A question on Turniquets for any of the first responders here.

The Last Standing Knight

The Last Standing Knight

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For my new post I had to take the American Red Cross CPR/AED/First Aid course. These days its on line instead of an active classroom.

It has been over twenty years since I had that certification and of course things have changed quite a bit...but one thing that concerns me is the use of a turniquet almost as a regular course of aid. I'm not totally onboard or comforatble with that.

IIRC the use of a turniquet was an absolute LAST RESORT for an injury to prevent either complete bleedout or due to a traumatic amputation. Anyone here know when that outlook changed?

IIRC the use of a turniquet almost guarenteed the loss of the limb beneath it

I've seen the turniquets in police supply and uniform stores all over the place and it seems they are far more widly used these days than I thought. Can anyone chime in on this?

Thanks!
 
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Advances in vascular surgery over the past years has made it so that if a person who has had a tourniquet applied is promptly brought to a trauma center, it is very unlikely that it will cause a loss of limb. Where I am, since the Boston Marathon bombing, tourniquets and "quick clot" are part of every police officers kit and everyone is required to annually certify in their use. I think a lot of the misgivings about their use comes from Hollywood and urban legend. It's really not all that complicated to learn how to properly use them.
 
Agreed.

I learned about their use in elementary school...then they were used for snake bites, etc.
In the military is where we were taught the drawbacks of them.
Times have changed...in this case for the better it seems. I hope I never have to use the training.

Thanks! I appreciate it!
 
The Last Standing Knight said:
For my new post I had to take the American Red Cross CPR/AED/First Aid course. These days its on line instead of an active classroom.

It has been over twenty years since I had that certification and of course things have changed quite a bit...but one thing that concerns me is the use of a turniquet almost as a regular course of aid. I'm not totally onboard or comforatble with that.

IIRC the use of a turniquet was an absolute LAST RESORT for an injury to prevent either complete bleedout or due to a traumatic amputation. Anyone here know when that outlook changed?

IIRC the use of a turniquet almost guarenteed the loss of the limb beneath it

I've seen the turniquets in police supply and uniform stores all over the place and it seems they are far more widly used these days than I thought. Can anyone chime in on this?

Thanks!
Click to expand...

(Please read to the end!) To start, let me say I know of which I speak - I was a professional paramedic for 30 years before I retired from fire-rescue work and not only did I do the work but I taught it as well. I was also a "preceptor" working with pm students, pm interns (newbies), and remedials. For most of the 2nd half of my career I was an EMS Supervisor in both the Lt and Capt ranks - so I can say with authority that I completely agree with what you've said in your post.

The concept of a tourniquet (TK) as a "last resort" method of bleeding control has never changed. But what has changed is the ease of using a TK with the modern military-style versions and how overly convenient they've become. This is the exact reason why my personal first-aid kit in my vehicle is loaded with "traditional" bandages and dressings and up until very recently I never carried a single TK at all.

Without getting into a long dissertation on bleeding control, the CORRECT use of a TK will be extremely PAINFUL, so much so as to most probably require medication if the situation warrants. It also completely debilitates the limb in question and the application demands IMMEDIATE transport to an advanced treatment facility (preferably with a surgeon available and standing by).

Notice that I wrote "CORRECT" above - because in the majority of cases I reviewed where a TK was applied it was either not called for in the circumstances or not applied correctly. In my view, the fact that it was messed up more often than not was the only saving grace of it being over-used - but that is NOT something to be relied on. I could go on and on, but this reply is long enough already!
 
A neighbor's life was saved due to the use of a necktie after a chainsaw accident. ER personnel said that without it, he'd bled out before reaching the hospital. They have other uses as well - I have a couple in my hunting backpack.
 
Eons ago when I took military first aid, you used whatever was available for a tourniquet. We were told to forget any stories of loosening it every so often. The tourniquet was used to save the life, not the limb.
 
A couple of days after the bombing, once the FBI made their ID's public, the Tsarnaev brothers executed a MIT police officer in Boston. Shortly after, the Watertown PD saw a car matching the description of a car that was at the scene and chased it into a neighborhood. There was a gun battle at that point. One of the Watertown officers got hit in the groin and his femoral artery was cut. It was never determined, or at least made public, weather he was hit by a bullet fired by the brothers or was hit by friendly fire. Another officer had some training and used a bootlace to stop the bleeding. The EMT's were out a ways and the officer would have lived about another three minutes had he not gotten that tourniquet applied. The gunfight ended with the death of the older brother. The younger one, Dzhokhar Tsarnaev, was able to drive away, running over the other brother in the process. A VERY large manhunt then started. I can tell you that until the "peaceful protests" we had a couple of years back, I had never seen so many police officers in one operation. Watertown was essentially shut down and the search was house to house. Tsarnaev was somehow able to slip through. He made it to the next town and hid in a boat in a back yard. The homeowner noticed that the shrink wrap on the boat was disturbed and went to check it out. He found him hiding and called the cops who took him into custody. He's now living large at the Federal prison in Colorado. The point is that this was one of those incidents that profoundly changed a lot of things in policing in New England. Once the response was analyzed, everything from radio communication to firearms training had changes. One of those things was first responder first aid. That's how we ended up with general issue of both tourniquets and quick clot. Neither of which were part of the curriculum prior to this incident for officers who were not certified EMT's .
 
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cmj8591 covered it. Things change. Like you, back when I first learned any of this stuff the tourniquet was the last resort. Cops almost everywhere now carry them on their belts. I've known a few instances where local guys used them in the field.

I walked into a high school classroom last week just as they were teaching students to apply tourniquets.
 
The stuff about using a tourniquet meant loss of the limb was based on World War 1 conditions where it could be days before a patient saw a surgeon.

One of the trauma surgeons I worked with started to push the use of tourniquets in the mid 1980s. That was based on his experience as a USN surgeon in Vietnam.

What he told us was that surgeons routinely put tourniquets on patients for 5-6 hours in the operating room without any issues. Putting one on for an hour is no risk.

One thing I can tell you is that the pain is excruciating once the tourniquet is applied.

A lot of police departments issue them to officers. I believe the military now includes them in self care kits.

See if you can find a "Stop the Bleed" course near you and take that too.

The Last Standing Knight said:
For my new post I had to take the American Red Cross CPR/AED/First Aid course. These days its on line instead of an active classroom.

It has been over twenty years since I had that certification and of course things have changed quite a bit...but one thing that concerns me is the use of a turniquet almost as a regular course of aid. I'm not totally onboard or comforatble with that.

IIRC the use of a turniquet was an absolute LAST RESORT for an injury to prevent either complete bleedout or due to a traumatic amputation. Anyone here know when that outlook changed?

IIRC the use of a turniquet almost guarenteed the loss of the limb beneath it

I've seen the turniquets in police supply and uniform stores all over the place and it seems they are far more widly used these days than I thought. Can anyone chime in on this?

Thanks!
Click to expand...
 
I had to take 1st aid every year for many, many years. The instructors(EMTs nurses)seemed a bit cynical about the frequent changes to protocols.
 
I took a local Trauma Care class a couple years ago and the instructor made the point that new life saving protocols came about with the IED's encountered in Iraq and Afghanistan. Common availability and use of TQ's and hemostatic agents increased survivability dramatically. Probably one of the few good things to come out of those conflicts.
 
We carry them and train with them. That being said, when SHTF can you find your sharpie and mark the time? And remember to loosen periodically? If I have to self apply can I? IDK. Also quick clot has become a lot more advanced. My son slashed his hand when I wasn't home and he grabbed a bag of my quick clot and applied it. I arrived a few minutes later and was worried he would have substantial damage. The ER doc shrugged and said the stuff is much better now. No real tissue damage and stopped the bleeding. I still would like to apply a tourniquet to some people's neck but I digress. I'm probably no help to your question and there are a lot of wounds where they can't be applied. But bleed out or lose a limb? I'd choose to control the bleeding.
 
I used them often over the years and we never marked the time on anything. That was mostly because we had short transport times, but even if we didn't we wouldn't do that.

Again, that's from the WW1 training that carried over through WW2, Korea, and into Vietnam despite time to surgery getting ever shorter. Just like the traction splint and Trendelenburg position. All outlived their usefulness, but EMS training took a long time to catch up.

As for loosening the tourniquet periodically, same thing. If you loosen tourniquet, you'll just start the bleeding again.

BTW, the #1 mistake people make when applying a tourniquet is not applying it tightly enough.

Also, if shoe laces, neckties, a kerchief, or your belt stop the bleeding then a tourniquet wasn't needed in the first place.

All those John Wayne westerns were wrong.



John_M52 said:
We carry them and train with them. That being said, when SHTF can you find your sharpie and mark the time? And remember to loosen periodically? If I have to self apply can I? IDK. Also quick clot has become a lot more advanced. My son slashed his hand when I wasn't home and he grabbed a bag of my quick clot and applied it. I arrived a few minutes later and was worried he would have substantial damage. The ER doc shrugged and said the stuff is much better now. No real tissue damage and stopped the bleeding. I still would like to apply a tourniquet to some people's neck but I digress. I'm probably no help to your question and there are a lot of wounds where they can't be applied. But bleed out or lose a limb? I'd choose to control the bleeding.
Click to expand...
 
My Boy Scout days are long past and I am not any kind of first responder, but since we're talking about stopping bleeding I wanted to add my little bit of experience.

It's amazing how some of the ancient treatments still work. Did somebody cut themselves badly in the kitchen and are bleeding like mad? Check the spice rack for cayenne pepper. Pour the cayenne pepper right on the cut and don't skimp. I had read somewhere that Indians in South America used cayenne pepper as an astringent for cuts, and it works! How do I know it works? I've used it as a first aid measure, on MYSELF.
 
The Last Standing Knight said:
IIRC the use of a turniquet was an absolute LAST RESORT for an injury to prevent either complete bleedout or due to a traumatic amputation. Anyone here know when that outlook changed?

IIRC the use of a turniquet almost guarenteed the loss of the limb beneath it
Click to expand...

Has changed a long time ago. Just like with everything else, medical assessments and procedures change as well. I'm not a dr., but I took some med classes during my time in mil and le.

An injury assessment still needs to happen, one just doesn't slap a TQ on. Unless it's gushing out. Don't forget to get off the X as well!

I'd recommend getting in touch with the guys over at North American Rescue.

They have great products and put out lifesaving info via social media, free of charge.

Other medical pages to follow are savageparamedics, nardoctor, global_surgical_medical_group, the_resuscitationist, specialforcesmedics, drmikesimpson and others. Look for them on social media :)
 
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Medical science once advocated intentional bleeding for many ailments, and high doses of mercury to cure syphilis.

100 years from now, stuff like CAT scans will seem barbaric. Things change...
 
In the early 1960’s my dad was an ambulance driver. After basic first aid he basically drove a station wagon to transport an injured person to an ER.

My son is a major metro firefighter/paramedic. Their rig has more advanced medical technology than the ER that my dad was driving to.

Thank god for the advances in medical technology.
 
okiegtrider said:
cmj8591 covered it. Things change. Like you, back when I first learned any of this stuff the tourniquet was the last resort. Cops almost everywhere now carry them on their belts. I've known a few instances where local guys used them in the field.

I walked into a high school classroom last week just as they were teaching students to apply tourniquets.
Click to expand...

Yes things do change - but some things don't. When I've asked people (including instructors) why they were placing so much early emphasis on the use of tourniquets I typically get referred to the package insert or advertising copy from the company that makes the things. A quick look through current first aid manuals and even a Google search for "when to use a tourniquet" reveals that the manner and reason involving tourniquet use hasn't changed since they started writing this stuff down in books.

The only real reason why they are receiving such attention is because the current generation of military-type tourniquets are both cheap and easy - neither of which is a valid reason to place any more emphasis on them over more traditional procedures for bleeding control. I even believe that more time and practice should be given over to the Israeli-style trauma dressings and the use of coagulants such as Quick-Clot that I currently see. Unfortunately, however, those items are quite a bit more expensive and don't stand up to repeated use in practice, even if they should be used first (or second or third) before a tourniquet.

The use of a tourniquet does not take the place of good bandaging practices and skills. Pay much more attention learning how to use modern tools for bleeding control such as "crepe tape", Israeli dressings and Quick-Clot; tourniquets should only need about 20 minutes for lecture and practice and not really much more.
 
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