Do you carry a tourniquet when diving?

[FF / EMT]

Perhaps it's Allah's will that we not survive a major bleeding event. As has been pointed out, we always have something that will work as a tourniquet with us. In a half century of diving I've never seen a major bleeding event. I've been around two fatalities and a few near misses, but in every case it was someone's stupidity. Sport diving is an adventure. There is nothing wrong with some danger. I used to sky dive, and never once did I see a medical emergency or need a tourniquet.

Makes you wonder, why skydiving instructors even need Insurnace…

 

[agilis]

Makes you wonder, why skydiving instructors even need Insurnace…

Mostly liability, I'd guess. One jumper hit the ground not far from where I once lived in Ocean County where the soil is mostly sand. He was three feet down, on his stomach. The autopsy was amazing.

 

[DeepSeaExplorer]

I carry a spool and shears and can easily spool off enough line to make a tourniquet.

 

[alexdives]

I think there are medical professionals on this thread thinking one way and people without experience thinking another. I hope everyone realizes a tourniquet is hardly ever necessary. Direct pressure or packing the wound is going to stop, by far, the majority of injuries you are likely to see. Talk to any experienced ER or EMS medical professional about how many times they have had to use a tourniquet and it's a really small number. One of the reasons tourniquet use has become more common is some studies that showed using it for up to 2 hours does not increase the incidence of amputation. Those studies, however assumed a commercial or home made tourniquet of sufficient width. a piece of string, wire etc is going to do serious damage and very much increase those odds. Just thinking about the dive gear everyone has a regulator hose would do less damage, a nylon strap, anything with some width.

 

[Ana]

I'm not a medical professional but I've been in several places where after I left or maybe the following day somebody shot someone. SE Florida is known for many things, friendly and tolerant is not one of them.
So having a well stocked glove box with first aid items takes little to no effort.
Same goes for the boat... we use an inlet also known for having pissy people... I'm not concerned about a shark bite or any diving issue, i have a bottle of O2 for that. Violence in this area is real, I've managed to be in the peripheral of all of it, but I'd be negligent if I don't consider the odds.

Not like i live in fear, just want to be prepared if it is my day in the news.

 

[kinoons]

I think there are medical professionals on this thread thinking one way and people without experience thinking another. I hope everyone realizes a tourniquet is hardly ever necessary. Direct pressure or packing the wound is going to stop, by far, the majority of injuries you are likely to see. Talk to any experienced ER or EMS medical professional about how many times they have had to use a tourniquet and it's a really small number. One of the reasons tourniquet use has become more common is some studies that showed using it for up to 2 hours does not increase the incidence of amputation. Those studies, however assumed a commercial or home made tourniquet of sufficient width. a piece of string, wire etc is going to do serious damage and very much increase those odds. Just thinking about the dive gear everyone has a regulator hose would do less damage, a nylon strap, anything with some width.

It is true that most civilian ERs and EMS rarely see the type of injury that requires a tourniquet. Think farm injuries. The last 20 years in Afghanistan has taught us a lot about tourniquets and blast injuries. Yes some GSWs to the extremity could require a tourniquet, but it’s the exception not the rule.

Thankfully shark attack is exceedingly rare, but that is the type of injury I could see a tourniquet being required.

 

[alexdives]

It is true that most civilian ERs and EMS rarely see the type of injury that requires a tourniquet. Think farm injuries. The last 20 years in Afghanistan has taught us a lot about tourniquets and blast injuries. Yes some GSWs to the extremity could require a tourniquet, but it’s the exception not the rule.

Thankfully shark attack is exceedingly rare, but that is the type of injury I could see a tourniquet being required.

I agree, I'm just concerned someone reading this thread might be a bit overzealous in tourniquet use, particularly the home grown variety that could do real damage. If a shark attack entirely removed a limb it would make sense but we are talking an extremely rare event.

 

[pauldw]

If I really wanted to carry everything imaginable just to be prepared for each and every emergency, I'd bring ECMO. It could perch on my dive flag float, maybe. Or I could instead take what I'm likely to need, and improvise from there, and stop fantasizing about being ready to save the day with every imaginable doo dad. Which brings me to...

Israeli battle dressings. These have always struck me as a holy icon carried by people who also have their chest needles, and whatever else they think marks them as a super duper hero. It's Israeli! What could be more badass? OLAES seems like a much better dressing, though, but still overkill for most personal first aid kits. Maybe for a boat. Those prop injuries can be pretty bad.

The thing about narrow tourniquets is this: Imaging using a piano wire to tighten around someone's extremity. Perhaps that might have a more amputative effect, so to speak, than a blood stopping effect. A wide tourniquet like an overinflated blood pressure cuff isn't going to do that kind of damage. So, somewhere in there is a happy medium. Just never, ever, use a tourniquet to stop bleeding from a head wound!

As for that sacred text, the TCCC, those guidelines are not for outside of combat. They do have some aspects that transfer over, but for heavens sake, read the first page! Or the first pages. Those guidelines are not about definitive care. They aren't about the best prehospital care. They aren't about EMS goals at all. They are about one thing, and it says it right at the beginning: how to get the wounded back in the fight as quickly as possible, and how to free up the rest of the warriors to stay in the fight. That's it. The reason to slap on a tourniquet is not because it has been proven to be the best tool for the job (although for rapid, life threatening hemmorage, it probably is), but because a one handed tourniquet is the fastest way to deal with being shot through an extremity, making it more likely that one can be able to stop worrying about it, and keep firing as soon as possible. After the fight is over, folks can return to normal medical care.

 

[PfcAJ]

Anything skinny like shoelace, paracord, line from a spool, etc, is wholly inappropriate for use as a tourniquet and will almost certainly be ineffective.

 

[PfcAJ]

If I really wanted to carry everything imaginable just to be prepared for each and every emergency, I'd bring ECMO. It could perch on my dive flag float, maybe. Or I could instead take what I'm likely to need, and improvise from there, and stop fantasizing about being ready to save the day with every imaginable doo dad. Which brings me to...

Israeli battle dressings. These have always struck me as a holy icon carried by people who also have their chest needles, and whatever else they think marks them as a super duper hero. It's Israeli! What could be more badass? OLAES seems like a much better dressing, though, but still overkill for most personal first aid kits. Maybe for a boat. Those prop injuries can be pretty bad.

The thing about narrow tourniquets is this: Imaging using a piano wire to tighten around someone's extremity. Perhaps that might have a more amputative effect, so to speak, than a blood stopping effect. A wide tourniquet like an overinflated blood pressure cuff isn't going to do that kind of damage. So, somewhere in there is a happy medium. Just never, ever, use a tourniquet to stop bleeding from a head wound!

As for that sacred text, the TCCC, those guidelines are not for outside of combat. They do have some aspects that transfer over, but for heavens sake, read the first page! Or the first pages. Those guidelines are not about definitive care. They aren't about the best prehospital care. They aren't about EMS goals at all. They are about one thing, and it says it right at the beginning: how to get the wounded back in the fight as quickly as possible, and how to free up the rest of the warriors to stay in the fight. That's it. The reason to slap on a tourniquet is not because it has been proven to be the best tool for the job (although for rapid, life threatening hemmorage, it probably is), but because a one handed tourniquet is the fastest way to deal with being shot through an extremity, and needing to be able to stop worrying about it, and keep firing as soon as possible. After the fight is over, folks can return to normal medical care.

TCCC and current PHTLS guidelines are extremely similar IRT tq use.