Tourniquets - What do you use and why?

[256]

Disagree slightly.

Medics don't mind the TQs, some just don't want to put on armor and sally forth into a hot or warm zone. It's not what they signed up for (same reason many paramedics balk at fire-based EMS systems). They're perfectly fine with applying a limb TQ in a safe area like the back of their ambulance.

Cops, on the other hand, tend to be reticent to engage in medical care at all--especially those with time on the job. Again, it's not what they signed up to do. There is a cultural shift happening that is changing that, but the problem does currently exist. We're starting to see more TQs placed by cops (anecdotal at this point), but most think of TQs as being for their use instead of for use on citizens.

I wouldn't have responded had I seen your post.

 

[policemedic]

I wouldn't have responded had I seen your post.

No worries. Jump on in!

 

[medicchick]

Is this really that great of work? I'm surprised to see no one mentioning that he should have used a knee to apply some pressure while he fumbled with the tournoquet.

I'm surpirsed the guy made it, if he did, after seeing how much blood he lost.

Dude took 19 shots and lived.

Suspect hit 19 times in shootout with officers, Las Vegas police say

 

[amlove21]

Daaaaaaaamn that officer was in the fight for sure.

Not a huge fan of dropping a knee on any heavy bleeding patient- if something was violent enough to damage a large vessel (and usually the bone next to it), I can't often guarantee that me putting 205lbs of pressure on that injured area won't do more, irreparable damage.

There is an AAR floating around from an SMU that detailed a shattered pelvis from a knee (attempting to use pressure to stop a femoral bleed), and that ended with the patient dead. I am sure it's worked at one time or another, but as a practice, there are better ways.

 

[Kraut783]

Disagree slightly.

Medics don't mind the TQs, some just don't want to put on armor and sally forth into a hot or warm zone. It's not what they signed up for (same reason many paramedics balk at fire-based EMS systems). They're perfectly fine with applying a limb TQ in a safe area like the back of their ambulance.

Cops, on the other hand, tend to be reticent to engage in medical care at all--especially those with time on the job. Again, it's not what they signed up to do. There is a cultural shift happening that is changing that, but the problem does currently exist. We're starting to see more TQs placed by cops (anecdotal at this point), but most think of TQs as being for their use instead of for use on citizens.

Probably the past 5 years have been a drastic change for our department, all patrol officer are issued TQ for carry on duty, we have a much closer relationship with our Fire Paramedics and PD*. The first recorded incident where a patrol officer used a issued TQ was on a traffic accident where part of an arm was torn off and the officer applied the TQ, kinda opened our admins eyes. Good changes and better training for us.

*The new Fire Chief was one of our first SWAT medics, so the bonds are there.

 

[Devildoc]

Probably the past 5 years have been a drastic change for our department, all patrol officer are issued TQ for carry on duty, we have a much closer relationship with our Fire Paramedics and PD*. The first recorded incident where a patrol officer used a issued TQ was on a traffic accident where part of an arm was torn off and the officer applied the TQ, kinda opened our admins eyes. Good changes and better training for us.

*The new Fire Chief was one of our first SWAT medics, so the bonds are there.

When I was a RN in the ED, I argued for tourniquets for a very long time, to no avail. The answer was "we're a level 1 tertiary care trauma center, why would we need tourniquets?"

We received a patient from a motorcycle MVC, right leg near amputation from colliding with a guardrail. The man was bleeding to death, I kept calling for a TQ (homemade, of course) or clamping the femoral, the docs were trying packing and pressure and the MTP (massive transfusion protocol). The guy bled to death before he hit the OR.

Afterward I was asked to come up with and protocol for TQs (I was the only one in the ED at that time with any experience). Even then, the protocol read MD-only application; the rationale being, we can't trust non-MDs to possess the knowledge and skill to know when and how to apply it. It was shortly after this I made an exit strategy from that ED and never looked back.

 

[Ooh-Rah]

We received a patient from a motorcycle MVC, right leg near amputation from colliding with a guardrail. The man was bleeding to death, I kept calling for a TQ (homemade, of course) or clamping the femoral, the docs were trying packing and pressure and the MTP (massive transfusion protocol). The guy bled to death before he hit the OR.

Try as I might, I cannot even begin to imagine the emotional roller coaster you must have been on....from start to finish.

 

[RustyShackleford]

Some of us need to sit down one of these days and discuss our agency/hospital protocols. I bet some solid ideas could come out of that.

Regarding the officer and the ankle TQ-we issue the ankle med kit to guys in certain jobs, all low vis, mostly oconus stuff. Our guys working the street are running TQs centerline, accessible with either hand (at least that is what we are teaching).

 

[FisherAD1]

Follow the evidence. Nonwindlass TQs have a high failure rate. CAT and SOFTT have demonstrated effective. Elastic TQs are inferior. Belts have up to 50% failure rate, improvised TQs fail 32% of the time. There is at least one TQ out there that will probably make the new CoTCCC recommended list. Every piece of medical equipment has an acceptable failure rate. Most CAT failures are due to user error-keeping it exposed to the environment, not recognizing when a second TQ should be applied, or not getting he strap cinched right before twisting the windlass. SOFTTs have failures too, no one TQ is without failure. Ratcheting TQs have historically performed poorly, still waiting on new data on the updated versions.

 

[Muppet]

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Strong work boys.

 

[Gunz]

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Strong work boys.

It’s combat, bro, out in the streets. And cops need to be geared for combat. Great work by these LEOs…and a sure and steady hand shooting that motherfucker by the Sarge despite getting hit 4 times.

 

[Muppet]

Just put a CAT TQ on a 28 male that had a huge piece of glass shred his right arm, perpendicular across both arteries in wrist.

Steady, non pumping bleeding, unable to control with direct pressure and pressure dressing, applied CAT, stopped, 3 min ride to trauma, trauma doc able to clean, sew everything shut. Large veins cut and nicked artery.

 

[policemedic]

Just put a CAT TQ on a 28 male that had a huge piece of glass shred his right arm, perpendicular across both arteries in wrist.

Steady, non pumping bleeding, unable to control with direct pressure and pressure dressing, applied CAT, stopped, 3 min ride to trauma, trauma doc able to clean, sew everything shut. Large veins cut and nicked artery.

Did he do it deliberately?

 

[Devildoc]

Just put a CAT TQ on a 28 male that had a huge piece of glass shred his right arm, perpendicular across both arteries in wrist.

Steady, non pumping bleeding, unable to control with direct pressure and pressure dressing, applied CAT, stopped, 3 min ride to trauma, trauma doc able to clean, sew everything shut. Large veins cut and nicked artery.

In the 90s we had a local college kid accidentally walk through a full glass window panel at a tux rental place. He thought it was a door. True story. Anyhoo, he lacerated his brachial artery on one of his arms, bled like the proverbial stuck pig. For-real shock....tachy, hypotensive, white as a ghost. We were about 8 blocks from the hospital, I shoved a handful of gauze into the gaping wound and fashioned a TQ (pre-TQ days) out of something and hauled ass. The makeshift TQ stopped the bleed by maybe 50%. I imagine a real TQ would have done much better. The trauma team whisked him to surgery lickity-split. Surgeon said he was lucky to keep his arm, and there had been a chance he could have bled to death.

These are not the usual suspects that come to mind when one thinks about TQ use.

 

[Muppet]

Did he do it deliberately?

Na, kitchen accident, how, no clue

 

[Muppet]

In the 90s we had a local college kid accidentally walk through a full glass window panel at a tux rental place. He thought it was a door. True story. Anyhoo, he lacerated his brachial artery on one of his arms, bled like the proverbial stuck pig. For-real shock....tachy, hypotensive, white as a ghost. We were about 8 blocks from the hospital, I shoved a handful of gauze into the gaping wound and fashioned a TQ (pre-TQ days) out of something and hauled ass. The makeshift TQ stopped the bleed by maybe 50%. I imagine a real TQ would have done much better. The trauma team whisked him to surgery lickity-split. Surgeon said he was lucky to keep his arm, and there had been a chance he could have bled to death.

These are not the usual suspects that come to mind when one thinks about TQ use.

Agreed. I used a TQ last year on a 60ish dude with dialysis fistula that exploded, fucking blood bath, same thing, hemodynamically unstable.

TQ stopped it. I laugh everytime I recall being a line doc in the 90s, hearing, "TQs are last resort".