1. Tourniquets for the EMS Provider Connecticut EMS Advisory Board Education and Training Committee Revised April, 2013

2. Goals  Program goals are to: Provide participants with information regarding bleeding control Provide participants with alternative methods of controlling bleeding when direct pressure is not effective

3. Objectives  At the end of the program, the student will be able to: Discuss current techniques for hemorrhage control Describe indications and contraindications of tourniquet use Describe the application process Describe the change in the bleeding control algorithm

4. Introduction  Hemorrhage control Previous Technique  Direct pressure  Pressure dressing  Elevation  Pressure point compression

5. New Recommendation “The use of ‘elevation’ and pressure on ‘pressure points’ is no longer recommended because of insufficient data supporting their effectiveness” (PHTLS, 7 th Ed, 2011. p.115)

6. New Recommendation  Hemorrhage control  Direct pressure  Pressure dressing  Tourniquet (PHTLS, 2011)

7. Indications Hemorrhage from an extremity that cannot be controlled with direct pressure or a pressure bandage

8. Contraindications There are NO contraindications to tourniquet application when faced with the appropriate clinical situation

9. REMEMBER …  Tourniquets can be used for: Life threatening extremity hemorrhage When direct pressure or pressure dressing can not be applied

10. Not all bleeding wounds require tourniquet application! Tourniquets Not Necessary when..

11. Bleeding that Requires a Tourniquet

12. Improvising…  Although a tourniquet can be improvised, it is recommended that a commercially available and thoroughly tested tourniquet be used  Input from EMS Sponsor Hospital/ EMS Medical Director may be helpful

13. Improvised Tourniquet  Necessary items: Tourniquet band At least 2 inches wide Rigid object Stick that is strong enough to tighten the tourniquet and be secured Padding Material placed between the limb and the tourniquet band Securing materials Material that will secure the rigid object once tourniquet tightened

14. Improvised Tourniquet

16. Various Types of Commercial Tourniquets

17. Commercial Tourniquets  Variety of types  Remember ! Must be trained on the specifics of the device Must follow specific manufacturers’ guidelines for application EMS Sponsor Hospital/ EMS Medical Director input on tourniquet selection is recommended

18. Application (1of 3)  2-3 inches above the wound  Watch for other sites of bleeding  above the wound  Multiple bleeding sites  proximal application

19. Application (2 of 3)  Should be tight enough to stop bleeding  The tourniquet should never be placed  Joint (knee or elbow)  Over an impaled object  Extremity should be exposed  Document application time  Write on patient!

20. Application (3 of 3)  A prehospital tourniquet should not be removed by EMS personnel without authorization from their EMS Sponsor Hospital/Medical Direction  If application exceeds six hours, removal should only be done by the physician providing definitive care

21. Pearls  Time of tourniquet application should be relayed to each provider that assumes care  Instruct patient to inform every care provider that they come in contact with that a tourniquet has been placed and its location

22. Questions ?

23.  Special Thanks to Dr. Richard Kamin for his time and effort in the development of this program  Ralf Coler and Terry DeVito for their project coordination  Advisory Board, State of CT Education and Training Committee ACKNOWLEDGEMENT

24. Bibliography  Doyle GS, Taillac PP. Tourniquets: a review of current use with proposals for expanded prehospital use. Prehosp Emerg Care. 2008 Apr-Jun;12(2):241-56.  Prehospital Trauma Life Support, Seventh Ed. Mosby, Inc. 2011