Do you carry a tourniquet when diving?

[FF / EMT]

No, you really can't.

Cool

Ischemia is the point of a tourniquet.

Compartment syndrome is completely different and not related to tourniquet application in field use at your level of function.

sure

I feel much better knowing both of these things.

 

[Zach The Diver]

I guess I did not elaborate enough. This thread went from having a tourniquet in the first place to applying it underwater. I find it hard to imagine what would warrant such an action.
By all means have it topside, but all this have it at all times on you is over the top.

You like sound of your voice, don't you?
What do you know, minimum target width for a tourniquet is 1.5 inches.......the same width of webbing my jon line is made out of. But you just made an assumption of what I use as a jon line.
Do you carry de-fib on your dive? I mean, it's recommended by science as best thing to get your heart pumping again if it stops.
Look what I said above.

No need for that tone in what was supposed to be a simple discussion.

My bad if I misinterpreted but when I hear things like “make a windlass with my light and secure it with john line” my instinct is to believe that you have no other alternative in the moment (I.e. you’re underwater with no actual tourniquet), because quite frankly that’s a terrible idea.

If you read the whole thread you’ll find that this whole discussion started with the topic of carrying a tourniquet underwater, so it’s not an imaginative leap to consider that’s what you were referring to.

 

[Scott G. Bonser]

Having the tourniquet is a good start but having it in a properly deployable setup, especially for self application is important and the. Having the training to use it is key. It’s one thing to slap it on and start cranking. When do you stop? When the patient cries out in pain? Nope keep going.

You can train it on yourself. Start with you non dominant arm. Get it high and tight near the shoulder. Start cranking that thing. When it starts to hurt your getting close but you’ll have a few more cranks to go before you lock it down. Test for a lack of distal pulse.

Had a partner apply one last week to a lady who ran her own leg over. He started cranking down on it as she started to cry out. I just told her, “Ma’am, this is going to hurt. It’s part of it working.” She stopped crying out after that. Like it was a reassurance that it was supposed to do that.

No need to overthink a tourniquet. I’ve made a field tourniquet for an Iraqi civilian using material cut from his pant leg and and a 4” bolt. It served its purpose although I didn’t have enough material to tie of the windlass so I had his buddy hold it.

The commercial tourniquets are nice and are affordable for any first aid kit. 40 years ago in the Boy Scouts the teaching was only use a tourniquet as a last resort when it was likely the patient would lose the limb. Now, medical science has adapted and they can be properly applied without regard for loss of limb. At least when there is reasonable access to Modern medical care.

On a dive boat one could easily improvise a tourniquet from some trousers and a screwdriver, dive light, closed pocket knife, or even a save a dive multitool for the windlass.

One ‘perspective’ I applaud from this response IS. Talk to your patient. Gain their trust. It keeps them focused on ‘helping you help them’ instead of the predicament and pain they are experiencing….

 

[Zach The Diver]

Or if you're operating covertly, and unable to exfil exigently.

Or if you're sailing or yachting.

Off if you're somewhere remote, say Midway or Kwaj.

Yeah, sure.

These are specific situations that require intensive contingency planning. Not the norm for the vast majority of divers.

 

[Zach The Diver]

that'll just add judgement points lay people don't need. they need to take the appropriate action without hesitation or debate.

You're on the slippery slope of knowledge vs action, I'm not teaching Andy Idiot about randomness in a stop the bleed, first aid, or similar OEC type curriculum. I'm also opposed to CT and MRI at the racetrack.

Appropriate action that isn’t informed becomes inappropriate action. I think your analogy is a bit hyperbolic.

You don’t need to inundate someone with hyper-specific information (a boat captain doesn’t need to know about acidosis and how it pertains to massive hemorrhage, for instance), but something as simple as “if you stack tourniquets, don’t leave a gap or that can hurt someone” is unlikely to breed hesitation.

 

[Allen-1]

I’m all about tourniquets too and wish civilian medical courses were less gunshy about them. They’ve saved thousands of lives in the military over the last 20+ years. I’ve seen them go quite literally from a last resort to a first resort for major bleeding. They take a bit of training but damn they work. If you spend a couple hours with a professional learning the nuance to them.

Local gun range may be a decent educational source. A couple of the clubs that I've belonged to schedule trauma courses somewhat regularly. The focus, as would be expected, is dealing with gunshot wounds - but the goals appear to be the same - render first aid until more qualified personnel can take over.

Tourniquet usage is included in the class because all too often the wound is in an extremity.

And - yes - I do carry a trauma kit including tourniquet with me on the range; second trauma kit and "booboo" kit live in the truck.

ETA - hadn't given any thought to carrying kit while diving. Interesting discussion.

 

[Scott G. Bonser]

Appropriate action that isn’t informed becomes inappropriate action. I think your analogy is a bit hyperbolic.

You don’t need to inundate someone with hyper-specific information (a boat captain doesn’t need to know about acidosis and how it pertains to massive hemorrhage, for instance), but something as simple as “if you stack tourniquets, don’t leave a gap or that can hurt someone” is unlikely to breed hesitation.

Y’know, folks, every post and response from this thread is ‘valid’ in many ways for various reasons. Acute attention to the ‘what if’s’ are amazing. The major ‘takeaway’ I believe would be IMHO, is…… (drum roll, please) …if faced with such a situation, without warning, what would YOU do with pre-prepared items or whatever was at your disposal…and to add THIS…. ‘Without hesitation’. Not everyone can perform First Aid in such a severe situation. It has to be done. One day you may be faced with possibility of ‘self-rescue’ …would you know what to do?? …off of the subject. I was alone in my kitchen and choked on a piece of food. ….no one to signal to get Heimlich help from. I was the ONLY one at home. Pick up phone for a text??or was I going to pass out and ‘croak’ in my kitchen and reek for days until I was discovered or…..was I going to live?? Incidentally Score: Life 1…. .. Z E R O…. I won this battle with the help of a bar stool with a ‘back. Not the finest of Heimlich gear but it WORKS. It took quite a few thrusts….. My mantra is ‘Don’t Give Up’ I believe YOURS should be the same….Touche’ my SB friends

 

[Waterwulf]

I guess I did not elaborate enough. This thread went from having a tourniquet in the first place to applying it underwater. I find it hard to imagine what would warrant such an action.
By all means have it topside, but all this have it at all times on you is over the top.

You like sound of your voice, don't you?
What do you know, minimum target width for a tourniquet is 1.5 inches.......the same width of webbing my jon line is made out of. But you just made an assumption of what I use as a jon line.
Do you carry de-fib on your dive? I mean, it's recommended by science as best thing to get your heart pumping again if it stops.
Look what I said above.

There are many situations where a diver might be required to apply a tourniquet in the water or under it. The chances of any sport diver being placed in any of those situations is slim but not impossible. However, to deny those possibilities is denying reality. Getting a deep cut from a piece of sharp debris, a line loop snap taking off a hand, a wildlife attack, etc. are all realistic possibilities that can happen underwater and require the use of a tourniquet. Have you ever in your life watched somebody bleed out?

No, I don't carry a defib or a rescue helicopter or a Parajumper in my gear. The trick is to evaluate your current situation and make realistic choices as you what gear you will carry. I don't carry my tourniquet or my RBFK (That's R for really) for pool work but I won't dive in wild water without them. If you don't want to carry it, then don't! Hopefully somebody else will have one if you have an accident.

 

[wlecyt40]

Really? We've taught direct pressure with elevation to tourniquets for 15 years. Must be fat old lazy EMT's who only know the way they learned it in school.

Well...... this old paramedic has been using them during my career. The National Registry of Emergency Medical Technicians has changed their instruction and added it back in. Evidence based research has shown that tourniquets are actually saving life and limb. Much of this evidence is coming from forward deployed military medical personnel and what they are seeing from their uses. As a paramedic with over 18 years of practice and a combat lifesaver with the US Army for 21 years, I have used them and seen them work. Our protocols for practice were updated by our medical director to include them as well medications that assist in clotting and controlling bleeding. I have two in my personal medic kit that I take when we have training and are teaching student divers. I have never had to use them (thankfully!) but I have them. Better to have and not need then need and not have.....

 

[rmorgan]

I haven't waded through this whole thread, but I searched it for mention of this device and found none--so here it is. Combat Application Tourniquet (C-A-T)