NREMT Bringing back Tourniquets !!??

[Dustdevil]

Never heard of DEAR here either, but it only took me a second to figure it out. Yeah, he's gonna be pissed.

I am not particularly fond of this change. Combat and tactical concerns are significantly different from civilian, street EMS concerns. In three decades on the street, I've needed a tourniquet a grand total of ZERO times to control haemorrhage. Could I have used it? Sure. There's quite a few times I could have trached someone too, but I didn't need it.

If something can be screwed up, an EMT-B will do it. We see numerous examples every day of EMTs doing things simply because they can, without hard medical indication. Protocol monkeys cooking by the book without ever once thinking about the indications and ramifications of what they are doing. That's what is going to become of tourniquet application.

The problems of tourniquet go beyond the old skool theory of negatively affecting the limb with impeded circulation. There is also the problem of local tissue damage due to overzealous application and/or use of improper materials for the tourniquet. But more importantly -- and more often -- is the false sense of security that comes with the tourniquet. Lazy, clueless EMTs are going to slap that on and then stop watching the wound, believing that it's all taken care of, looking back five minutes later to find two pints of blood on the floor.

The whole purpose of a tourniquet is to apply pressure where there are not enough available hands to do so manually. Typically, this is when you are under fire and need both hands to shoot back. That doesn't occur too often in street EMS. You or one of your firemonkeys ought to be holding that pressure manually, so that you can constantly monitor the effectiveness of the intervention.

If one of those once in a career scenarios arises, where you have severe, uncontrollable arterial extremity bleeding, and you do not have the manpower to apply the pressure and carry out other necessary duties at the same time, then that's a valid indication for a tourniquet. Go for it. But I really fear that this is going to become just another "because I can!" monkey skill for EMTs to misuse.

[Chief1C]

Maybe I hang around old people too much.

[p3medic]

We use tq's fairly often, big fan. There is no reason to try direct pressure, elevation, pressure dressings etc when you have someone with an arterial hemmhorage in shock. There is no benefit to allowing continued bleeding while f'ing around with bandages and pressure points when a quickly and correctly applied tq will do. Holding direct pressure while in a moving ambulance is ineffective and dangerous, no different than doing CPR. The same retard EMT's that place a tq and never re assess it are the same ones to apply a pressure dressing and never re assess it either.

[Dustdevil]

Agreed. My concern is mostly that it will be applied inappropriately. Again, arterial bleeding in a limb in civilian EMS is a damn rare occurrence. And I'd be confident in saying that most EMTs in this country are not competent enough to tell the difference between arterial and strong venous. Just like a lot of morons in Iraq decided to stick Quick Clot into venous wounds, a lot of morons in the US will now stick a tourniquet on them.

[spenac]

Agreed. My concern is mostly that it will be applied inappropriately. Again, arterial bleeding in a limb in civilian EMS is a damn rare occurrence. And I'd be confident in saying that most EMTs in this country are not competent enough to tell the difference between arterial and strong venous. Just like a lot of morons in Iraq decided to stick Quick Clot into venous wounds, a lot of morons in the US will now stick a tourniquet on them.

:shock:

[sirduke]

Was taught tourniquits in the military, way back when, and prior to getting out, they had dropped the process except as a last resort. Have seen some severe bleeding in EMS, but have yet to have a situation that I had to resort to one.

Had one ER doc give me hell for not applying one, and as he was in the process of chastising me, the surgeon came in and his first words were, "Thank God you didn't put a damn tourniquit on."

Needless to say the ER doc shut the hell up and made himself scarce.

[Richard B the EMT]

I was taught the TK back in 1973, when I first started training as an EMT. They told us, "Use it ONLY if it is a choice between the life, or the limb."

In that time, I have never seen one applied by any EMTs or Paramedics in the field.

I have, however, seen makeshift ones, from handkerchiefs or belts, applied by untrained bystanders prior to EMS arrival. You can't really scold them, they think they are doing some good, but I always document, Document, DOCUMENT the details of what aid was supplied prior to me getting there.

[Arizonaffcep]

I've seen 2 for-sure cases for TK's...one came in coding from GSW to the lower leg...the other a guy who got into a fight with a plate glass window (NOOOOO ETOH on that one... :roll: ). The FD didn't use a TK on the GSW...and he bled out...as soon as we infused 6 units and at least as many L's...he painted the opposite wall red (no joke...over 10 feet way!). So...there is a use, but I agree with Dust...not terribly often (and both instances I was working at the trauma center).

[Richard B the EMT]

a guy who got into a fight with a plate glass window

I'll presume the window won, but was really shattered by the experience.

[Asysin2leads]

I've seen 2 for-sure cases for TK's...one came in coding from GSW to the lower leg...the other a guy who got into a fight with a plate glass window (NOOOOO ETOH on that one... :roll: ). The FD didn't use a TK on the GSW...and he bled out...as soon as we infused 6 units and at least as many L's...he painted the opposite wall red (no joke...over 10 feet way!). So...there is a use, but I agree with Dust...not terribly often (and both instances I was working at the trauma center).

Funny you should say that, the last guy I had who honestly needed a tourniquet also had a misshap with a plate glass window after tying one on. I think I even did a post about it discussing glass injuries and exsanguination. All I can say is that this guy had transected literally everything right down to the mid humerus. It looked like a beef roast.