A tourniquet is like a firearm, you never need one until you need it very badly and you need it RIGHT NOW!
I can think of 5 incidents of the top of my head where I would have used hemostatics if I had them and 3 cases where I had hemostatics and used them very effectively. All but one of those incidents were gunshot wounds. As for tourniquets, what we have been finding is that EMS providers working in an urban or suburban setting underestimate the need applying a tourniquet due to the proximity of hospitals.
It is not uncommon to see trauma patients brought into the ED with stacks of soaked through dressings. Pressure dressings are not always effective. They work for the majority of bleeds we encounter, especially the new dressings like Cinch-Tight, H-Dressing and Israeli dressings but sometimes a "bigger hammer" is needed.
I look at both these adjuncts (tourniquets and hemostatics) as some of the drugs we carry in our drug box... you use them rarely but when your patient needs them there is no replacement. They take up very little space and weigh next to nothing.
If there is anything worse than a loose cannon on the decks, it would be a rusty loose cannon..
So, I am a rusty loose cannon, seeking enlightenment...
Years ago, as an EMT primarily doing mountain SAR we treated numerous major wounds doing just fine with direct pressure and pressure points. At no time did we need to resort to a tourniquet. This included one situation involving an amputated arm (bad mistake with a rear rotor).
I recall talking with a fairly new paramedic friend and colleague, about the number of times he had used a tourniquet on the street. Drawing on about three years experience, he said he had never needed to use one.
Now I see a lot of excitement over the new clotting agents. I have no doubt they have value in a battlefield environment, but I, like many of us, am not on a battlefield.
Is it really worth carrying any of the clotting materials in a standard FAK, given that the vast majority of situations can be handled with direct pressure, and, in extremis, with the big T?
Previous Topic
Index
