Wow! what great information! I learned arterial pressure points which work great but take up both hands most the time. Better for a more controlled situation. Pressure and elevation still work well for slowing/stopping bleeding and decreasing swelling around the wound if it's not too large a wound.
Combat Application Tourniquet (C-A-T)
Posted 26 November 2015 - 12:54 AM
As I am working on a post regarding the use of tourniquets I wanted to point out that I found that the C.A.T tourniquets have been know to break in regards to the stick/windlass used to torque down on the limb under stress as they are made of plastic.
I have not used a C.A.T tourniquet in a long long time, they are now several generations refined so this may no longer be an issue I am not sure.
What I used in the Army and carry with me now are the SOF-TT tourniquets. The windlass that they use I believe is aluminum and will not break..
Posted 26 November 2015 - 10:11 AM
This is good knowledge. I'm over 15 years past EMS and the hospital. As others have said, tourniquets are a last step in controlling bleeding. In most traumatic amputations, the veins retract and hence local bleeding control will usually control the bleeding. I would be leary about applying a tourniquet as a civilian do to the liabilities if nerve or limb damage occurred. Like it or not, We Americans live in a lawsuit happy society. Even if you win the suit you're out money and the mental stress.
I carry one in my long term medical kit and am debating rather to carry on in everyday bag. A quick clot type product, yes but a tourniquet, I'm not sure. I might think different if EMS or a hospital was more than a hour away. In a mass casualty situation, the first two items of the ABCs (Airway and Breathing) will probably keep you busy enough. The vast majority of the C (circulation) should be controlled by direct pressure or a clotting product. In these situations, unfortunately, a big bad bleed will probably mean death. The goal is to save the most people so a hard decision has to be made.
Posted 26 November 2015 - 10:45 AM
Wally- Most states have 1st responder laws/protections as they want people to take action rather someone be on the sidelines letting someone bleed to death or die of a heart attack out of fear of a lawsuit.
These protections can vary greatly from state to state and I would suggest anyone and everyone be well read up on their states protections.
The new CPR standards get rid of the mouth to mouth aspects all together due to peoples aversion to contamination. The research presented states that chest compressions alone can work as well if not better than the older style CPR.
The newer standards are B-ABC ( at least within the military) any major bleeds need to be controlled as you can be working on giving a guy chest compressions and everytime you pump that chest more blood is spurting out and the patient dies due to blood loss while still trying to get him breathing.
Putting on a tourniquet takes seconds, and then you are back to the normal ABCs. The military advocated temporary tourniquets as well.
Posted 30 November 2015 - 02:38 PM
The Doc is correct and in this case I am going with what the military says. They have the data to back up what is being taught with B-ABC or MARCH (I like MARCH cause it adds Hypothermia).
Flat out, a tourniquet should not be the last step, it is the second step and the first step (Direct Pressure) should not even be considered if you think the bleed is arterial. Both the NAEMT and NREMT use skill sheets for EMT's and Paramedics that have TQ application as the second step. Pressure Points and elevation are no longer in the teaching.
It has taken civilian EMS years to catch up to the military in regards to tourniquets and hemostatic agents. In 2009 and FIRE/EMS agency told their Police counterparts that a tourniquet would cause you to loose the limb and you don't need to worry because we will be there when you need us. Three years later two officers were shot and both had CAT's applied . . . . by LEO's as EMS was staging and could not get close enough to "be there". Eight months ago an EMT was overheard saying that you should not apply a tourniquet because of the damage and possible loss of a limb. This is 2015 and we still have people pushing bad information when the data proves them wrong.
Posted 08 December 2015 - 10:17 PM
On another note a Denver Police Officer was saved today because of Tourniquets. He was shot 5 times, twice in one leg, once in the other leg, and twice in the arm.
“I should note the paramedics did a phenomenal job because those tourniquets they put on in the field saved his life. He lost so much blood that his heart almost stopped when he arrived. Those tourniquets clearly saved his life," Dr. Moore said.
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