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Tourniquets

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

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  1. Tourniquets Do they belong in civilian EMS ?

  2. Tourniquets Do they belong in civilian EMS ? If Yes How and When

  3. Hemorrhage Control in the FieldNon-combat patient care Direct hand pressure Yes Pressure Bandage Hospital No Torso Extremity Hemostatic Agent Tourniquet Hospital

  4. TourniquetsPHTLS Scientific Panel 2008 • Were we wrong? • Why? • Do they work? • What is their place in modern EMS • Civilian • Military • Guidelines for their use

  5. 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.

  6. 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.

  7. 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

  8. TourniquetsClinical application • Combat operations => delay in transport • 16 hours = no complications • Patient life saved Kragh et al J Ortho Trauma ‘07

  9. 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

  10. 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

  11. 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

  12. Special Operation Forces Tactical TourniquetSOFT-T

  13. Combat Applied Tactical TourniquetCATT

  14. Application of CATT

  15. Emergency Medical TourniquetEMT

  16. 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

  17. Hemorrhage Control in the FieldNon-combat patient care Direct hand pressure Yes Pressure Bandage Hospital No Torso Extremity Hemostatic Agent Tourniquet Hospital

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