Who here carries a Tourniquet?

[toddnjoyce]

.. TQ placement in the prehospital environment happens pretty regularly.

Uh, if that’s the case, there’s some serious reconsideration that needs to occur.

ETA: allow me to expound; tourniquet use is only indicated in when a vascular bleed is present. Even then, direct pressure is likely to be as effective in most cases. Having said that, there was study done here in Texas a few years ago on tourniquet use. The cohort was vascular bleed patients, so a small group and something like 1 in 6 of that group was treated with tourniquet by a first responder. Of that smaller group, a larger percent survived.

What was as important, if not more so, was the time it took to stop the bleed. The quicker someone started to stop the bleed with an effective method the more likely a patient was to survive.

 

[innominate]

The thing with the tourniquet for me is training. Does everyone that carries one have training in how to use it? I can understand why a first responder etc would carry one. I will say I've never been trained in the use of one. But I can extrapolate that is more than just simply putting it on and twisting. I could see how one would not apply enough pressure to stop the bleeding. For it to stop bleeding it is going to be painful to the pt. Would someone without training know to keep twisting once the pt starts yelling "it hurts! "? I have no training in tourniquet use but we puncture femoral arteries everyday. It's easy to control the bleeding when you have something to press against. In our case it's the center of the femoral head. Above the femoral head is the abdominal cavity, below the artery moves away from the femur. That tourniquet is going to have to be very tight around a thigh to stop bleeding. But, all bleeding eventually stops. Just my 2c

 

[BandAidPro]

Uh, if that’s the case, there’s some serious reconsideration that needs to occur.

"Pretty regularly" is a very vague term so perhaps I should have been more clear.... we might place a TQ once for every 1000-2000 calls (just a guesstimate), as opposed to something like a surgical crike, which most of us will probably never do in our entire careers.

 

[msharley]

Hey TGT,

Don't have...hope to never really need one...

Do know some folk...........if they wuz to cut they selves shavin'?

Be glad to apply a TQ to they fool NECK! (or is that PIANO WIRE? I get confused)....

Later, Mark

 

[toddnjoyce]

The thing with the tourniquet for me is training. Does everyone that carries one have training in how to use it?

Background: SABC, Army CLS, Wilderness First Responder, TCCC. Except for driving an IV, it’s all basic first aid, CPR, AED stuff.

The CATs I’ve come across simply say apply above injury, twist until tight, secure windlass. How a CAT is designed makes it easy to have not enough pressure than too much. Whether it’s a CAT or
Quicklot/Israeli bandage to me, is a judgement call. I’d rather use a CAT on a vascular bleed.

 

[candcallen]

Hey TGT,

Don't have...hope to never really need one...

Do know some folk...........if they wuz to cut they selves shavin'?

Be glad to apply a TQ to they fool NECK! (or is that PIANO WIRE? I get confused)....

Later, Mark

That's what the arrogance of the Dr seems to be implying.

 

[msharley]

That's what the arrogance of the Dr seems to be implying.

Sumpin' like this?

 

[toddnjoyce]

"Pretty regularly" is a very vague term so perhaps I should have been more clear.... we might place a TQ once for every 1000-2000 calls (just a guesstimate), as opposed to something like a surgical crike, which most of us will probably never do in our entire careers.

No worries, this is a conversation that pops up pretty regularly. I have a unique .mil background and challenge some stuff that gets carried over in the .civ environment and CAT usage is one of them. For 8 of my 24 years, I went OTW with a CAT on each upper extremity two on each lower because we trained against an lED strike with an emphasis to stop the bleed on am amputation while trying to salvage enough limb to keep people in the service.

I’m passionate about the subject.

 

[innominate]

Background: SABC, Army CLS, Wilderness First Responder, TCCC. Except for driving an IV, it’s all basic first aid, CPR, AED stuff.

The CATs I’ve come across simply say apply above injury, twist until tight, secure windlass. How a CAT is designed makes it easy to have not enough pressure than too much. Whether it’s a CAT or
Quicklot/Israeli bandage to me, is a judgement call. I’d rather use a CAT on a vascular bleed.

Yeah. I probably should have said, would someone with no training be able to use a tourniquet effectively? It takes me a second to collect my thoughts after a couple vodaks.

 

[andre3k]

Yeah. I probably should have said, would someone with no training be able to use a tourniquet effectively? It takes me a second to collect my thoughts after a couple vodaks.

Could they figure it out? Probably. But you shouldn't be figuring it out while the person you want to help is bleeding out. The most common issue I see is people not cranking down on that windlass until the blood flow stops.

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[cycleguy2300]

ABC---airway, breathing,circulation.
Take care of those 3 things in order and you will make a difference!
#1 your safety first, don't become a victim.

Bleeding first.

ABC was an easy acronym for folks to remember, but misorders the steps, which for smaller stuff isnt a big deal, but it causes problems with more major bleeding

MARCH is current training and stands for:
- Massive bleeding
- Airway management
- Respiration
- Circulation
- Head injury and Hypothermia

CPR on a causality that has/is bled out is pointless. Stop the big bleeding first, then get airway.

Training and practice is key.
I am doing a IFAK for each of my sibling's and inlaw's and for my parents since we all do a bit of shooting and may roll up on a bad crash etc... It has TQ, chest seals pressure bandage, combat gauze, gloves, shears and the folks who have the training are getting a decomp needle and a nose tube. My brother also has combat first aid training, so I got a blue training CAT TQ (same as the real ones, just blue so you can know its been used and can't be relied on for a real bleed) so we can put folks through some MARCH reps.

This is a link to the Army document I took the screenshot of: https://www.google.com/url?q=https:...8QFnoECAoQAg&usg=AOvVaw1u4c3v3OW9mZM4qpzu3dkg

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[1911'S 4 Me]

I hear you, but what are your credentials and background to assert this?

How many actual "limbs & lives" have you actually seen "saved" by tourniquets in the civilian world ?

I spent some 12 years on Emergency Trauma services & over 35 years on Vascular Interventional services at some very large hospitals like Charity, Ben Taub, Jeff Davis, LBJ, Hermann Memorial, Saint Luke's, The Methodist, Saint David's, Midland Memorial, Valley Regional, John Sealy, Brook Army, & UMC New Orleans, etc; and haven't seen ONE !

And, in many of those places, I was the guy they called to stop "uncontrollable" bleeding!

leVieux

Didn't stay in one place long did you.

 

[innominate]

Bleeding first.

ABC was an easy acronym for folks to remember, but misorders the steps, which for smaller stuff isnt a big deal, but it causes problems with more major bleeding

MARCH is current training and stands for:
- Massive bleeding
- Airway management
- Respiration
- Circulation
- Head injury and Hypothermia

CPR on a causality that has/is bled out is pointless. Stop the big bleeding first, then get airway.

Training and practice is key.
I am doing a IFAK for each of my sibling's and inlaw's and for my parents since we all do a bit of shooting and may roll up on a bad crash etc... It has TQ, chest seals pressure bandage, combat gauze, gloves, shears and the folks who have the training are getting a decomp needle and a nose tube. My brother also has combat first aid training, so I got a blue training CAT TQ (same as the real ones, just blue so you can know its been used and can't be relied on for a real bleed) so we can put folks through some MARCH reps.

This is a link to the Army document I took the screenshot of: https://www.google.com/url?q=https:...8QFnoECAoQAg&usg=AOvVaw1u4c3v3OW9mZM4qpzu3dkg

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I'm assuming ABC stays because of BLS training. Guess the thinking is most people are going to walk up or witness a MI,CVA, seizure or choking situation.

 

[cycleguy2300]

I'm assuming ABC stays because of BLS training. Guess the thinking is most people are going to walk up or witness a MI,CVA, seizure or choking situation.

I'm sure thays what the idea behind ABC, that and it is short and sweet to remember.

I'm not going to do a full body rake with my fingertips to check for penetrating trauma if someone gags and falls out at a steak house... but it pays to pay attention, they may have fell onto their steak knife and lacerated an artery too.

For many things ABC works OK but the fact is it is a bad habit when compared to MARCH and leaves holes in the response while they may be less common can lead to critical problems if things are missed.

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[candcallen]

As stated I was BLS instructor and while ABC is a starting point it was never for me scripture cause in my experience the obvious is priority. Arterial bleeding is always trumps airway and I've seen guys with a dozen or more stab wounds to organs easily get to the er and live.

Airway always came after or along with the others.

Infact the new CPR methods that focus only on head positioning over breathing for the patient signal this.

Dont miss the Forrest for the trees.

 

[Axxe55]

As I mentioned, the first aid I learned many years was pretty much just the basics, and to be honest, I really do need to refresh my learning some.

But common sense tells me to treat the injury that is the most life-threatening at the moment, whatever that might be. If the victim's airway is compromised, and lacerations are lesser threatening, treat the airway constriction first. If the lacerations are artery or vein related and the victim is losing bast amounts of blood rapidly, that should be treated first.

 

[innominate]

Wouldn't be a bad idea to carry a thermometer either. You can take a rectal temp to make sure they haven't been down to long so you don't waste your time doing compressions. And if they jump up you know you have achieved ROSC.

 

[Byrd666]

As I mentioned, the first aid I learned many years was pretty much just the basics, and to be honest, I really do need to refresh my learning some.

But common sense tells me to treat the injury that is the most life-threatening at the moment, whatever that might be. If the victim's airway is compromised, and lacerations are lesser threatening, treat the airway constriction first. If the lacerations are artery or vein related and the victim is losing bast amounts of blood rapidly, that should be treated first.

It would still fall into an OODA loop type category.

Regardless of physical skill or ability, I Highly recommend that folks take TCCC or TECC class. Well worth the time and expense. I did a thread, or a few posts, don't remember which, a few years back after I attended a class here.

 

[cycleguy2300]

It would still fall into an OODA loop type category.

Regardless of physical skill or ability, I Highly recommend that folks take TCCC or TECC class. Well worth the time and expense. I did a thread, or a few posts, don't remember which, a few years back after I attended a class here.

To paraphrase Garand Thumb:

"The goal is to look good, but you can't do that without training"

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[leVieux]

Good for you.

Phucking Dr god complex. Lol

Condescending and dated come to mind or maybe out of touch. Do you think people put TQs on everything from a splinter to a minor wound?

Again, there is a difference in how Dr in a hospital and lay people in the field address bleeding. Maybe your degree is blinding you to that. The TQ is so we can get to you alive and you can tell us what lucky mouth breathing knuckle daggers we are that we had you to save our lives oblivious to the fact we would have bleed out otherwise.

You sound like the Drs who howled about paramedics killing people at their inception cause they dared to trespass upon your realm.

No, simply telling years of experience. The ex-Chief Paramedic for Houston FD is a lifelong friend and my Son served was a Paramedic for years.

I'll grant that there is a difference with combat injuries, which I never had to care for acutely.

I listed my experience to show that I do know what I'm talking about.

The stressing of tourniquet use in civilian trauma is overdone.

leVieux