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Tourniquets. Do they belong in civilian EMS ?. Tourniquets. Do they belong in civilian EMS ?. If Yes How and When. Hemorrhage Control in the Field Non-combat patient care. Direct hand pressure. Yes. Pressure Bandage. Hospital. No. Torso. Extremity. Hemostatic Agent. Tourniquet.

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tourniquets

Tourniquets

Do they belong in civilian EMS ?

tourniquets1

Tourniquets

Do they belong in civilian EMS ?

If Yes

How and When

hemorrhage control in the field non combat patient care
Hemorrhage Control in the FieldNon-combat patient care

Direct hand pressure

Yes

Pressure Bandage

Hospital

No

Torso

Extremity

Hemostatic Agent

Tourniquet

Hospital

tourniquets phtls scientific panel 2008
TourniquetsPHTLS Scientific Panel 2008
  • Were we wrong?
  • Why?
  • Do they work?
  • What is their place in modern EMS
    • Civilian
    • Military
  • Guidelines for their use
tourniquets2
Tourniquets
  • Why were we wrong?
    • Don’t confuse me with no data, my mind is made up?
    • The data does not support their use
    • Data? What data?
    • Medical
    • Well if you put them on, that determines the level of the amputation. They distal extremity will die.
    • If they are too tight, the artery will be damaged.
    • If they are too tight, the nerve will be damaged.
albert sidney johnston general confederate army
Albert Sidney JohnstonGeneral, Confederate Army
  • Gun shot would to thigh
  • Blood ran down into boot
  • Directed medic to another solder
  • Exsanguinated
  • Tourniquet would have saved his life
  • Reportedly in his pocket.
tourniquets clinical experience
TourniquetsClinical experience
  • Kandahar AFB - 4 months (2006)
  • 134 patients treated
  • 6 patients – 8 tourniquets
  • Lives saved = 4 patients – 5 tourniquets
  • Misuse = 1 venous tight only => Bleeding
  • Prolonged use = 1 (4 hours) no complications

Tien et al

JACS ‘08

tourniquet s clinical application
TourniquetsClinical application
  • Combat operations => delay in transport
  • 16 hours = no complications
  • Patient life saved

Kragh et al

J Ortho Trauma ‘07

tourniquets clinical experience1
TourniquetsClinical Experience
  • UK Joint Trauma Registry
  • 66 months
  • 1375 patients
  • Tourniquets = 70 (5%) patients
  • Tourniquets used = 107
  • 2 or > = 24%
  • 87% survival

Brodie et al

JR Army Med corps ‘07

tourniquets clinical experience2
TourniquetsClinical Experience
  • Vietnam KIA exsanguination = 9%
  • OTF 31st Combat Support Hospital
  • 12 months = 3444 patients
  • Major vascular, traumatic amputation, tourniquet
  • 165 patients
  • Prehospital tourniquet = 67 (TK)
  • Severe extremity injury no tourniquet = 98 (No TK)
  • Bleeding control = TK=83% vs No TK-60%
  • Secondary amputation = TK=6% vs No TK=9%
  • Potentially preventable deaths = 57%

Beekley et al

J Trauma ‘08

military tourniquet design criteria
Military TourniquetDesign Criteria
  • Self applied to arm
    • On handed
  • Elimination of arterial blood flow
  • 3 tourniquets met the requirements
    • CATT
    • SOFT-T
    • EMT

Walters

ISR Technical Report

tourniquets clinical experience3
TourniquetsClinical Experience
  • Israeli Defense Forces
  • 550 patients
  • 91 prehospital tourniquets (16%)
  • Injury to application 15 minutes
  • Ischemia time = 83 minutes
  • 78% effective

Lakstein et al

J Trauma ‘03

hemorrhage control in the field non combat patient care1
Hemorrhage Control in the FieldNon-combat patient care

Direct hand pressure

Yes

Pressure Bandage

Hospital

No

Torso

Extremity

Hemostatic Agent

Tourniquet

Hospital