Severe Hemorrhage Control Application of the SOF® TACTICAL TOURNIQUET - WIDE

Medical Director Approval Before using tourniquets, all services must have: Patient care guideline (protocol) signed by the medical director Training, approved by the medical director, on the use of tourniquets State EMS Unit approval of the protocol and training

Objectives Discuss the indications, contraindications and considerations in the use of a tourniquet for hemorrhage control Identify the steps required to control major hemorrhage with a Tactical Medical Solutions SOF® TACTICAL TOURNIQUET - WIDE Review documentation and communication requirements of the procedure

Indications Severe bleeding of an extremity that is not controlled with direct pressure Severe bleeding of an extremity when resources to provide direct pressure are limited MCI, tactical situation, difficult extrication Don’t wait! Application of a tourniquet before the patient goes into shock has been shown to improve outcomes in military studies

Contraindications There are no true contraindications to the use of a tourniquet when used to control life-threatening hemorrhage when direct pressure has failed or is not practical

Considerations Tourniquet application will likely be painful Tourniquet application has been associated with tissue damage but this is generally minor and often temporary Tourniquets are typically safe for up to two hours. A tourniquet should never be removed without medical control consultation.

The SOF® TACTICAL TOURNIQUET - WIDE Constricting Band Triangle Ring Quick-Release Buckle Loose End Windlass

Procedure Remove clothing and expose wound Do not remove previously applied direct pressure

Procedure Disconnect the quick release buckle

Procedure Route the band around the injured extremity Place the band 2 – 3 inches above the wound Do not place it over a joint

Procedure Reconnect the quick release buckle Remove the slack by pulling the loose end of the band

Procedure Turn the windlass to tighten the tourniquet Tighten until major blood flow stops Slight seeping may still be present

Procedure Lock the windlass in place by slipping the triangle ring over the end of the windlass Triangle ring End of windlass

Procedure Note time of application Keep tourniquet visible Do not cover with blankets Ongoing re-assessment for return of active bleeding Tighten windlass, then Apply 2nd tourniquet if bleeding remains active

Notify all caregivers involved in the care of the patient that a tourniquet has been placed http://www.bdems.com/med3.htm news.legalexaminer.com http://www.postindependent.com/article/20050621/VALLEYNEWS/50620012 ALS Ground Intercept ALS Air Intercept Emergency Room Report

Documentation Indication for tourniquet Time of placement Severity of bleeding Failure of direct pressure Time of placement Tourniquet location Change in patient condition Provider performing skill Complications Communication to hospital about tourniquet

Complications Consider placing a second tourniquet above the first one if severe bleeding continues Generally, tourniquet application is safe for up to 2 hours Contact medical control before loosening or removing a tourniquet