What would you do???

enjoynz

enjoynz

Lady Enjoynz
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This is not a scenario...it was something that I watched on a reality police show, and I'm interested as to how you would handle the patient.

A police patrol car was driving along the road and came across a teenager sitting semi recumbent on the side of the road with a her friend.
She is holding her leg, which is bleeding profusely (spurting) from her lower limb.

The police officers radio for an ambulance and perform First Aid....placing a pad and roller bandage over the wound.
They take a lace from the girls' shoe to make a torniquet. At this stage she is starting to lose conciousness.
The ambulance arrives...the police officer tells the EMT that the patient had been running and tripped over...
she was bleeding badly and the blood was spruting out from the wound.

As the EMT taking this patient... what would you have done???

After I get a good amount of replies...I'll tell you what the EMT at this call did.
The reason for this is both, my husband and I (vollie and ex vollie Ambo's) would not have done what this EMT did.

Cheers Enjoynz
 
I would not have removed the tourniquet or bandage in place.

Transport safely and rapidly.
 
Unless there's a "gotcha" in here somewhere, it sounds pretty straightforward; apply additional pressure dressings, elevate the extremity, look for a pressure point if the wound continues to bleed, get them flat on their back with legs raised, apply high flow O2 via NRB, treat for heat loss, get a line started, check vitals, transport. Using a shoelace for a tourniquet is contraindicated; a better choice would be a BP cuff or a commercial device.
 
i agree with the above poster...pressure,apply, elevate, more dressing, pressure point,bandage...tourniquet is last ditch effort.....simple...rapid transport,fluid...2 large bores w/ NS running....maintain BP ,trendelumberg position ...O2,prevent heat loss..
 
Same as above but I'd make sure to obtain the time the tourniquet was applied. Depending on transport times and local protocals I may try and loosen the tourniquet or replace it with a bp cuff or triangular.
 
The shoestring isn't ideal, but hey, good for the cop for the thought. I would apply a more appropriate tq and remove the shoestring most likely.
 
Additional dressings, elevate the legs (just the one leg if possible), oxygen with device and flow rated dependent on the patient's v/s, resp status, and skin color. As long as the bleeding is controlled and the limb isn't completely hypoprofused distal to the tourniquet, I'd most likely leave it in place. If I had an extra large cuff or thigh cuff, I might consider replacing the shoelace with a BP cuff as it would be easier to titrate the pressure of the tourniquet to the patient's condition.
 
On second thought, I would also be questioning how tripping while running could cause such a major, and presumably arterial bleed.
 
Very good everyone....Keep the posts coming, I will post the reply later today!

Cheers Enjoynz
 
Looks like no-one else wants to add to this, so as promised....here is what happened!

After the police officer explained clearly what the wound was...they load the patient onto the ambulance.
The police officer was saying sorry for the messy job on the bandage...quite frankly, it looked fine to me.
" No worries" said the EMT..."I have to undo it anyway to check the wound! ":blink:
Which she processed to do.

Hubbie and I sat there dumb founded.
I couldn't believe why an Ambulance Officer from a city station, no less, would be doing that when everything that we have been taught was not too.

My thought's were:

1. She didn't believe the Police officer that it was an arterial bleed.:unsure:
2. Perhaps she had never seen an arterial bleed before, and just wanted to look.:wacko:
3. Prehaps she needs to go back and do her Basic First Aid training.<_<

What a foolish thing to do!

At the end of the article...the report from the hospital said the patient had a severed tendon and artery.

Good on the police officer's for their quick thinking and good First Aid attempts.

Cheers Enjoynz
 
First aid versus professional care, and two realities.


1. Ever try to make a thigh TK with a real shoelace in the real world?
2. Do folks believe everything they see on and hear on TV?

I'd have moved the pt to the vehicle, started a line, checked distal signs, replaced the TK (place new one, then remove old one carefully), gingerly lifted and re-placed (put back) and reinforced, or replaced (removed and rebandaged) the bandage, then released the TK carefully to asses for haemostasis unless the destination was under about ten minutes away or less. Then I would have done first two steps and let the hospital get her. (Oh, wait..I'd have acted in accordance with standards of the proper associations and my employer. Sorry.).

Recent battlefield experience is that proper (non-traumatic) TK's can be used to good advantage and surprisingly little harm if left on for short periods, or left on because help is so far away or nothing else will stop the flow. Intermediate time periods require TK only for "life or limb", and often (often) haemostasis is achievable with proper pressure dressing plus immobilization.Wait for knowledge to trickle down.

First aiders, having nothing to offer by examining the wound after bleeding is determined to be the foremost problem and it is apparently stopped, do not remove a dressing, but reinforce it as needed. Many first aiders have trouble and lack materials to do a real, bangup pressure dressing.
 
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Here's an interesting tidbit of information for all of you. In 2010 when Ma plans on updating their EMS protocols, they plan to remove elevation and pressure points from the bleeding protocols.They argue that there is a lack of evidence supporting their effectiveness. Instead, EMTs will be instructed to first apply pressure and if the bleeding cannot be controlled, then apply a tourniquet. With recent advances in medicine, limbs are seldom lost because of tourniquets. They can often save limbs that have been in tourniquets for over an hour! This is what the military has been doing for the past 10 years as mycrofft mentioned.

As to the scenario presented here...:wacko:
 
mycrofft said:
1. Ever try to make a thigh TK with a real shoelace in the real world?
2. Do folks believe everything they see on and hear on TV?




First aiders, having nothing to offer by examining the wound after bleeding is determined to be the foremost problem and it is apparently stopped, do not remove a dressing, but reinforce it as needed. Many first aiders have trouble and lack materials to do a real, bangup pressure dressing.
Click to expand...
Mycroft: This was the real world...it happened here in New Zealand and the Reality show was of our New Zealand police force. They were using a shoe lace as they had nothing else on offer...I didn't say I agreed with that idea...In fact we are not taught to use TK's at all in our Ambulance training.
I don't make stories up for the fun of it, as most people who know me on this site already know!

The Ambulance officer on the ambulance was not a First Aider (My husband thought they had Advanced Paramedic (EMT-P) on their patch (It would have even been worse if it was). I was pretty sure they were an Ambulance Officer level (which is the same as your EMT-B )...They were responding to a 111 (911) call from the police.
The point I was trying to make was maybe they should go back to their First Aid training...even a person with basic first aid knows to keep applying pressure and bandages to an arterial bleed... not take them off!

Enjoynz
 
mycrofft said:

1. Ever try to make a thigh TK with a real shoelace in the real world?
2. Do folks believe everything they see on and hear on TV?

I'd have moved the pt to the vehicle, started a line, checked distal signs, replaced the TK (place new one, then remove old one carefully), gingerly lifted and re-placed (put back) and reinforced, or replaced (removed and rebandaged) the bandage, then released the TK carefully to asses for haemostasis unless the destination was under about ten minutes away or less. Then I would have done first two steps and let the hospital get her. .
Click to expand...

BLS love, BLS. :P
 
Personally, I would had removed the make shift bandaging as well. No description was made of it. Description of how it occurred. Sorry, there are very few times that one needs a tourniquet. If MA wants to make a tourniquet a secondary treatment we will probably see more damage than good. Its their state, so be it, they are known to do things differently.

If one wants to argue for tourniquet usage let's examine the wounds and injuries the military is treating in comparison to civilian injuries. There is much more damage from an explosion and blasting injuries than a simple laceration with an arterial bleed.

If you cannot find an article documenting the effect of pressure point, then one is not reading much. Applying pressure to the artery proximal has the same effect, the problem is that is does work but the practitioner is not either properly trained or does not perform it properly.

So does tourniquets work? Yes ! Anyone working around trauma always have known this as well as the length of time to cause death of the tissue was much longer than always assumed. Again though, one needs to be sure that simplistic measures has been carried out properly.

In my 31+ years, I have only seen a few times a tourniquet was ever warranted. Yes, I have worked several hundred total amputations (even three patients with leg amputations at one time). Even this event no tourniquets were needed. Again, I would probably count the number of times on one hand I have had to place a "true" tourniquet.

Back to the original post. So yes, I would had removed the improper tourniquet. There are so many times I have arrived to find such garbage on patients. When in reality it was never warranted. I have removed and placed simple good pressure dressing to the wounds, which was the only thing required to begin with. As well, I prefer to examine the wound to be able to document and apply dressing and bandaging. If it starts to re-bleed, I can control it and IF need be re-apply a proper tourniquet. If it truly does appear to have lost a lot of blood, then I may leave alone. Again, depends upon the situation.

Remember, the medical field deals with arterial bleeds everyday. Really, its not that big of a deal. Good direct pressure for a period of time, and then good dressing and bandaging usually controls most of them. Again, this is much different than war injuries in which many are attempting to compare treatment to which are not the same and should not be compared to.

R/r 911
 
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Ridryder911 said:
Yes, I have worked several hundred total amputations (even three patients with leg amputations at one time). Even this event no tourniquets were needed.
Click to expand...
Was it because blood vessels constricted near amputation site, or they still bled profusely but it could be controlled with pressure dressing?
 
No one should hesitate using a tourniquet in a patient that is actively hemmorhaging, losing consciousness with a reported arterial bleed. The risk of tq application is much less than the risk of wasting time applying pressure dressings, elevation, pressure points, etc...How long are you going to wait to see if it works? How much more blood can the patient lose without increasing morbidity? Don't want to rehash the tourniquet arguement, but in this case, it sounds as if it was applied to an appropriate pt (arterial bleed, excessive blood loss, losing consciousness).
 
TK use

I know BLS, I know the rules. But they do say at a certain scope of practice that the tourniqet can be loosened gently / reevaluated even for the benefit of future needed CMS.
I know in the past I have found Tourniquets some that were detrimental, some that had not really been need, but all of them could be gently loosened and replaced w/ pressure dressings, replaced w/ proper tourniquets, or retightened if urgently needed. All w/ hemostasis achieved appropriately.
 
Rid, I've never seen a TK actually needed either, and the dozen or so I've seen attempted were inadequate or harmful. Military is getting much quicker with TK for lesser wounds, I think expediency is also a matter for them...hard to drag the pt away or fire back with one or two hands holding pressure point(s).

Sasha "BLS" versus "I would"...I'm not strictly BLS. (Imagine what Rid or Vent would be doing!)

Foxbat, hard to pressure dress a true complete amputation, or the more common nearly-complete-mangled-mooshed up-sorta amputation.

Boingo, a TK can be rapidly placed to buy time for a pressure dressing, then carefully loosen it off if that is clinically appropriate. However if you are moving things along, you oughta be enroute by the time you are dinking around with a provisional, temporary or ad hoc dressing/TK. This is not your agency policy or probably not kosher in the texts, but it is done by people above first-aid and BLS every day.

And the amount of blood you can lose during a quick check on the wound can easily be equal or less than that lost when it just soaks up into a big old combine dressing or mess of 5x9 ABD's without clotting. Literally throw down some plain old gauze before the fancy stuff, and leave that alone.

Oh, and remember...force to cause that sort of damage can cause other injuries. Do not fixate on the blood and miss the angulated thigh or embarassed airway.
 
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