Tourniquet Application (Combat and Legality)

[DragonDoc]

There is a reason that the military has gone to tourniquets as a first line defense against exsanguination. By the time you go through the levels of treatment escalation for bleeding your patient is near death. To many people died needlessly because the medical responders were afraid to use tourniquets. It takes hours before a limb suffers significant tissue damage from lack of blood. We all operate under the one hour "Golden Rule" for trauma. The way I see it, use a tourniquet first to stop the bleeding then evacuate after treating any other life threatening injuries. I also think that if you have a tourniquet in place long enough to cause loss of limb because of delayed evac in the field, then you needed a tourniquet to begin with.

[DragonDoc]

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.

Factor in the "Golden Hour" and the patient will likely keep the limb too.

[NinjaMedic]

The current medical literature is now showing 8-12hrs of viability for the limb with tourniquet use so definitely no concern there in most any reasonable civilian setting.

[Gutshot John]

With the recent war on terror and the influx of medical data as a result, there have been several studies that show that the risk of amputation even after a tourniquet has been applied for several hours has been vastly overstated.

Here is one:
http://journals.lww.com/annalsofsurg...to_Stop.1.aspx

Coupled with a significant improvement in survival rates for applying the tourniquet early on and you understand why the military has gone to the tourniquet as a first line treatment for extremity hemorrhage.

http://brownems.org/2009/08/tourniquet/

Civilian EMS has lagged behind this realization but the change will happen.

[Failure2Stop]

In my experience, it's not a matter of whether or not to use a tourniquet, but rather how many tourniquets to use.

[DragonDoc]

In my experience, it's not a matter of whether or not to use a tourniquet, but rather how many tourniquets to use.

Amen Brother. You can never have to many rounds or use to many tourniquets.

[fireftrjef]

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.

Indeed. I got my NREMTP license in the fall of '09 and it was one of our skill sheets. Pretty basic... Direct pressure - still bleeding - apply tourniquet.

[drsal]

As mentioned above, USE A TOURNIQUET. period. TCCC and PHTLS guidelines, as well as most physician, pa, emt, instructors will teach you to use/apply one or more than one if the situation requires it.

[usmcvet]

As mentioned above, USE A TOURNIQUET. period. TCCC and PHTLS guidelines, as well as most physician, pa, emt, instructors will teach you to use/apply one or more than one if the situation requires it.

When you're talking about multiple T's is it for one wound or several ie a leg and arm.

[drsal]

When you're talking about multiple T's is it for one wound or several ie a leg and arm.

It depends. Sometimes a lower extremity wound may require two trqts, if both upper and lower extremity wounds are suffered then one would place a trqt on both the right arm and left leg for example.