Tourniquet discussion

[stimpy4242]

Discussion here:
http://www.scubaboard.com/forums/pu...6-ifak-diving-ffs-medics-drs.html#post5392297

Would like to hear more professional oppinions.

 

[TSandM]

Tourniquet use is discouraged, because of complications. This is in a civilian setting, however, where definitive care is expected to be available in short order. Direct pressure to the bleeding site is a far better way to control most extremity bleeding than a tourniquet; however, in the event of a limb amputation, and especially if I were a single rescuer with other responsibilities as well, I'd have no hesitation to place a tourniquet to limit blood loss.

As with so many other things in life, one has to consider the entire situation. Can the bleeding be controlled another way? Are there enough people present to do everything that needs to be done? How much blood is the patient losing? Are there other injuries that are more life-threatening? How far away is definitive care? A tourniquet is something in your toolbox, but it shouldn't be something that is often used.

 

[Cave Diver]

Discussion here:
http://www.scubaboard.com/forums/pu...6-ifak-diving-ffs-medics-drs.html#post5392297

Would like to hear more professional oppinions.

I'm not a professional but have taken a lot of first aid, emergency response, etc. classes for various personal reasons. The last one I did covered light search and rescue and field triage following a disaster.

The use of tourniquets was mentioned and it was considered a last resort after bandage and pressure points fail. If it has to be used, it is only to be removed by an emergency physician and the victim should be marked ("T" on the forehead) to alert professionals that a victim has a tourniquet applied.

 

[billsreef]

In any first aid course I've taken that covers tourniquet use, it's always been a last resort of "life or limb".

 

[tc]

Heart Association is looking at modification of the first aid procedures for their 2010 consensus standards to include earlier use of tourniquets.

This page- First Aid Worksheets

Has a number of papers on the topic, look in the "Bleeding" section of the table.

(Note- I believe the public comment period is over- the recommendations are scheduled to be published in October)

 

[tracydr]

Sounds like you did very well in those ATLS classes, TsandM! The first time I took it I failed a prtion because I couldn't figure out I wasn't splinting my patient's leg instead of using the tourniquet. Kept on bleeding, I finally knew it was the wrong answer but said "I'm going to apply a tourniquet".
The instructor says "your patient just lost her leg".
The Army still teaches tourniquets in all they're trauma classes, including buddy first aid and Medic expert field medical. I guess they have so many near or full amputations from explosive devices that it still makes sense.
Had my first ATLS through the Army while an intern and also taught my medics EFMB and EMT classes.
Great question from OP and answer from TsandM!

 

[huzenhagen]

Tourniquets for hemorrhage control on the battlefi... [J Trauma. 2003] - PubMed result

A study done by the israeli army showing that from 91 applications there were 5 complcations with no loss of limb and the tourniquet had to be on for a minimum of 108minutes for ischaemic injury to be detected. I think the danger from tourniquets can be overstated and in any case save the life then worry about the limb but buy a proper one. If your worried about trauma there's a lot worse you can do then look to the military, in many ways they are light-years ahead of the civ side.