. The example cited to which my message was a response is evidence of that.

This isn't entirely correct, while I can't talk to all nursing schools, I recently graduated RN school and tourniquet use wasn't discouraged. I'd have to dig out the text books, but I do believe tourniquets weren't the primary device for bleeders, except spurters and when direct pressure isn't working. This has come a long way since I graduated with my PN in 05 when TQ use WAS discouraged. Looking through some of the association(s) materials, info is sparse.

The whole "ABC" think comes to mind, and with hemorrhage, I think it's a misnomer as it's not really a circulatory issue but a perfusion issue. I digress though.

 

[2A_Tom]

Direct pressure is always the first line of defense. When the bleeding cannot be staunched any other way the tourniquet is literally the necessary choice.

If you do not have one it is most likely too late.

 

[rhino]

Speaking from the perspective of the layman, isn't a tourniquet one of those things where, when you actually need one, nothing else will do? Your options are bleed out or tourniquet.

So the real argument is whether they should be applied first or last in the procedure to stop blood loss. This is probably hard to determine with a high degree certainty without real field experience. Because I don't have that experience I have to error on the side of "most likely to survive". If it looks like a life-threatening flow... Tourniquet. If I understand correctly, the military takes a similar approach to training the average soldier. If so, I'm assuming the reasons are similar.

As for whether I carry a med kit, I don't keep one on my person. I keep a few things in my car and my range bag. They probably need to be refreshed.

I think whether it's a first resort or a last resort depends on the circumstances beyond the wound. Do you have time and two hands to try other measures first? Or are you on the ground with one hand injured and arterial spray coming out of your leg? Or something in between. It's tough to choose a non-diagnostic approach to this.

 

[rhino]

This isn't entirely correct, while I can't talk to all nursing schools, I recently graduated RN school and tourniquet use wasn't discouraged. I'd have to dig out the text books, but I do believe tourniquets weren't the primary device for bleeders, except spurters and when direct pressure isn't working. This has come a long way since I graduated with my PN in 05 when TQ use WAS discouraged. Looking through some of the association(s) materials, info is sparse.

The whole "ABC" think comes to mind, and with hemorrhage, I think it's a misnomer as it's not really a circulatory issue but a perfusion issue. I digress though.

Your response . . . "recently" graduated. That's a huge factor. Your training materials were (hopefully) up to date. Again, I didn't say "all" I said "plenty" for a reason. A lot more doctors and nurses got their emergency med training NOT recently than who did recently. Among them are people who are going to cling to (tourniquet = loss of limb) indefinitely and they're going to keep telling/teaching other people based on their training biases.

Send some emails to non-ER/trauma nurses and docs who have been out of school for 20 years in different parts of the country and ask them about tourniquet use. It's going to be a couple of generations before everyone is on the same page and by that time, the practices will probably have changed again. I'm not sure why people are finding it hard to believe that not everyone in the medical community is 100% on-board with tourniquet use in the field. It's easy to find examples (like in the comments in a previous message) that show there are working medical professionals who really believe that applying a tourniquet guarantees eventual loss of the limb.

 

[rhino]

Direct pressure is always the first line of defense. When the bleeding cannot be staunched any other way the tourniquet is literally the necessary choice.

If you do not have one it is most likely too late.

Agreed. Even if you realize right away that a tourniquet is needed, if it's possible someone should apply pressure as you're getting the TQ applied properly.

 

[Jackson]

I think whether it's a first resort or a last resort depends on the circumstances beyond the wound. Do you have time and two hands to try other measures first? Or are you on the ground with one hand injured and arterial spray coming out of your leg? Or something in between. It's tough to choose a non-diagnostic approach to this.

Right. I'm not looking for a completely nondiagnostic approach. But as someone with no real experience with life-threatening wounds, my ability to diagnose is more limited. I have to break things down in to bigger categories: squirting, gushing, part of limb missing, feel I may lose consciousness.... maybe it's TQ time; paper cut, clean hole with minimal blood or a bit of an ooze, superficial slashed/gashes... pressure. If I'm on the fence between the two I think go TQ first is the way.

I post these things not because I think they are the way, but so you people who are smarter than me can tell me if this approach is going to cause me problems.

 

[VERT]

I keep telling my corporate safety director that for things like paper cuts and dog bites the TQ goes on tight just under the chin.

 

[rimfireOH]

My recent "first aid" training has largely been through the Boy Scouts these days, specifically their wilderness first aid courses, and they have come around to using TQ again. Maybe the pendulum will swing back the other way some day, but at the moment, that's what they're teaching.

I don't yet have one in my kit or my range back. Perhaps it's time for me to reconsider that deficiency.

 

[IndyDave1776]

I can't believe that no one thought of the obvious and immediate answer to the original question: You are going to hurt like a son of a b***h.

 

[Jackson]

I can't believe that no one thought of the obvious and immediate answer to the original question: You are going to hurt like a son of a b***h.

There's definitely that. I actually just hope I can keep it together mentally. I'm generally ok when others get injured but when I'm looking at my own injuries I tend to freak out a little. Light headed, panic, etc. That was my first thought. But who wants to admit that on the internet?

 

[rhino]

Right. I'm not looking for a completely nondiagnostic approach. But as someone with no real experience with life-threatening wounds, my ability to diagnose is more limited. I have to break things down in to bigger categories: squirting, gushing, part of limb missing, feel I may lose consciousness.... maybe it's TQ time; paper cut, clean hole with minimal blood or a bit of an ooze, superficial slashed/gashes... pressure. If I'm on the fence between the two I think go TQ first is the way.

I post these things not because I think they are the way, but so you people who are smarter than me can tell me if this approach is going to cause me problems.

In that case, I'll step aside on this issue since I am not qualified!

 

[rhino]

I can't believe that no one thought of the obvious and immediate answer to the original question: You are going to hurt like a son of a b***h.

. . . except when they don't!

Sometimes people don't realize they are shot for quite a while!

 

[Jackson]

In that case, I'll step aside on this issue since I am not qualified!

Not so, sir. Not so. I'm happy to be corrected by the rhino.

 

[2A_Tom]

Mindset. I hope that some of the mental gymnastics that I practice will help me to stay in the fight.

I do know that the many times that I have been injured, a couple of bad ones, I've kept my head and been able to preform first aid on myself. Only a couple times (since adulthood) have I gone to the emergency room.

The one time I have been under fire I ran to the aid if a person who was down.

I hope that I will react the way I plan.

 

[rhino]

Mindset. I hope that some of the mental gymnastics that I practice will help me to stay in the fight.

I do know that the many times that I have been injured, a couple of bad ones, I've kept my head and been able to preform first aid on myself. Only a couple times (since adulthood) have I gone to the emergency room.

The one time I have been under fire I ran to the aid if a person who was down.

I hope that I will react the way I plan.

Those are some very important points to consider and closely related to how you would react to any kind of emergency.

In my opinion, I think learning and practicing skills until you are confident that you can perform them at will helps overall confidence in how you will react. More important, I think the act of deciding how you want to react can play a huge role, especially if you reinforce your decision over time.

I've been tested by several medical emergencies (some that did not involve my own bleeding!) and in each case, I was way more calm and methodical than I normally am. I don't know why it happens, but so far it has happened every time. It might be how I react to a sudden release of epinephrine or it might be conditioning or it might just be a weird personality quirk. I've found people have seizures, collapsed on the ground and unable to move, passed out from low blood sugar (confirmed after the fact in each case, but learned to suspect it), etc. Each time my brain just started ticking off the list of things I needed to do, check, and then what to do next.

 

[Jackson]

I find when it is someone else I tend to downplay the severity... Oh, no big deal. I've seen this on TV and they were fine.

When it's me I assume death is imminent and freak out a little. I'm a pansy in that way.

 

[rhino]

I find when it is someone else I tend to downplay the severity... Oh, no big deal. I've seen this on TV and they were fine.

When it's me I assume death is imminent and freak out a little. I'm a pansy on that way.

Maybe I'm just so used to seeing my own blood that it doesn't bother me anymore?

The Boss of Me (aka SWMBO = She Who Must Be Obeyed) still teases me about what I said to her on the phone when I realized I cut leg. "I have to go." She reminds me that I was so calm when I said that she knew something was wrong. HAHA!