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#293928 - 10/24/19 06:54 AM Re: Recon Medical Tourniquets [Re: Jeanette_Isabelle]
Burncycle Offline
Addict

Registered: 09/16/04
Posts: 538
For those who aren't in the medical field, you're going to see a lot of people who are in the medical field saying they rarely used them in their careers.

This is partially because you really don't need them for the vast majority of cases, but also because for a long time it was thought that tourniquets would cause more harm than good if not needed and protocols tended to reflect that.

Through evidence based practice, experiences in combat has changed that mentality over time and slowly some departments started de-stigmatizing them as data regarding how long they can safely be applied has trickled down and become better understood. A properly designed tourniquet, properly placed, will not cause lasting tissue damage over the time periods we will most likely encounter before the patient is handed over to higher medical care. Further, if it turns out a tourniquet is not needed, it can generally be converted in the field to a regular pressure dressing safely (there are some caveats with regards to the time window in which this is considered safe, and how to do it).

I suspect, to a lot of people, it seems like a KISS solution to arrest extremity bleeding, and now that "being prepared" has become in vogue this last decade or so, it's unsurprising that their popularity has risen given their military use and recent proliferation in public safety circles.

We know that a lot of people tend to buy gear over training (unfortunately) and it's become a sort of badge of pride to acquire the cool stuff the Government uses -- but to a layperson who may not have ever really seen significant bleeding before in their lives, any amount of blood could very well be an alarming amount to them, which may result in a trend of tourniquets being used as first line rather than last resort.

Preaching to the choir here of course, but a lot of this can be mitigated through education and I really hope we see a day where the average person becomes literate in basic first aid even out of high school.



Edited by Burncycle (10/24/19 06:58 AM)

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#293930 - 10/24/19 04:35 PM Re: Recon Medical Tourniquets [Re: Burncycle]
nursemike Offline
Old Hand

Registered: 11/09/06
Posts: 814
Loc: wellington, fl
Originally Posted By: Burncycle
For those who aren't in the medical field, you're going to see a lot of people who are in the medical field saying they rarely used them in their careers.

This is partially because you really don't need them for the vast majority of cases, but also because for a long time it was thought that tourniquets would cause more harm than good if not needed and protocols tended to reflect that.



Guilty as charged. Well said, burncycle.

The medical professions tend to guard jealously their technology and job descriptions. I started in this line of work before emergency medicine residencies were invented, and witnessed the creation of ACLS, ATLS, paramedics and automated defibrillators. As each of these developed, wars were fought over the advisability of authorizing folks who were not doctors to perform them. The outcomes of pre hospital care have proven the viability of the plan.

I am not older than dirt, but dirt was brand new when I was born
_________________________
Dance like you have never been hurt, work like no one is watching,love like you don't need the money.

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#293932 - 10/25/19 01:15 AM Re: Recon Medical Tourniquets [Re: Jeanette_Isabelle]
Robert_McCall Offline
Stranger

Registered: 12/27/14
Posts: 17
The other mistake medical pros make is that they confuse THEIR context with YOUR context.

The injuries for which a tourniquet (TQ) is the right solution will kill you in 3-10 minutes, depending on the bleed. How long does it take an ambulance to reach you? When EMS and SAR guys say "I've never needed a tourniquet", how likely is it that they had a 3-10 minute response time to the injured party?

I didn't use a TQ in my EMS time either. But that's because by the time we got on scene, the patient had bled out and was dead.

Medical pros do so much work in a rather narrow, well-defined context that they begin to think everyone else's problems will be in that context too. It's just not true.

Consider an arterial bleed in these scenarios:

- pilot crashes, gets gashed by torn sheet metal
- logger slices open his leg with a saw
- hunter gets shot by another hunter who thought he was a buck

In each case, would EMS or SAR have arrived in 3-10 minutes? No. So their TQ usage rate is zero, and they think everyone else's rate will be zero.

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#293933 - 10/25/19 02:58 AM Re: Recon Medical Tourniquets [Re: Jeanette_Isabelle]
Phaedrus Offline
Pooh-Bah

Registered: 04/28/10
Posts: 2422
Loc: Big Sky Country
Great points, Robert_McCall. A TQ is kind of like a parachute- if you ever need one and don't have one you'll probably never need one again. However rare their application they do save lives, and they're not always easy to improvise. Some of you may recall the logger in Wisconsin that had his leg amputated by a tree; he tried to TQ the stump with his belt but his belt broke! He hobbled to his truck and called 911, then drove as far as he could go before losing consciousness. By a miracle EMS met him halfway and he was saved but the amount of blood he lost was staggering, and there's no way he should have survived. So yeah, he survived without the TQ but I think it was more luck than anything.

In another case I can recall a guy at a public range was blasted through both legs with a .30/06 and survived. There were several guys there to help and improvised TQs were applied (leather belts, natch) and neither was adequate to stop the bleeding.

I carry a lot of things that I have never needed to use: Full coverage insurance on my car, a sidearm and spare mag, etc. Still I know that the fact I haven't used them yet doesn't mean I won't need them in the future.
_________________________
“You can tell whether a man is clever by his answers. You can tell whether a man is wise by his questions.” Naguib Mahfouz

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#293935 - 10/25/19 03:17 PM Re: Recon Medical Tourniquets [Re: Robert_McCall]
haertig Offline
Pooh-Bah

Registered: 03/13/05
Posts: 2098
Loc: Colorado
Originally Posted By: Robert_McCall
The other mistake medical pros make is that they confuse THEIR context with YOUR context.

And the flip side of that is when bystanders confuse a non-emergency with an emergency. They try to help, but not knowing what they are doing, actually do harm.

You see this occasionally - luckily quite rarely - when a bystander with good intentions starts CPR on someone who doesn't need it. Or slathers up a burn victim with their sunscreen cream thinking that will help. Or needlessly drags a person from a car wreck, thinking the car may explode, and paralyses them because they didn't take cervical precautions. Or applies a tourniquet when simple direct pressure would have solved the problem.

IMHO, the solution to the above is training. Everyone should take a basic first aid class. But unfortunately, that will never happen. For every untrained person who successfully apples a tourniquet under appropriate circumstances there will be a matching untrained person who makes a real mess of things and does damage under inappropriate circumstances. So we're stuck between a rock and a hard place.

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