# When to use TQ over pressure bandage?



## CanadianBagel (Feb 3, 2018)

I may be answering my own question here, but wouldn’t you use a pressure bandage on a wound that CAN be controlled with direct pressure and a TQ on a wound that CANNOT? 

We didn’t go over a lot of different bandages in EMT school, just the different jack-of-all-trades applications of a few. The reason I’m asking though is because I saw an ankle holster (Tacticool, right?) that holds a TQ and an Israeli Bandage. I was wondering why I would need both, when I could just use a SWAT-T brand TQ as a pressure bandage and a TQ? Maybe I’m thinking too much into this, idk.

Thank you for enlightening me,
- a guy with too much time on his hands


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## Flying (Feb 3, 2018)

My first thought is, who cares, just be familiar with and use what is given to you. SWAT, CAT, RAT, whatever.

Tourniquets are primarily indicated for life threatening extremity wounds that can't be controlled by direct pressure or other means. Having a multitask TQ seems a bit frivolous to me (then again, so is an ankle holster for medical supplies).

Embrace the jack of all trades.


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## hometownmedic5 (Feb 3, 2018)

An ankle holster for bleeding control items? Are you effing kidding me?

As a general rule, you use the least invasive measure possible to accomplish your goal. Central lines are awesome, right? Multiple ports, almost instantaneous addition to central circulation, you can do massive volume infusions very quickly. Why doesn't every patient int he hospital have a central line then? Because the risk of iatrogenic complications is staggering, so they are only used when necessary. Tourniquets come with risks. They are used when all less invasive measures have failed.

If you can get the job done with a pressure bandage, do so. If not, grab the tourniquet. And don't buy an ankle holster for this crap, unless you're working executive protection and need inconspicuous but instantaneous access to these items. or you're going to look like a jackass. I can forgive a bat belt and other minor affectations of the industry, but this is a bridge too far...


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## VFlutter (Feb 3, 2018)

hometownmedic5 said:


> An ankle holster for bleeding control items? Are you effing kidding me?



Actually pretty useful. If you CCW you should have an IFAK on you. Ankle kit conceal well with normal jeans and much more comfortable than on your belt. To each their own.

http://soldiersystems.net/2018/01/12/149694/


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## CanadianBagel (Feb 3, 2018)

VFlutter said:


> Actually pretty useful. If you CCW you should have an IFAK on you. Ankle kit conceal well with normal jeans and much more comfortable than on your belt. To each their own.
> 
> http://soldiersystems.net/2018/01/12/149694/


It may be a bit much for some applications, but it makes sense to me for an edc.


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## MackTheKnife (Feb 3, 2018)

SplintedTheWrongLeg said:


> I may be answering my own question here, but wouldn’t you use a pressure bandage on a wound that CAN be controlled with direct pressure and a TQ on a wound that CANNOT?
> 
> We didn’t go over a lot of different bandages in EMT school, just the different jack-of-all-trades applications of a few. The reason I’m asking though is because I saw an ankle holster (Tacticool, right?) that holds a TQ and an Israeli Bandage. I was wondering why I would need both, when I could just use a SWAT-T brand TQ as a pressure bandage and a TQ? Maybe I’m thinking too much into this, idk.
> 
> ...


You did answer your own question.


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## MackTheKnife (Feb 3, 2018)

hometownmedic5 said:


> An ankle holster for bleeding control items? Are you effing kidding me?
> 
> As a general rule, you use the least invasive measure possible to accomplish your goal. Central lines are awesome, right? Multiple ports, almost instantaneous addition to central circulation, you can do massive volume infusions very quickly. Why doesn't every patient int he hospital have a central line then? Because the risk of iatrogenic complications is staggering, so they are only used when necessary. Tourniquets come with risks. They are used when all less invasive measures have failed.
> 
> If you can get the job done with a pressure bandage, do so. If not, grab the tourniquet. And don't buy an ankle holster for this crap, unless you're working executive protection and need inconspicuous but instantaneous access to these items. or you're going to look like a jackass. I can forgive a bat belt and other minor affectations of the industry, but this is a bridge too far...


Tourniquets are not that risky. EBP proves it.


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## medichopeful (Feb 3, 2018)

If there's any question about which to use, go with the tourniquet.


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## DesertMedic66 (Feb 4, 2018)

VFlutter said:


> Actually pretty useful. If you CCW you should have an IFAK on you. Ankle kit conceal well with normal jeans and much more comfortable than on your belt. To each their own.
> 
> http://soldiersystems.net/2018/01/12/149694/


I prefer the style of the ankle holster TQ and denim shorts


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## hometownmedic5 (Feb 4, 2018)

MackTheKnife said:


> Tourniquets are not that risky. EBP proves it.



“Not that risky” is not the same as without risk.


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## MackTheKnife (Feb 4, 2018)

hometownmedic5 said:


> “Not that risky” is not the same as without risk.


Ok. Let me CLARIFY what I was trying to say that I thought everyone would know what I meant without using big words: There are minimal attendant neurovascular sequelae with the use of compression vascular devices on the extremities when used for several hours. Translation into English: Not that risky.


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## Tigger (Feb 4, 2018)

An Israeli/Pressure bandage is not the same as a tourniquet. You cannot generate nearly as much force with the bandage as the tourniquet. Israeli bandages are useful for wounds that don't need a TK, they've got everything you need in one wrapper and are pretty easy to apply. Also can apply them in places that TKs don't go but you'll probably need to apply real manual pressure on top of it. SWAT-T has no actual dressing in it.


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## ffxemt (Feb 11, 2018)

Per TECC, "When you see the victim and think/say "Holy &(*& that's a lot of blood"". Apparently you can't really go wrong with a TQ anymore, based on the studies done (I can find them if required), a negligible risk is posed for most EMS situations. I would definitely still go through the motions and not throw a TQ on a missing finger.


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## Akulahawk (Feb 12, 2018)

ffxemt said:


> Per TECC, "When you see the victim and think/say "*Holy &(*& that's a lot of blood*"". Apparently you can't really go wrong with a TQ anymore, based on the studies done (I can find them if required), a negligible risk is posed for most EMS situations. I would definitely still go through the motions and not throw a TQ on a missing finger.


There's basically two times you would use a TQ. One is that time you outlined (and I bolded) above. The other is when you're still too early in the fight to get to that point and you're attempting (and failing) to control bleeding using direct pressure. Knowledge of pressure points is good at this point as you might want to use them to slow bleeding down further while you're applying a TQ.


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## EpiEMS (Feb 15, 2018)

Akulahawk said:


> One is that time you outlined (and I bolded) above. The other is when you're still too early in the fight to get to that point and you're attempting (and failing) to control bleeding using direct pressure.



Definitely.

@SplintedTheWrongLeg, it's better to throw on the TQ early and discontinue it later than to not put it on. It's not as if we can (most EMS providers) put more blood in.


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## VFlutter (Feb 15, 2018)

EpiEMS said:


> Definitely.
> 
> @SplintedTheWrongLeg, it's better to throw on the TQ early and discontinue it later than to not put it on. It's not as if we can (most EMS providers) put more blood in.



I like the idea of starting with a TQ to quickly stop the bleeding so you can correctly place a pressure dressing with less stress then remove the TQ if not necessary. However I know logistically some protocols don't allow removal of TQ after application.


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## EpiEMS (Feb 15, 2018)

VFlutter said:


> I like the idea of starting with a TQ to quickly stop the bleeding so you can correctly place a pressure dressing with less stress then remove the TQ if not necessary. However I know logistically some protocols don't allow removal of TQ after application.



My protocols (stupidly) expressly prohibit it - "Do not remove or loosen tourniquet once hemostasis achieved". Of course, that's totally inconsistent with the guidelines I've seen (TECC guidlines, for example).

Tourniquets can save time (by reducing the need for extra hands) - I'm busy trying to move this patient, and there's only two people, we can't hold pressure *and* start getting them moving to the surgeon.

Maybe I should petition for a change...


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## VFlutter (Feb 15, 2018)

EpiEMS said:


> My protocols (stupidly) expressly prohibit it - "Do not remove or loosen tourniquet once hemostasis achieved". Of course, that's totally inconsistent with the guidelines I've seen (TECC guidlines, for example).
> 
> Tourniquets can save time (by reducing the need for extra hands) - I'm busy trying to move this patient, and there's only two people, we can't hold pressure *and* start getting them moving to the surgeon.
> 
> Maybe I should petition for a change...



I understand the concern for re-perfusion injury and circulatory collapse upon tourniquet removal however realistically that isn't going to be an issue in the few minutes it takes for you to move the patient, gather supplies, and apply an alternative dressing. 

Maybe clarify TQ for treatment of Arterial Hemorrhage vs as an adjunct to pressure dressing? 

When I used to pull Venous and Arterial sheaths (5-9fr) in the Cath lab i could completely control the arterial puncture site with a single 4x4 and two fingers. As opposed to when someone inadvertently dislodged a sheath and I had to use my fist and multiple dressings to get incomplete control just to identify where the actual puncture was. If prepared and starting without active bleeding most hemorrhages can be easily controlled with direct pressure or dressings.


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## EpiEMS (Feb 15, 2018)

VFlutter said:


> I understand the concern for re-perfusion injury and circulatory collapse upon tourniquet removal however realistically that isn't going to be an issue in the few minutes it takes for you to move the patient, gather supplies, and apply an alternative dressing.



Seems reasonable to me!



VFlutter said:


> I understand the concern for re-perfusion injury and circulatory collapse upon tourniquet removal however realistically that isn't going to be an issue in the few minutes it takes for you to move the patient, gather supplies, and apply an alternative dressing.



Totally didn't think about that as the worry...
Though I'm not sure why you'd (prehospitally) remove a tourniquet on a profoundly injured extremity...


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## ParamagicFF (Mar 30, 2018)

I see a large amount of traumatic injuries in my area, generally penetrating trauma or pedestrian vs vehicle. We have recently been issued Israeli bandages, and we have always had some type of commercial TQ. Part of my decision making comes from a quick determination of the patient's overall condition aside from the individual bleed. Next I quickly try to determine if the actual source of bleeding can be accessed. If either of those are in question, I will apply a TQ and move on. It goes without saying that gross deformity with significant bleeding gets a TQ unless there is some reason it cannot be applied. I am 10-15 minutes from a major trauma center, so I believe the benefit outweighs the risk.


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## johnrsemt (Apr 18, 2018)

The protocols about loosening tourniquets are probably when it is going to be over 12 hours before you get the patient to surgery.  Where I work PT where every hospital is at least 2 hours away, I still wouldn't loosen a TQ.

Even the Boy Scouts have stopped teaching raise the injury and pressure points.  They teach Pressure, more pressure, TQ.


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## Unicorn (Jul 7, 2021)

There are only two tourniquets approved by the DoD. The CAT-T and the SOFT-T W (wide). No other have passed the tests, and no other has been proven in real world use.

The SWAT-T is better than nothing and has it's uses, but it's not great. It's nice that it can be used for both pressure or a tourniquet, but it's also easy to screw it up.

Having both an Israeli bandage and a CAT-T covers both needs without the negatives of a SWAT-T. Use the pressure dressing when you can, use the Tourniquet if/when the pressure dressing doesn't or won't work. A SWAT-T is nice because it's small and easy to carry.  A jack of all trades, master of none.

In this scenario though it really doesn't offer anything over carrying a separate bandage and tourniquet. Are you going to apply it directly on the wound without using any sort of gauze? Also, if the direct pressure turns out not to be enough, you have to remove it and place it proximal to the wound. I'd much rather just leave the pressure dressing and apply a separate tourniquet.

*EDIT: I didn't notice the date of this post. I didn't mean to resurrect such a dead thread and there is no delete option.*


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## CCCSD (Jul 7, 2021)

DoD also authorized the SAM Ratchet TQ.


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## Akulahawk (Jul 8, 2021)

Because this is an old thread, I'm going to lock it. That being said, this was a good discussion. If there's any major interest in this topic, it can be reopened.


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