To Tourniquet or Not to Tourniquet

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As a Prepper or as a Militia Member you may not be up on all the advances in Tactical Medicine. That’s no one’s fault. Things change ALL the time. I teach CERT (community emergency response teams) to preppers and veterans. There are two things in CERT that are almost positive to generate debate from people. 1. CPR in Mass Causality Incidents… or the lack there of. 2. Tourniquet use. Now let me just pause for a second. What I’m about to teach you is NOT taught in CERT. In my opinion it should be. CERT is a FEMA (federal emergency management agency) Program, and we all know how reactive and high-speed they are. What follows is not professional medical advice from a doctor… If you want that follow the links below and be prepared to reread everything I will discuss.

First before we begin let me state what a tourniquet is and what it isn’t. A tourniquet is made of a bandage, strap, webbing, belt that does not stretch 1 3/4 inches to 4 inches. It has a windlass to tighten it and a method of securing that windlass. If you cannot apply a tourniquet with one hand it is not suitable for combat use. Just so we are clear what is NOT an effective tourniquet is thin material such as rope, wire, 550 cord or a SWAT Tourniquet. If you are a cop and that offends you. Let me just say… Your department wants to save money by buying you a rubber band instead of a tourniquet that works reliably. Before you say that they are recommended by Surgeons… NOTE THAT IS IN SURGERY!!! Not in the field. I refuse to risk someones life on the use of a SWAT Tourniquet. AMEDD (Army Medical Department) only recognizes two types of tourniquets for use and purchase and there is a good reason why! Those are the Combat Action Tourniquet (CAT) by North American Rescue and the SOFTT by Tacmedsolutions.com

There is a lot of controversy about the use of Tourniquets. In fact the number one most debated topic in pre-hospital care is this topic. So do you use a tourniquet or not? Yes. Every time there is an extremity hemorrhage you use a tourniquet. BTW your head doesn’t count… Don’t be that guy who tries to tourniquet the neck.

WHAT!?!! That goes against everything I was taught as a; EMT (emergency medical technician), Fire Fighter, Paramedic, Nurse, PA, Doctor, and etc.!!! Well if you are saying that you’re not up on the latest in medical science I will post links below, but allow me to explain…

Your heart and your brain die quickly without blood flow… like in a matter of minutes. Your Kidneys and Liver… anywhere from 30 minutes to an hour. If you have ever slept wrong and woken up with your foot or arm asleep… you know your arms and legs can go significantly longer. Up to 6 hours in some cases before tissue necrosis sends toxins into your body that will send you into toxic shock.

That is why you have always written a big “T” and the time you placed the tourniquet. You still do that. Here is what both Tactical and Wilderness Medicine currently teaches. Assuming it is feasibly safe to help the patient. A Hasty Tourniquet is placed over clothing as proximal (as close to the body) as you can get it. Once that is done then you expose the entire extremity. Then you place a Deliberate Tourniquet that is placed 3-4 inches above the wound site and never over a joint. Then you dress the wound with a pressure dressing. Mark a “T” or “TK” on the forehead of the patient and the time.

If you are more than an hour from higher medical resources… after 1 hour has elapsed from the time you placed the tourniquet then you may SLOWLY loosen the Hasty Tourniquet but leave it in place. If bleeding continues then tighten it. If not proceed to SLOWLY loosen the Deliberate Tourniquet while leaving it in place. If bleeding resumes then tighten it. If not the pressure dressing works.

WHY!?!? Why do it this way? Well it saves a lot of blood. In the field you have no way of replacing blood cells. So while many people think tourniquets are a measure of last resort there is no evidence to support it. In Southwest Asia AKA the sandbox 68% of preventable combat deaths occur from extremity hemorrhage. Since the policy was put in place, how many people needlessly lost a limb due to improper tourniquet placement? ZERO!!! So that means of the 68% of people you can save from combat related injuries need a tourniquet placed immediately.

NOW. Let’s say you’re not convinced. FINE! Assume you are not in Care Under Fire…Here is a process that you can use that will make a tourniquet a measure of last resort in a timely fashion without spilling blood needlessly. If someone is bleeding from an extremity. You place your knee on their leg or arm over either the groin or arm pit… That is what we call a pressure point. THEN you place a pressure dressing and a loosen tourniquet. Remove knee. If there is bleeding then tighten the windlass on the tourniquet. If not then you are good to go. Mystery and controversy solved! Booyah!

Tourniquets work. Here is the proof.

http://www.ncbi.nlm.nih.gov/pubmed/19106667

http://www.wildmed.com/blog/when-to-use-tourniquets/

http://www.health.mil/Education_And_Training/TCCC.aspx

The Dave Black, 68W

ACLS, PALS, NREMT EMT certified.

CLS, CERT, and First Aid Instructor.

 

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About David Black

Trained and Certified: National Registry EMT, Wilderness EMT, US Army 68W, Tactical Combat Causality Care (TCCC), Basic Life Support for Healthcare Workers, Advanced Cardiac Life Support, Pediatric Advanced Life Support, US Coast Guard Medical Person In-Charge, Pre-Hospital Trauma Life Support. International Trauma Life Support. HAM Radio Technician. Trained and Certified to Instruct: Combat Life Saver Instructor and Community Emergency Response Team Trainer. CPR, AED, First Aid.

3 thoughts on “To Tourniquet or Not to Tourniquet

  1. Pingback: The Ultimate Prepper's Medical Kit - Prepper Cult | Prepper Cult

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