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Discussion in 'Survival Medicine' started by phishi, Jul 24, 2006.

  1. phishi

    phishi Psy-Ops Moderator Emeritus Founding Member

    Let me start by telling a story. Patient is brought into an ER from a Nursing Home. She had attempted to get up out a chair, but had stumbled and ripped open the side of her leg on the corner of a coffee table. Laceration was not terrible, couple of inches long, would need stiches to close.

    The staff at the Nursing Home however had freaked out. First thing that they had done is applied a Tourniquet to stop the bleeding. To compound this mistake, the tourniquet applied was one of the ones used to draw blood. That is, an elastic band roughly 1/2" in width, blue or white in color. Its sole use is to make a vein pop up so that it can be hit with a needle. It does nothing to stop the flow of blood. EMS was on the ball however, the tourniquet was removed, and direct pressure was successfully applied to make the wound stop bleeding.

    Currently there are two schools of thought concerning tourniquet use. Both stem from the idea of life vs. limb. The civillian school is that a tourniquet is never to be applied. This is based on the ideas that higher medical care is only a phone call away, that direct pressure will stop the bleeding, and that more damage will be done to the limb than is warranted. In most cases that you will run across, all of the above is true.

    The second school is one that is being advanced by the military, tactical medics attached to SWAT teams, and possibly even some wilderness medicine. (Note: Wilderness Medicine protocals only come into play if a higher level of medical care is greater than 2 hours away.) This school believes that there are times when appling a tourniquet is neccissary.

    There are only two reasons that a tourniquet should be applied. The first is that the situation does not allow for bleeding control. Having to move a patient due to environmental factors such as a forest fire, flash flood, or rapidly deteriorating situation that involves firearms and big, loud explosives are good reasons to use your training, apply the tourniquet, and move the patient. In this case, the tourniquet should be released before one hour has elapsed.

    The second is after all other forms of bleeding control have failed. All other forms includes elevating the limb, applying direct pressure (This should be done without removing the bandage. If it bleeds thru, slap on another over it, and keep up the pressure. If it stops bleeding thru, you have been successful.), and clamping off the bleeder. (This is something that I have not been trained to do. I present it only as an option, not something that I would reach for first.) If you choose this route, you should dress the wound, while still applying pressure, with the tourniquet in place. The tourniquet should be released at 1 hour to see if the bleeding has stopped.

    Lets discuss what the tourniquet should be made of, and where and how it is to be applied. Material should be firm with little give. It should be 2 to 4 inches in width to help prevent tissue damage. A cotton bandana rolled into a band is a great option, mostly due to the fact that it is something that you may have on you. I would be hesitent to use a belt, most are too thin in width and too stiff to allow for mechanical leverage.

    Mechanical levearage is the second piece of the equation. A windlass type device is needed to get the tourniquet tight enough. If using a bandana, a small stick inserted between the layers (never against the skin) of fabric will be enough. Simply turn the stick until a pulse can no longer be felt at a point past the tourniquet and anchor in place. Remeber that this is going to be uncomfortable for the patient, and that by doing this you have made a choice that may affect the life of your patient. While the patient may live, they may loose the limb that you have stoped the blood from flowing out of. This should give you good pause to consider if there is not another way to do this.

    The easiest way to discribe where placement is to be made, is to think of a tourniquet as a road block. Nothing gets past this point, and as such it must be strategically placed. You want the tourniquet between the heart and the wound. If the cut is on the forearm, for instance, then placeing the tourniquet on the upper arm would be a logical choice. This will then keep the patient's blood from flowing out of the wound and onto the floor.

    Places where a tourniquet does no good are on the trunk of the body (chest, abdomin, pelvis) or the neck and head. It is virtually impossible to stop blood flow to these regions with out killing your patient. If they are bleeding from one of these sites, your best bet is to stop what bleeding you can with direct pressure and move with extreme haste to higher medical care.

    Finally, as in the nursing home case, most bleeding will stop with direct pressure. Some EMS reports that I have read state that even in the case of complete limb amputation, there is little bleeding that can't be controled by direct pressure. I present the above material mostly as an option of last resort that is available to you. Think long and hard before hand, as to if you would be willing to use these techniques.

  2. E.L.

    E.L. Moderator of Lead Moderator Emeritus Founding Member

    Excellent! Thanks Phishi, good info.
  3. TailorMadeHell

    TailorMadeHell Lurking Shadow Creature

    I knew about the tourniquet and the direct pressure and the like. Been through a class of sorts. Not pro though hence the questions.

    If you are in an area with med help a ways off and the victim, let's say has been shot in the torso. You do the direct pressure thing and can you also wrap their torso as if they had broken ribs to hold the pressure gauze in place without causing them harm such as a tourniquet on a minor wound?

    Another thing, you know more than I definitely so I'll believe your answer, however if someone has an amputated limb or a wound in a limb wouldn't it be better to have the tourniquet just a little above the wound so that if they do lose part of the limb, the doctors can save enough to fit them for prosthetics? If so, how close? I don't know, that's why I'm asking.

    Good info by the way.
  4. phishi

    phishi Psy-Ops Moderator Emeritus Founding Member

    TMH: Wrapping ribs when broken is not so common any more. The theory is that it makes it harder for the patient to breath, therefore they breath less deeply. As a result, there is more of a chance for an infection to creep in. That is one of the reasons that they try and get you up and walking the day of surgery. Lying in bed is a sure fire way to get a respiratory infection.

    In answer to question one, it depends on where/how they were hit. Do they have a sucking chest wound or is it superficial? Are any bones broken? Is the lung punctured? My answer would be that provided that the patient can tolerate it, and nothing worse is going on, then yes, wrap to hold the bandage in place. If they can not tolerate it, then tape the bandage in place and have someone (you, the patient, joe blow) continue with pressure.

    Question two, yes, you are probably right. Any number of factors could be at play here, and it does no good to save the limb (or what is left of it) and lose the life. Meaning, get as close as you can while still being effective. If its not working, then move it up higher. I've got nothing to base this on, but it seems to me that if you could place the tourniquet right over a pulse point, then you would have an easier time stopping the flow. That really is nothing more than my .02 cents and an educated guess.....

    Hope this helped,
  5. melbo

    melbo Hunter Gatherer Administrator Founding Member

    nice post.

    I'm taking the morale of the story to be: Only Tourniquet if/when you have to. Use Pressure if you can.


    Good to see you
  6. TnAndy

    TnAndy Senior Member Founding Member

    Tried the tourniquet thing on my little brother once when he fell in a patch of catbriar and was bleeding pretty good around the head area.

    Applied tourniquet right at the neck and it sure seemed to stop the bleeding, however when his face turned this cool blue-black color ( sort of a reverse Michael Jackson effect ), we decided it was probably too tight and switched to bandaids.

    No permanent effect from it, unless of course you count that tick thing and the way he slurs his speech......which I personally believe is just to get attention.


    Good to see ya phishi.....thanks for the info.....continue on !
  7. sniper-66

    sniper-66 Monkey+++ Moderator Emeritus Founding Member

    The military has started to issue the CAT tourniquet. It is a one handed tourniquet with it's own stick. Hard to come by, but fairly effective.
  8. phishi

    phishi Psy-Ops Moderator Emeritus Founding Member

    Good to see all of you, sorry that it has been so long between posts.

    Sniper brings up a good point about military issue tourniquets. They can be found at sites like Lightfighter, some military medical sites, others. Some models work bettter than others, and you will pay heavily in price for what could be improvised from what you probably have in your pockets.

    Their advantage is that they can be put on by you. Imagine that you are hiking by yourself and take a fall, resulting in a bad cut on your arm that you can't effectively apply pressure to. If you tried the bandana trick, you may find that you are spinning your wheels. One of these new fangled one handed tourniquets however may be just the thing to fix ya.

    Take it for what its worth. Remember, if you decide that the risk is worth cost, it does you no good to leave it at home. Make sure that it is with you, in a reachable spot, by both hands.

    Just my .02.
  9. TailorMadeHell

    TailorMadeHell Lurking Shadow Creature

    Thanks for all the posts. The more information I can get is the more information I can use.
  10. monkeyman

    monkeyman Monkey+++ Moderator Emeritus Founding Member

    I was just wondering if I had outdated or wrong info but had heard that if you did the tournaquet you would leave it applied for something like 15 min then release it for a min or 2 in order to let enouph blood flow to keep the limb viable while greatly reduceing the amount of blood loss.
  11. Quigley_Sharps

    Quigley_Sharps The Badministrator Administrator Founding Member

    That was taught to me in the Service. in the 80's
  12. phishi

    phishi Psy-Ops Moderator Emeritus Founding Member

    The most recent I've found states no more than 1 hour and then release. If I remember correctly, the limb is no longer viable after 4 hours. Between 1 and 4 you have various form of tissue damage.

    That being said, there is no reason that you can't release before 1 hour and see what happens. You must continue to hold pressure and see if the bleeding comes thru. If it does, snug the tourniquet back up and continue holding pressure.

    Hope this answers some questions.

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