Tourniquet Application (Combat and Legality)

[J8127]

Curious to hear from some EMT and above types on this, especially anybody with first hand expirience.

I am military with basic medical training. Aside from the standard B.S. self aid buddy care I have been through the "old" Combat Lifesaver where you actually did saline locks and such, and (wait for it) basic life saver (CPR and Defibrillator). Not looking for cool guy points, just giving you my (brief) background.

My question(s) are about the application of tourniquets because I have conflicting training. SABC teaches (or at least it did in BMT a few years ago) that a tourniquet is a last resort, only to be used after pressure, dressing, blah blah blah has been applied and the alternative is to bleed out. The limb will most likely be lost, etc... This belief seems to still be prevalent amongst grunt types.

CLS, (an Army course), taught to just go the tourniquet in a combat situation because it was the fastest, most effective way to treat bleeding. I was also told that a tourniquet is not the fast lane to amputation and that as long as the casualty gets to "real" medics in 6-8 hours the tourniquet will not be an issue in that regard.

So my combat application question is which one is correct, or neither?

Which brings up a civilian use question, what are the legal issues with tourniquets? I carry a tourniquet on my kit where I can get to it with either arm, should it stay there in a civilian scenario?

[Weaver]

Combat use - do not be afraid of using tourniquets (TQs) as there is no real risk that it will be the determining factor of whether the patient loses a limb or not - but not using one could well be the determining factor on whether he survives or not. When in doubt, especially in the rapid-evac combat model of today, use the TQ.

In the civilian world, the rules depend on what a "reasonable person" would within the limits of their training. While many civilian protocols still preach the old scare stories about TQ use, the bottom line is that if you cannot stop the bleeding any other way, the TQ is the treatment method of choice. As long as you can show that you have been trained to use TQs, and that you attempted to stop the bleeding using other methods before resorting to the TQ, you will be fine.

When I taught EMT as a Lab Instructor, we used to remind students that all 50 states have "good Samaritan" protections, and that as long as you do not exceed your limits of training, you may well be sued (anyone can sue anyone else for anything) but that you will not lose - and probably won't even go to trial.

Bottom line - TQs save lives in cases of serious extremity bleeds. Use them as needed in conjunction with your training. Don't be afraid of them, any more than you are afraid of direct pressure or pressure dressings.

[rsgard]

In my paramedic class a couple years ago we were taught that if the circumstance permits you should go straight to a tourny to stop immediately life threatening bleeding. We were told new studies showed that as long as the tourney wasnt on longer than 2 hours it didnt cause any damage to the limb. Its hard to tell if a tourney use means more amputations because of the nature of the injury might warrant amputation with or without a tourney.

As far as good samaritan laws in ohio it only covers non trained personel. So as a paramedic im not covered.

[ZX672]

From a tactical standpoint, it is "X"ABC

X - Get off the X, apply T to stop life threatening bleeding (we are talking arterial bleeds...).

A, B, C

Like others have mentioned before, surgery techniques have evolved to the point were limbs can be saved after several hours of T use.

[Danny Boy]

If you're military and not a Whiskey or other medical MOS, please use a tourniquet as high up on the limb as you can that bleeding is coming from. It can be downgraded easily if needed later but the main priority is to keep as much blood inside the body as possible. Turn off the faucet to that limb if it's leaking and then continue assessing for other injuries. It will buy you valuable time if there is bleeding that cannot physically be controlled by other means than direct pressure to areas like the neck or pelvis.

[dsa]

Pre-Hospital Trauma Life Support (PHTLS), Advanced Trauma Life Support (ATLS) and International Trauma Life Support (ITLS) all recommend the use of a tourniquet to control life threatening bleeding.

[J8127]

I appreciate the feedback, thank you

[ST911]

Pre-Hospital Trauma Life Support (PHTLS), Advanced Trauma Life Support (ATLS) and International Trauma Life Support (ITLS) all recommend the use of a tourniquet to control life threatening bleeding.

Those curriculum revisions will also soon be seen is DOT EMT training as well. Direct Pressure --> TQ.

In general, application of the TQ depends on wound type, location, bleeding, blood loss, distance, etc.

When and how you apply the TQ, and what you do afterward, is dictated by the protocol or standard of care you are bound by and accountable to. Bystander layman's first aid is pretty permissive, and if you have no duty to act, applicable good sam law will be a help.

[NinjaMedic]

If you come across someone civilian or otherwise with a hole in the them bad enough to make you say "damn thats ****ed up" or "shit thats a lot of blood" and there is room on the limb to put a tourniquet, put the tourniquet on the limb.

Most people grossly overestimate the loss of blood. This works in our favor and lowers the threshold for placement of a tourniquet. THIS IS A GOOD THING. If you guess wrong, oh well, too bad, someone can remove the tourniquet later from the still living person.

[crashbubba]

Tourniquet use after direct pressure has been on the NREMT skill sheet for bleeding control since last year. Last year's Brady Book also had the change.

Lots of medicine science is coming out of OEF/OIF that leads to changes on the EMS side. Some don't directly correlate but the benefits are there.

I just took NAEMT's TCCC course. It was interesting to see the military techniques that are now being presented en mass to the EMS community. It was painful to see career medics try and wrap their heads around the austere environments that these techniques were originally developed for.