Tac Med Tuesday HIGH AND TIGHT!!! “Tourniquets kill!!!” We still hear this from time-to-time and even with a proven track record, there is still a lot of negativity and stigma surrounding the use of a tourniquet. Tourniquets, when I came in the military back in 1991, were the last resort. “Whatever you put it on will die”, I was told. “They’ll lose the limb for sure”, they said. Well, “they” were wrong and if your instructor has been nay-saying TQ’s, well, as a good buddy of mine put it, they’re about 15 years behind the times. Unfortunately, you can’t stop a bleed with ignorance, but you can educate someone and bring them up to speed. Tourniquets have been used successfully, without complication, in operating rooms since the late 1800’s and the last several years of combat have given us new information and a new perspective on the use of a tourniquet as well as terrorist activity in Boston and natural disasters like the tornadoes in Oklahoma. In Iraq and Afghanistan, the much-maligned device has been credited with saving close to 2,000 lives. In the Boston bombing incident, makeshift/expedient TQ’s are credited with saving at least 50 lives. That’s over 50 families who will get to celebrate birthdays, anniversaries and holidays with their loved ones due to a tourniquet being used successfully. We’re seeing more and more law enforcement officers being trained on and employing TQ’s with great results. Fire and EMS agencies have changed their protocols to include TQ’s and even national curriculum is finally teaching that TQ’s can be used in the event of life-threatening hemorrhage. Massive, life-threatening hemorrhage accounts for approximately 80% of all combat deaths, and around 40% of civilian deaths, with about half of those being compressible either with a TQ or hemostatic agent. The other half are non-compressible, unfortunately, and they will most likely expire during the “acute” phase of their trauma (shortly after the injury due to large vessels being dissected in the trunk of the body). However, with the advent and success of the Abdominal Aortic Junctional Tourniquet (AAJT), as well as other junctional devices, we will see that percentage decrease. A TQ, as well call it, enables the medic, or person performing self-aid, to quickly and efficiently achieve hemostasis (stopping the flow of blood) from a compressible extremity injury. It can be done when there are multiple casualties or when the situation may not be suitable for taking the time to attempt placing a pressure dressing or hemostatic gauze. Once all the casualties have been treated or the threat has passed, the wounds can be re-evaluated to see if they are amenable to wound packing and pressure wrapping. If the TQ was put on for initial hemorrhage control of an injury which would be amenable to hemostatics and pressure dressing but time wouldn’t be packed or dressed due to an unsafe environment or multiple casualties and has been on for greater than 30 minutes, go ahead and leave it in place due to concerns over micro-clots and potassium release from broken down cells. However, don’t be overly concerned about limb loss as the average TQ time in a study done in Iraq in 2006 was 1.3 hrs and no limb was lost due to TQ application. The limb may have been lost as a result of the injury which necessitated the TQ but not as a direct result of the TQ. Can there be nerve injuries? Sure, but even those were minimal in the study at a rate of
Posted on: Tue, 06 Jan 2015 16:39:34 +0000
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