Who here carries a Tourniquet?

[leVieux]

By "civilian" do you mean lay person or any non military person to include professional responders?

It would certainly be great for a person to understand C-spine immobilization, basic airway maneuvers and adjuncts, pocket mask/BVM ventilation, occlusive dressings, direct pressure, wound packing, and tourniquet use, but at that point, we're pretty much talking about an EMT.

There's really not that much for the lay person to do for a patient with life threatening head trauma or intrathoracic or intraabdominal bleeding... but they can definitely save a life with direct pressure and/or a tourniquet.

Back in the 1970's, we realized that our training of our military "Medics" over-emphasized C-spine immobilization, to the detriment of airway support. As a career Neuroradiologist, C-spine injuries have been a major concern of mine "forever"; but we were hearing field reports of injured personnel coming in with extensive C-spine support, but D.O.A. from suffocation.

Our extensive later experience told us that, while possible, real-life SIGNIFICANT aggravation of cervical injuries by medics and field caregivers was fairly rare, and that keeping the airway open should almost always take precedence.

 

[cycleguy2300]

Thank you, and I don't disagree EXCEPT that most of what you describe sounds like it could have been better managed by better DIRECT COMPRESSION control of bleeding, which is much simpler and less dangerous.

One caveat is that the pressure must be applied ABOVE the obvious bleeding, or as we say, "between the heart and the bleeding", and must be maintained until direct control of the bleeder is achieved. Lay folks often try to compress where they see the blood coming out of the skin wound, which is usually ineffective.

OTOH, I have seen numerous instances of immediate airway "clearing" and/or respiratory assistance being immediately needed to save a life.

Once more, a battlefield can be very, very different from civilian trauma. Of course, battlefield medics should be equipped with tourniquets, and be prepared to use them.

leVieux

You are right.

In a hospital or most home scenarios, direct pressure or manual occlusion of the artery upstream would/may have worked well. However for me as a gun toting cop a TQ let's me treat/self-treat so I have my hands free and eyes-up for other threats, "helpful" friends or family with no enhanced risk to the patient that I know of.

My medical training is very much combat first aid in theory and practice and has to take into account SIM. Security, immediate action and (wait for it) Medical. I am not afforded the ability to devote 100% of my attention into treating someone. I may need my hands (or knee) which is applying direct pressure or occluding an artery for something else or I may have to leave the casualty there to go stop the killing (immediate action plan).

On the watermelon wrist slasher, she was drunk, all her family was drunk and freaking out. MO would have worked. They had tried DP with paper towels to no obvious effect. I could have balled up a shirt and jammed it between her arm and her ribs to occlude the bracial, but she wasn't going to stay still for it to remain in place and I didn't want be dancing with her trying to keep pressure while surrounded by bogies.

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[cycleguy2300]

Back in the 1970's, we realized that our training of our military "Medics" over-emphasized C-spine immobilization, to the detriment of airway support. As a career Neuroradiologist, C-spine injuries have been a major concern of mine "forever"; but we were hearing field reports of injured personnel coming in with extensive C-spine support, but D.O.A. from suffocation.

Our extensive later experience told us that, while possible, real-life SIGNIFICANT aggravation of cervical injuries by medics and field caregivers was fairly rare, and that keeping the airway open should almost always take precedence.

Probably why HEAD is at the end of MARCH

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[toddnjoyce]

Thank you, and I don't disagree EXCEPT that most of what you describe sounds like it could have been better managed by better DIRECT COMPRESSION control of bleeding, which is much simpler and less dangerous….
leVieux

Two, well three points. First, better is a subjective word, especially when used retrospectively. Second, immediate wound management decisions can be constrained not just by the tools and training available but also (human) resources immediately available and other responsibilities of the first responder. Finally, as I mentioned earlier, the modern generation of CAT style tourniquets offer significant improvements to patient safety.

I’ll offer this comparative study of tourniquet use in Texas, published in 2018.

Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury

Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury - PubMed

Although still underused, civilian prehospital tourniquet application was independently associated with a 6-fold mortality reduction in patients with peripheral vascular injuries. More aggressive prehospital application of extremity tourniquets in civilian trauma patients with extremity...

pubmed.ncbi.nlm.nih.gov

Results: During 6 years, 1,026 patients with peripheral vascular injuries were admitted. Prehospital tourniquets were used in 181 (17.6%) patients. Tourniquet time averaged 77.3 ± 63.3 minutes (interquartile range 39.0 to 92.3 minutes). Traumatic amputations occurred in 98 patients (35.7% had a tourniquet). Mortality was 5.2% in the non-tourniquet group compared with 3.9% in the tourniquet group (odds ratio 1.36; 95% CI 0.60 to 1.65; p = 0.452). After multivariable analysis, the use of tourniquets was found to be independently associated with survival (adjusted odds ratio 5.86; 95% CI 1.41 to 24.47; adjusted p = 0.015). Delayed amputation rates were not significantly different between the 2 groups (1.1% vs 1.1%; adjusted odds ratio 1.82; 95% CI 0.36 to 9.99; adjusted p = 0.473).


Teixeira, P., Brown, C., Emigh, B., Long, M., Foreman, M., Eastridge, B., Gale, S., Truitt, M. S., Dissanaike, S., Duane, T., Holcomb, J., Eastman, A., Regner, J., & Texas Tourniquet Study Group (2018). Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. Journal of the American College of Surgeons, 226(5), 769–776.e1. https://doi.org/10.1016/j.jamcollsurg.2018.01.047

 

[leVieux]

Two, well three points. First, better is a subjective word, especially when used retrospectively. Second, immediate wound management decisions can be constrained not just by the tools and training available but also (human) resources immediately available and other responsibilities of the first responder. Finally, as I mentioned earlier, the modern generation of CAT style tourniquets offer significant improvements to patient safety.

I’ll offer this comparative study of tourniquet use in Texas, published in 2018.

Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury

Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury - PubMed

Although still underused, civilian prehospital tourniquet application was independently associated with a 6-fold mortality reduction in patients with peripheral vascular injuries. More aggressive prehospital application of extremity tourniquets in civilian trauma patients with extremity...

pubmed.ncbi.nlm.nih.gov

Results: During 6 years, 1,026 patients with peripheral vascular injuries were admitted. Prehospital tourniquets were used in 181 (17.6%) patients. Tourniquet time averaged 77.3 ± 63.3 minutes (interquartile range 39.0 to 92.3 minutes). Traumatic amputations occurred in 98 patients (35.7% had a tourniquet). Mortality was 5.2% in the non-tourniquet group compared with 3.9% in the tourniquet group (odds ratio 1.36; 95% CI 0.60 to 1.65; p = 0.452). After multivariable analysis, the use of tourniquets was found to be independently associated with survival (adjusted odds ratio 5.86; 95% CI 1.41 to 24.47; adjusted p = 0.015). Delayed amputation rates were not significantly different between the 2 groups (1.1% vs 1.1%; adjusted odds ratio 1.82; 95% CI 0.36 to 9.99; adjusted p = 0.473).


Teixeira, P., Brown, C., Emigh, B., Long, M., Foreman, M., Eastridge, B., Gale, S., Truitt, M. S., Dissanaike, S., Duane, T., Holcomb, J., Eastman, A., Regner, J., & Texas Tourniquet Study Group (2018). Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. Journal of the American College of Surgeons, 226(5), 769–776.e1. https://doi.org/10.1016/j.jamcollsurg.2018.01.047

~10% traumatic amputation of other than a toe or fingertip sounds awfully high to me. And, if one is familiar with medical literature, one can find "studies" to support ANY conclusion.

 

[toddnjoyce]

~10% traumatic amputation of other than a toe or fingertip sounds awfully high to me. And, if one is familiar with medical literature, one can find "studies" to support ANY conclusion.

Read the literature. There’s literally hundreds of scholarly articles, case reviews, trials and other citable information on the subject.

 

[m5215]

Do you have a Tourniquet?​

Yes, here is mine.

 

[BRD@66]

Who revived this thread? IBTL.

 

[BandAidPro]

Back in the 1970's, we realized that our training of our military "Medics" over-emphasized C-spine immobilization, to the detriment of airway support. As a career Neuroradiologist, C-spine injuries have been a major concern of mine "forever"; but we were hearing field reports of injured personnel coming in with extensive C-spine support, but D.O.A. from suffocation.

Our extensive later experience told us that, while possible, real-life SIGNIFICANT aggravation of cervical injuries by medics and field caregivers was fairly rare, and that keeping the airway open should almost always take precedence.

Of course maintaining an airway is more important than C-spine, but that doesn't really address entire point of my post, which was that placing a TQ is one of the few interventions a lay person is likely to do that will actually save somebody's life.

 

[BandAidPro]

Thank you, and I don't disagree EXCEPT that most of what you describe sounds like it could have been better managed by better DIRECT COMPRESSION control of bleeding, which is much simpler and less dangerous.

One caveat is that the pressure must be applied ABOVE the obvious bleeding, or as we say, "between the heart and the bleeding", and must be maintained until direct control of the bleeder is achieved.

"Direct control of the bleeder"... that sounds a lot like you're talking about surgical intervention.

Which isn't available in the field.

Which is why we place tourniquets, allowing the pt. to live long enough to get to the OR where "direct control of the bleeder" can be achieved.

Trying to maintain manual pressure on a life threatening bleed in the field is not "simpler and less dangerous" than placing a tourniquet. It might work great in the OR, but the field is an entirely different environment.

 

[PracticalCarry]

Army Vet, current EMT, SARTech Medic, and First Aid trainer - I have dozens and do know how to use them. Never used one outside of training or being trained but much like I also have a fire extinguisher, burglar alarm, defensive weapons --- rather have one and not need it... Was reading through the thread and clearly some experienced medical providers - and some not so much. There's nothing cooler than to be able to save a friend, or stranger's life because you have training and tools, but the training is clearly the most useful thing, tools can be improvised. Simple rules to live by: Air goes in and out, blood goes round and round, sometimes diesel (or Jet-A) therapy is the only solution for the patient.

 

[leVieux]

"Direct control of the bleeder"... that sounds a lot like you're talking about surgical intervention.

Which isn't available in the field.

Which is why we place tourniquets, allowing the pt. to live long enough to get to the OR where "direct control of the bleeder" can be achieved.

Trying to maintain manual pressure on a life threatening bleed in the field is not "simpler and less dangerous" than placing a tourniquet. It might work great in the OR, but the field is an entirely different environment.

Well, in the first place, you misquoted me. If adequate help is there, and if a treatment facility is not too far away, direct pressure is recommended.

If on a battlefield, yes, tourniquets may be useful.

I never told anyone to not carry or not use a tourniquet. What I said, and maintain, is that the use of tourniquets in civilian trauma is OVER-EMPHASIZED. Terribly !

Just like we once overemphasized stabilizing the neck, especially in patients with no sign of spinal injury, at the expense of airway management.

BTW, in modern medicine, much of bleeder control not achievable by direct compression or clamping is done by trans-vascular embolization, which is what I was doing, and teaching, for the past 30 or so years.

leVieux
.

 

[leVieux]

Army Vet, current EMT, SARTech Medic, and First Aid trainer - I have dozens and do know how to use them. Never used one outside of training or being trained but much like I also have a fire extinguisher, burglar alarm, defensive weapons --- rather have one and not need it... Was reading through the thread and clearly some experienced medical providers - and some not so much. There's nothing cooler than to be able to save a friend, or stranger's life because you have training and tools, but the training is clearly the most useful thing, tools can be improvised. Simple rules to live by: Air goes in and out, blood goes round and round, sometimes diesel (or Jet-A) therapy is the only solution for the patient.

No argument here !

What I said is that the use of tourniquets is over-emphasized.

I never said to not carry or not use them.

leVieux
.

 

[BandAidPro]

Well, in the first place, you misquoted me. If adequate help is there, and if a treatment facility is not too far away, direct pressure is recommended.

If on a battlefield, yes, tourniquets may be useful.

I never told anyone to not carry or not use a tourniquet. What I said, and maintain, is that the use of tourniquets in civilian trauma is OVER-EMPHASIZED. Terribly !

Just like we once overemphasized stabilizing the neck, especially in patients with no sign of spinal injury, at the expense of airway management.

BTW, in modern medicine, much of bleeder control not achievable by direct compression or clamping is done by trans-vascular embolization, which is what I was doing, and teaching, for the past 30 or so years.

leVieux
.

While I certainly respect your experience, I do strongly disagree with your perspective. The field, even off the battlefield, is not a controlled environment.

We might be extricating a bleeding pt. from a vehicle on the side of the highway in the middle of the night, or struggling with an agitated and intoxicated person. Or even under the best of circumstances, picking a cooperative pt. off their bathroom floor and placing them onto the stretcher before maneuvering through their house out the yard and into the ambulance.

The risk of placing a tourniquet is low, but the risk (and likelihood) of losing bleeding control trying to maintain direct pressure in the field environment is high.

 

[leVieux]

While I certainly respect your experience, I do strongly disagree with your perspective. The field, even off the battlefield, is not a controlled environment.

We might be extricating a bleeding pt. from a vehicle on the side of the highway in the middle of the night, or struggling with an agitated and intoxicated person. Or even under the best of circumstances, picking a cooperative pt. off their bathroom floor and placing them onto the stretcher before maneuvering through their house out the yard and into the ambulance.

The risk of placing a tourniquet is low, but the risk (and likelihood) of losing bleeding control trying to maintain direct pressure in the field environment is high.

OK, but, what I said is that this is overemphasized. More attention should be placed on airway problems which demand immediate attention. I once saw a man whose entire left arm was torn completely off by oil rig machinery. Humerus was disarticulated from glenoid, axillary artery hanging out. He had lost blood, but hadn't bled-out, and the artery stump had spastic contraction, I was able to identify it and place a clamp on it via the trauma hole. Even in that just-about worst case scenario, there was no place to use a tourniquet.

 

[candcallen]

Christ almighty just give up.

 

[jtw2]

I have two home built IFAKs in the back seat of the truck each of which has a tourniquet, Israeli bandage, quick clot, etc. there are two because I had two of everything so I just went with that

 

[andre3k]

Well, in the first place, you misquoted me. If adequate help is there, and if a treatment facility is not too far away, direct pressure is recommended.

If on a battlefield, yes, tourniquets may be useful.

I never told anyone to not carry or not use a tourniquet. What I said, and maintain, is that the use of tourniquets in civilian trauma is OVER-EMPHASIZED. Terribly !

Just like we once overemphasized stabilizing the neck, especially in patients with no sign of spinal injury, at the expense of airway management.

BTW, in modern medicine, much of bleeder control not achievable by direct compression or clamping is done by trans-vascular embolization, which is what I was doing, and teaching, for the past 30 or so years.

leVieux
.

Heres a TQ application from a few weeks ago. This one just happen to be caught on BWC video that was released. We use them....A LOT.



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[leVieux]

Heres a TQ application from a few weeks ago. This one just happen to be caught on BWC video that was released. We use them....A LOT.



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Please read my post again. leVieux

 

[andre3k]

Please read my post again. leVieux

I don't have to reread it. Just wanted to post an example.

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