…not the lethal, last resort tool we were all taught to never use! TOURNIQUETS

OLD Bleeding Control Methods Don’t Work for Major Bleeding Direct Pressure Elevation Pressure Points Pressure Bandages

NEW Bleeding Control Methods Do Work for Major Bleeding Direct Pressure – Aggressive direct pressure for a period of time without improvement. Tourniquet – Placed & not removed

Boston Medical Center retrospective tourniquet study 11 Patients – Average age 27 – All male – Mechanisms of injury 55% were GSW (Gun Shot Wounds) 27% were SW (Stab Wounds) 18% were LAC (Lacerations) – Mean on scene time 8.5 Minutes – +/- 4.6 minutes – Mean time of Tourniquets in Place 75 Minutes – +/- 38 minutes

Boston Medical Center retrospective study 100% of GSW patients had injury to a major artery – 50% had concomitant injury to a major vein 33% of SW patients had injury to a major artery 100% of LAC patient had injury to major artery of upper extremities

Boston Medical Center retrospective study ALL but ONE patient survived – Pt who died was pulseless on the scene and only regained pulses with CPR – Remaining patients were all discharged from hospital – Lower Extremity Injury Patients (GSW & SW) 100% recovery No neurological deficit – Upper Extremity Injury Patients (LAC) Both had neurosensory loss, but both were attributed to original injury

Holcomb JB, et al: retrospective study 14 patients who all died from isolated penetrating extremity injuries despite reaching the hospital – 12 of the 14 showed signs of life in the field & required CPR while enroute to the ER – 9 of the 14 were resuscitated and taken to the OR – All eventually died within a 12 hour period, succumbing to the isolated injury Traditional hemorrhage control techniques were used – 8 of the 14 had injury sites amenable to the use of a tourniquet

The reason why so many of our Military men and women are alive today is because of the effectiveness of tourniquets.

So what does this all mean? Should we be deploying tourniquets? What do our protocols say? Uncontrolled Bleeding

Consider… Every time you place a blood pressure cuff, you place a temporary tourniquet. We do this every day, why not do it when the patients life is at stake?

PROTOCOL TITLE: MULTISYSTEM TRAUMA MULTIISYSTEM TRAUMA I. BASIC LIFE SUPPORT 1. Establish and maintain airway. 2. Administer L/min by nonrebreather mask. 3. Control severe external hemorrhage as indicated. 4. Provide spinal immobilization. 5. Stabilize unstable pelvic or femur fractures. a. Pelvic sling. b. Femur traction splint. T3

What does the National Registry Do? Takes and verbalizes, BSI or standard precautions. Applies direct pressure to the wound. Note: The examiner must now inform the candidate that the wound continues to bleed. Applies tourniquet. Note: The examiner must now inform the candidate the patient is now showing signs and symptoms indicative of hypoperfusion. Properly positions patient. Administers high flow oxygen Initiates steps to prevent heat loss from the patient Indicates the need for immediate transportation

Tourniquet Options Combat Application Tourniquet (Top) Mechanical Advantage Tourniquet (Bottom)

THE BOTTOM LINE… “With proper education & training, tourniquets can be adopted into the prehospital system without adverse effects on limb salvage or functional outcome.” JEMS August 2008 Return of Tourniquets

Message from Dr. Hodges… If agencies want to deploy tourniquets when other bleeding control measures fail, I think that is appropriate and necessary to continue to provide the level of care we desire in Benton/Franklin Counties.

How & When to Apply When The patient has and is continuing to lose blood from an external source. The bleeding is from a site distal to the core and amenable to the application of a tourniquet. Aggressive direct pressure has failed to stop the bleeding. How Wrap a 2 inch wide tourniquet, (either commercially made or out of other fabric material), around the extremity above the bleeding site. Tighten the tourniquet until the free flow of blood has stopped. Secure, immobilize, note time, and transport rapidly.

Once Applied Do Not Remove!

1. Following the Skill Sheet Procedures, apply a tourniquet to a simulated patient. 2. Be evaluated by an ALS OTEP Evaluator. 3. Turn in appropriate paperwork to agency training department. Practice!