Can we talk about sequence of operations?

[Iraq Ninja]

If you are part of a team, then everyone on the team has to know the location of everyone's med kit. Some groups require specific locations, for instance, on the left side of your vest. If IEDs are a threat, then the left side is best since most blasts come from the right side. So, you don't want your med kit to get messed up in the blast.

Everyone in your family needs to know how to use your kit as well.

A medic once taught me to carry some of those strong altoids mints. Use them around situations where the smell may make you nauseated, such as open bowel wounds, smelly dead folks, Iraqis who haven't bathed since Saddam was President, etc. I guess the mints overload your sense of smell.

If you expect to do some shooting, then expect to get shot. That means each hit you take may have and entrance and an exit wound. Carry more than one field dressing. I once took an AK round in my right leg, but the bullet partially broke apart when it went thru the vehicle. Some of the shrapnel went into my left leg. I only had two dressings, and used them up quickly. I carry at least four now. We had a total of four guys hit, and we went thru our medical supplies very fast.

Medical training in a classroom is like rifle shooting off of a bench. It is not the best way to learn. Can you use your med kit in the dark, or in a moving vehicle, or upside down in a ditch?

[browningboy84]

After talking to a few flight medics that I know, who service parts of the Panhandle in Florida, some services down there use the Quick CLot ACS, but only after consulting with an ER physician, also known to those of us who are in the EMS business as medica control. It is used, but only on a very limited basis. I have used a tourniquet before, but it was a last resort, and he was tore up from a boat propeller. You can get away with using a tourniquet, but I was told to leave it on for a max of 15 minutes!!!! Remember, most of the time, you can get things done with pressure, a dressing, and elevation!!!!!! Best bet, haul ass to the hospital. You could always do what I have seen a guy do, then he could not stand the pain and called EMS. He took a piece of rebar, heated up with a torch, and cauterized his wound where he fell on a piece of metal......... he wound up worse off doing that..... HINT: Dont do what he did.

[Iraq Ninja]

15 minutes max for a tourniquet? LOL. That is so 80's. We have much more experience now that shows otherwise.

[Joe_Friday]

No offense bb84, but I would not advise taking a tourniquet off until I was at a medical facility that could control the bleeding. It is already a last resort and you have basically given up hope for that limb anyway.

Besides that what are you doing listening to FL medics anyway?




No flames please, I have friends that are medics in FL and its just a friendly joke between most of us concerning what GA medics can do vs. FL medics.

[lazythekid]

JEMS put out a pertinent series of articles a couple of months ago.

http://www.jems.com/resources/supple...on_trauma.html

[browningboy84]

They were flight medics that used to work in Grady County part time when I was working down there. As for the tourniquet, the ER doc himself told me to put it on for 15 minutes, and no more. Besides in 10 minutes, the chopper crew was landing, and 15 minutes later, the medevac was takin off headed to Grady Memorial. No longer my call. I was taught in medic school 15 minutes if you have to use a tourniquet.... Either way, I dont like using a tourniquet!!!!!!!

[rob_s]

I was taught in medic school 15 minutes if you have to use a tourniquet....

Please understand I mean no disrespect, and am trying to learn from those that know more than me...

Do you mind if I ask when you went to medic school? From everything I'm researching and learning with regards to lessons learned coming out of the GWOT, the current thinking has shifted such that tourniquets are considered good for upwards of 4 hours without tissue damage based on real-world case studies from actual use. To the point (if I'm not mistaken) that it's being taught as the first course of action by some agencies.

I'm curious to know if your instructors had this latest (meaning the last few years) information at their disposal when you went through school.

again, not questioning your opinion or experience, just looking for clarification to measure it against conflicting information I'm getting from elsewhere.

[browningboy84]

I graduated in 2007, and my instructor has been around teaching almost 30 years now. She did say that the millitary was conducting studies from what they learned in Iraq and Afghanistan. The ER doctor told me no more than 15 minutes when I had the boating accident back last July. I am not trying to piss anybody off. Personally, I will do what I gotta do to save a life, and if I get in trouble for taking a chance, then so be it. Life over Limb is the guiding principle here.

[Doc Solo]

No offense bb84, but I would not advise taking a tourniquet off until I was at a medical facility that could control the bleeding. It is already a last resort and you have basically given up hope for that limb anyway.

We convert tourniquets to pressure dressings, there is a protocol for it . One of the biggest reasons is precisely how free we are in having people go to a tourniquet. They don't fool around with one failed step in the bleeding control continuum, to go to the next level, etc etc, all the while bleeding out. Getting hit in a low light setting, with the threat still in play means our guys wil go to a TK first. We teach them not to white light illum themselves to try and differentiate from a venous vs an arterial bleed. For obvious reasons.

Tourniquet it. When the threat is addressed, and the dust settles a medic will take a look at you, and based on experience either leave the TK in place or convert it.

As was stated earlier, we have come a long way in de-bunking most of those old tourniquet myths. A lot of it was due to too narrow tourniquets, torqued to a point that they crushed the underlying tissues and structures resulting in needless limb loss. This is no longer an issue with any of the purpose built tourniquets that are commonly being carried.

The current window on tourniquets staying in place is 4 hours, there are people I respect that are saying 6. We don't teach any form of a 15 minute rule, nor have I seen that referenced in any literature or courses I have attended. If we place a tourniquet due to bleeding we couldnt control otherwise, the tourniquet stays on.

[Joe_Friday]

We convert tourniquets to pressure dressings, there is a protocol for it .

To give a little insight to those that may not know, protocols are developed by the Medical Director (Physician) of an individual EMS service. Therefore, you can have two adjacent counties, or two services in the same county, with totally different protocols. What I am getting at is YOU have a protocol for this. In Ohio. I am in GEORGIA and I do not have a protocol for this. As I stated in my orginal post, this information is what I was taught in my AO and in the departments that I have worked for. It may not pertain to you or you may wish to go a different route. If so that is your prerogative.

While I agree that there have been new ideas and new studies that support the use of Tourniquets, there are still many areas that do not agree with these studies and still do not advocate the use of tourniquets except as a last resort or for amputations. The NR, in their infinite wisdom has even added tourniquets to their skills this year, from what I understand.

I have invited a friend and former co-worker that is an EMT-P and the medic that wrote the standards for Tactical Medic I, II and Operator Tactical Medic III for the NAOTM, to join M4C and give us a little insight. He is a gun guy and all around good person. When I talked with him at the range the other day he stated an interest in joining but also said that he was pretty busy with the new NAOTM site (naotm.com), hopefully he will join us.