Severe Hemorrhage Control

1. Severe Hemorrhage Control Application of theSOF® TACTICAL TOURNIQUET - WIDE

2. Medical Director Approval • Before using tourniquets, all services must have: • Patient care guideline (protocol) signed by the medical director • Training, approved by the medical director, on the use of tourniquets • State EMS Unit approval of the protocol and training

3. Objectives • Discuss the indications, contraindications and considerations in the use of a tourniquet for hemorrhage control • Identify the steps required to control major hemorrhage with a Tactical Medical Solutions SOF® TACTICAL TOURNIQUET - WIDE • Review documentation and communication requirements of the procedure

4. Indications • Severe bleeding of an extremity that is not controlled with direct pressure • Severe bleeding of an extremity when resources to provide direct pressure are limited • MCI, tactical situation, difficult extrication Don’t wait! Application of a tourniquet before the patient goes into shock has been shown to improve outcomes in military studies

5. Contraindications • There are no true contraindications to the use of a tourniquet when used to control life-threatening hemorrhage when direct pressure has failed or is not practical

6. Considerations • Tourniquet application will likely be painful • Tourniquet application has been associated with tissue damage but this is generally minor and often temporary • Tourniquets are typically safe for up to two hours. • A tourniquet should never be removed without medical control consultation.

7. The SOF® TACTICAL TOURNIQUET - WIDE Constricting Band Triangle Ring Quick-Release Buckle Loose End Windlass

8. Procedure • Remove clothing and expose wound • Do not remove previously applied direct pressure

9. Procedure • Disconnect the quick release buckle

10. Procedure • Route the band around the injured extremity • Place the band 2 – 3 inches above the wound • Do not place it over a joint

11. Procedure • Reconnect the quick release buckle • Remove the slack by pulling the loose end of the band

12. Procedure • Turn the windlass to tighten the tourniquet • Tighten until major blood flow stops • Slight seeping may still be present

13. Procedure • Lock the windlass in place by slipping the triangle ring over the end of the windlass Triangle ring End of windlass

14. Procedure • Note time of application • Keep tourniquet visible • Do not cover with blankets • Ongoing re-assessment for return of active bleeding • Tighten windlass, then • Apply 2nd tourniquet if bleeding remains active

15. Notify all caregivers involved in the care of the patient that a tourniquet has been placed http://www.bdems.com/med3.htm news.legalexaminer.com http://www.postindependent.com/article/20050621/VALLEYNEWS/50620012 ALS Ground Intercept ALS Air Intercept Emergency Room Report

16. Documentation • Indication for tourniquet • Severity of bleeding • Failure of direct pressure • Time of placement • Tourniquet location • Change in patient condition • Provider performing skill • Complications • Communication to hospital about tourniquet

17. Complications • Consider placing a second tourniquet above the first one if severe bleeding continues • Generally, tourniquet application is safe for up to 2 hours • Contact medical control before loosening or removing a tourniquet