Tourniquet Protocol?

[bigdogems]

So the NREMT skills checkoff is as follows. BSI of course. Direct pressure, Tourniquet, treat for shock. You can get the skills sheets of their website so it's no secret. I wouldn't say that Civilian and Military don't overlap. War is the proving ground for medicine. With that, it is where we started with the idea that using a tourniquet will mean an amputation of a limb. So if we flash back to the Civil War... Leg gets blown off... Tourniquet applied.... Spend a couple days at a medical unit before a doc looks at your leg... By that time infection has set in and you lose your leg. Nobody should ever die from an extremity injury. I have a friend that was a Cpt with the 101st in Afghanistan. They would go out on patrol with a tourniquet on each limb. With any traumatic extremity would they would immediately lock down the tourniquet until they got back to a medical unit. And its easy to find BDUs that have them built in.

With all that said. It will be hard to find a time you really need to use them. As said above direct pressure can work wonders. Even in traumatic amputations the veins will vaso constrict and direct pressure can usually stop the last of the bleeding

 

[Veneficus]

I wouldn't say that Civilian and Military don't overlap. War is the experimenting ground for medical device manufacturers and medicine.

Fixed it for you.

There have been lots of medical advances in war, there is even some overlap.

I didn't mean to suggest there was none. (every now and again a blast in jury)

But just because the military uses or does something does not make it the blanket solution for the civillian world.

Not to be a smart ***, but I am not going out and buying a pair of sweatpants with a TK built in incase I get hit by a bus.

I keep hearing about extremity wounds where bleeding cannot be controled.

How often in the civillian world is tha exactly? 1:1000, 1:100000 1:inept providers who saw a tk used on the military channel, or 1rovider who made a 1/2 assed effort at direct pressure because they don't actually have experience or know what an uncontrolled bleed looks like?

Back to the military environment.

How often do they need a TK in Afghanistan in a day? 3? 4? 10? (depending on how bad the day right?)

How many would you estimate are needed in the whole continental US in a day?

How many do you think would be applied if we made it the blanket first line in extremity hemorrhage control?

I could just see EMS bring somebody into an ED with a TK applied to a partial thickness extremity wound 2-3 cm in length with less blood than when I cut myself shaving. (and I don't use chemical clotting agents for that either.)

 

[MedicBrew]

Interesting?!?!?(No sarcasm intended)

We utilize a commercially made tourniquet for our extremity injury protocol, based on evidence published in the PHTLS 6th ed, as well as other sources. I’ve read somewhere (sorry, don’t recall) of the application of tourniquets on the battlefield for up to 6 hrs with no residual effects attributed to the tourniquet. Granted, it’s a rescue measure when all else fails.

Did a search and found a lot of information and studies to support their application. Have a buddy that just returned from Afghanistan and another getting ready to re-deploy and they both state that tourniquets are 1st line for hemorrhage control (both are medics). Seems a bit excessive to me, but I don’t work in the desert or mountains with people shooting at me.

It never ceases to amaze me how different treatment modalities are in different areas of the same country.

Good discussion!

 

[EMDispatch]

Fixed it for you.
There have been lots of medical advances in war, there is even some overlap.

I agree current overlap is limited, but historically it has brought us:
-The "Golden Period"
-Dedicated ambulance services and prehospital providers
-Triage system

Those are some pretty significant overlaps.

 

[Veneficus]

I agree current overlap is limited, but historically it has brought us:
-The "Golden Period"
-Dedicated ambulance services and prehospital providers
-Triage system

Those are some pretty significant overlaps.

Burn care
IO needles
whole blood transfusion
infection control

Many more and significant advances for me to recall at the moment.

 

[EMDispatch]

My question is what will transfer over from the Iraq and Afghanistan wars?

As a relatively lay person on the subject I'd assume work with traumatic brain injuries would be the area to watch.

 

[EpiEMS]

For some reading about the research that the military is doing and experience of military medicine in Iraq and Afghanistan, I suggest this: http://www.bordeninstitute.army.mil/
There's some really interesting case studies.

I'd wager that beyond TBIs, there's a lot of seriously good work in PM&R that's gonna come out of these conflicts because of the nature of extremity injuries.

 

[Veneficus]

Have copies, read them last year.

War surgery in Iraq and Afg. was by far my favorite, but after witnessing military medicine in action, they get a thumbs down.

The ones I encountered seemed to have forgotten the whole hippocratic oath.

As such, true to its word, they have brought discredit upon themselves as doctors.

 

[EpiEMS]

I've no personal experience with military medicine, but the books have been interesting reads. Frankly, they and books on medicine/public health in austere environments are what motivated my interest in epidemiology and taking an EMT-B/WEMT course.

Guy I know is aPM&R MD —:censored:I gotta ask him what he thinks about the rehab side of military medicine.

 

[Bullets]

Weve just gotten TKs moved up in our bleeding control protocol. Now its direct pressure->TK

And our local SWAT unit wears BDUs with TKs built in, they stay secure under a velcro flap, rip and twist. pretty slick IMO

 

[zmedic]

I'd just point out that the clips in that picture aren't for holding the wound edges together. They clip onto the cut edges of the scalp to prevent it from bleeding, allowing your to work on the skull underneath. At the end of the case you take the clips off and sew the scalp back together.

I'm all for TKs in certain situations. I'm just not sure that there have been that many people in the civillian world that have bled out from extremity wounds. Just keep in the back of your mind that the companies that make these things want to convince you that you should have one in your pocket, one in your jump back, and 2 more in the ambulance. $$$$

(Clearly there are people who should be carrying them on their person. SWAT, maybe police in general)

 

[RocketMedic]

I'd just point out that the clips in that picture aren't for holding the wound edges together. They clip onto the cut edges of the scalp to prevent it from bleeding, allowing your to work on the skull underneath. At the end of the case you take the clips off and sew the scalp back together.

I'm all for TKs in certain situations. I'm just not sure that there have been that many people in the civillian world that have bled out from extremity wounds. Just keep in the back of your mind that the companies that make these things want to convince you that you should have one in your pocket, one in your jump back, and 2 more in the ambulance. $$$$

(Clearly there are people who should be carrying them on their person. SWAT, maybe police in general)

Our unit's practice is to place a tourniquet on a penetrating extremity wound if the medic thinks that there may be vascular compromise. The classic example given is a rifle round to the thigh that leaves a small entry wound and no exit wound, yet cuts the femoral. Bleeding will be profuse and internal for the most part.

 

[Tigger]

Weve just gotten TKs moved up in our bleeding control protocol. Now its direct pressure->TK

And our local SWAT unit wears BDUs with TKs built in, they stay secure under a velcro flap, rip and twist. pretty slick IMO

Supposedly the built in TKs are going to be a part of the next set of BDUs for our soldiers, can anyone on here confirm?

 

[911bru]

TD work wonders and I have seen someone have one on for about 5 hours without any damage when removed. There are people who have had them on longer without any problems.
I expect for them to become more prominent in protocols in the next few years.

Army veteran
2006-2011
OEF-A 2008

 

[DPM]

Supposedly the built in TKs are going to be a part of the next set of BDUs for our soldiers, can anyone on here confirm?

I wouldn't have thought so. In Afghanistan around 50% of our casualties came from IED's and these have a tendency to shred your trousers as well as the rest of you. Likewise, where is the TK sewn in? Above the knee, bellow it? If it's built in then you've really only got one option for where you want to place it, and if the wound is in the wrong place then you're stuffed.

If you think the time it takes to remove a TK from a MOLLE loop / pouch is going to make the difference between life and death then this fella is probably going to die anyway.

 

[Desette]

I wouldn't have thought so. In Afghanistan around 50% of our casualties came from IED's and these have a tendency to shred your trousers as well as the rest of you. Likewise, where is the TK sewn in? Above the knee, bellow it? If it's built in then you've really only got one option for where you want to place it, and if the wound is in the wrong place then you're stuffed..

The ones that I have seen have 4 in the pants (One lower leg below knee and one high on the thigh) and you can also move the pants up and down depending on where you need it. There are shirts as well that have 4 as well.

The destruction of them in an IED is a very good point, another good reason for a back up

Video below on the pants

http://www.youtube.com/watch?v=SKSx6952ya4

 

[Veneficus]

Maybe it's just me...

But if your battle dress is better with built in hemorrhage control devices, you may want to re-evaluate your strategy and tactics.

 

[mycrofft]

Short shots

I was taught by a former US Army nurse who served at Pleiku than many if not most TK's used during Vietnam conflict were medically unnecessary. Maybe battle-hasty expedient.

(I thought they rejected the built-in TK uniforms years ago?).

Public Radio article said yesterday they now have a TBI "center" at KAF (Afgahnistan/ Kandahar). Now use multiple versions of TBI eval cards because troops were memorizing them!

Some approaches are later found not to be panaceas, like clotting agents.

At Kandahar, the biggest inroads I saw were mandatory hand washing before dining, and hand washing means available at toileting facilities. As well as disposable utensils and plates, and real live sewage and trash/garbage control, and bottled water in sanitary packaging.

R.O.T., 85% of war casualties are disease and accidents.

 

[DPM]

To add to the tourniquet trousers idea, I've been in contact in a PB wearing a pair of gym shorts and body armour. If I'd been hit in the legs then my mates would have had to put my trousers on me to get the tourniquets working! All of our guys carry two a piece, team medics had a couple more. That's more than enough to go round.

The trousers in the vid look cool but that's it really. In the UK all troops carry their tourniquets and field dressings in the same place, their mates know where they are and how to use them. It's cheaper, more effective and probably more comfortable.

 

[Bullets]

I actually just got a pair of those blackhawk pants (for free, natch) seem comfortable, ripstop is sweet, lots of deep pockets. Even without the TKs, a well made pair of pants

And im not saying stop carrying a separate TK if they switch to a built in style