Tourniquet Use

[LoneRider]

As a military veteran I've had nearly three years worth of CLS initial training and recertifications under my belt. During those training sessions I was taught that tourniquets are not last resorts for controlling bleeding from extremities and the MARCH system of patient assessment (Massive Bleeding, Airway, Respiration, Circulation, Head Injury/Hypothermia). I am also aware that military trauma treatment methods don't always mesh with civilian trauma treatment methods as what military medics/Corpsmen deal with differs vastly than what civilian paramedics deal with on a day to day basis.

I'm curious as to what EMS doctrine (at levels ranging from the first responder, EMT-B and EMT-Paramedic), so to speak, is regarding tourniquets? The last thing I recall was that tourniquets were viewed as last resort measures when it came to first aid. Admittedly the reference I got that from was a lecture given to me as a student at the National Outdoor Leadership School in Lander, WY in 2005 and shipboard damage control training from 2006-2008 timeframe when I served in the US Navy before I transitioned to the US Army in 2009.

*Hyperlinked thread leads to a discussion I'd started over a year ago regarding the MARCH versus ABC (Airway, Breathing, Circulation) means of assessing patients.

Edited March 21, 2011 by LoneRider

[Happiness]

So I am a PCP which is a basic in the states. I am trained the tourniquet is a last resort. The reasoning is that most bleeds can be controlled with direct pressure, and that by appling a tourniquet the blood supply distal to it is stopping and going to die. This means that if there was a chance that a limb may be reattached chances are going to be slim.

So with that being In a military arena I can understand why it would be different, as you are a situation that the chances of a limb being reattached is basicaly next to none so why worrie right?

[island emt]

our current protocol for severe bleeding control is to:

A. Apply direct pressure dressing to wound.

B. Apply pressure point control to artery above injury site.

C. Use of a mat type tourniquet 2 inches above the injury site.

This protocol is for all license levels from first responders up to Critical Care Paramedics.

We all carry a commercial tourniquet such as the MAT, which was designed for US military troops for use in the field.

[Happiness]

our current protocol for severe bleeding control is to:

A. Apply direct pressure dressing to wound.

B. Apply pressure point control to artery above injury site.

C. Use of a mat type tourniquet 2 inches above the injury site.

This protocol is for all license levels from first responders up to Critical Care Paramedics.

We all carry a commercial tourniquet such as the MAT, which was designed for US military troops for use in the field.

The above is what I ment with extra babble

[Richard B the EMT]

our current protocol for severe bleeding control is to:

A. Apply direct pressure dressing to wound.

B. Apply pressure point control to artery above injury site.

C. Use of a mat type tourniquet 2 inches above the injury site.

New York State protocol, at both BLS and ALS level.

Also, as where I have been working, the NYC metyropolitan area, I have the advantage of usually being no more than 15 minutes from an ER, and 30 from a Trauma Center, so I know how to apply one, but never, in 37 years, have had to apply one.

[fakingpatience]

In my two different systems we had different protocols

In my old system bleeding control was

1. Direct pressure

2. Tourniquet/ quick clot (depending on location of wound)

My new system:

1. Direct pressure

2. Pressure point

3. Tourniquet. BUT we don't carry and official tourniquets, so you have to make shift one...

I believe the new research showed that a tourniquet for a short (I believe w/ in 5 hours) amount of time is actually not as detrimental as once believed to the pt, and so you might as well skip to that vs. attempting a pressure point.

[Richard B the EMT]

I just realized that I misspoke. The actual order in New York State is:

A) Direct pressure to the site,

If possible, elevate the site to above the heart,

C) Pressure Point,

D) Tourniquet.

[uglyEMT]

I just realized that I misspoke. The actual order in New York State is:

A) Direct pressure to the site,

If possible, elevate the site to above the heart,

C) Pressure Point,

D) Tourniquet.

Thats the current NJ protocol as well

soon to be changed though after the research faking stated.

Direct pressure

Tourniquet

Glad to see our Medical Director is foward thinking and used sound research in protocol making.

[ccmedoc]

here is a decent article [re]examining the use of tourniquet in civilian practice..

Doyle, G.S., & Taillac, P.P. (2008). Tourniquets: a review of current use with proposals for expanded prehospital use. Prehospital Emergency Care, 12(2), 241-257.

[AnatomyChick]

The New Guidelines are: Direct Pressure and then Tourniquet. My 'guess' is that in 10 more years, we'll go back to: Direct Pressure, Elevation, Pressure Point and THEN Tourniquet. This has been an on again off again thing for many years.

By the way... The latest feedback on the use of Tourniquets in the Civilian World is based on the success with them out in the Sandbox.

AC