Do not use a tourniquet???

[bwframe]

Happened to catch some of the shark attack(s) coverage on the news. They played one of the 911 calls. I haven't listened to much beyond the 911 operator telling the caller to not use a tourniquet, (@ 2:25 min mark in the first call.) Is this appropriate?

Frantic 911 calls in NC shark attacks paint gory picture | WAVY-TV

I'm not sure which attack had a professional medic on the scene? However, her interview had her explaining the first thing she did was fabricate at tourniquet.

Who is right here?
Maybe I'm mistaken in that an amputation is a text book indication of where a tourniquet is necessary?

 

[hemicharger]

Maybe their protocols are different in that area.

 

[Double T]

If you don't stop an arterial bleed, they won't make it. Use of a tourniquet can save a life, even with an ambulance on the way.

 

[bwframe]

Maybe their protocols are different in that area.

Maybe they shouldn't be?

 

[JeremiahJohnson]

Use the tourniquet. 911 is wrong.

 

[chezuki]

911 operator was a tard. You have to stop the bleeding. She was likely just reading a "severe laceration" card from a rolodex calling for direct pressure. I doubt they have an "amputation by shark bite" card.

 

[MCgrease08]

Not a medic here.

My understanding is that a tourniquet pretty much guarantees the loss of a limb because of the severe nerve and tissue damage they cause by cutting off all blood flow. They should only be used when direct pressure has no chance to stop bleeding and severe blood loss poses a risk of death.

They are basically a last resort.

Considering that both shark attack victims ended up losing limbs anyway, a tourniquet was probably the right call. Because the dispatcher was not there, they were likely being cautious.

 

[malern28us]

Not a medic here.

My understanding is that a tourniquet pretty much guarantees the loss of a limb because of the severe nerve and tissue damage they cause by cutting off all blood flow. They should only be used when direct pressure has no chance to stop bleeding and severe blood loss poses a risk of death.

They are basically a last resort.

Considering that both shark attack victims ended up losing limbs anyway, a tourniquet was probably the right call. Because the dispatcher was not there, they were likely being cautious.

They use tourniquets in surgery when working on a specific limb. I know for a fact that people come out with all of their limbs. I would bet it has much more to do with the amount of time the tourniquet is left on versus using one to stop blood loss.

 

[BehindBlueI's]

911 operator was a tard. You have to stop the bleeding. She was likely just reading a "severe laceration" card from a rolodex calling for direct pressure. I doubt they have an "amputation by shark bite" card.

This. I used to be an EMT. I was also a EMD (emergency medical dispatcher). EMD just use a flip book and flow charts.

Unless it's got to go on the neck, there are very few contraindications for a tourniquet, and none would apply here. Put it on.

 

[JeremiahJohnson]

Not a medic here.

My understanding is that a tourniquet pretty much guarantees the loss of a limb because of the severe nerve and tissue damage they cause by cutting off all blood flow. They should only be used when direct pressure has no chance to stop bleeding and severe blood loss poses a risk of death.

They are basically a last resort.

Considering that both shark attack victims ended up losing limbs anyway, a tourniquet was probably the right call. Because the dispatcher was not there, they were likely being cautious.

Here's a quickie guide: Apply A Tourniquet (ArmyStudyGuide.com)

Possible loss of life - use it.

 

[bwframe]

...My understanding is that a tourniquet pretty much guarantees the loss of a limb because of the severe nerve and tissue damage they cause by cutting off all blood flow. They should only be used when direct pressure has no chance to stop bleeding and severe blood loss poses a risk of death.

They are basically a last resort...

I believe that is THE argument. Old thinking VS new thinking and experience.

I have been to classes that taught both thought processes. The more modern thought process indicated that there was a number of hours before tissue damage took place. The assumption being that most folks in the modern day would be in surgery before tissue damage took place.

 

[JeremiahJohnson]

Good wilderness training stuff here: How to Use a Tourniquet | The Art of Manliness

You're good out to 2 hours, maybe even 5 hours. If pressure don't do it, use the tourniquet.

 

[Alamo]

Not a medic here.

My understanding is that a tourniquet pretty much guarantees the loss of a limb because of the severe nerve and tissue damage they cause by cutting off all blood flow. They should only be used when direct pressure has no chance to stop bleeding and severe blood loss poses a risk of death.

They are basically a last resort.

Considering that both shark attack victims ended up losing limbs anyway, a tourniquet was probably the right call. Because the dispatcher was not there, they were likely being cautious.

"Last resort" yes, but when bleeding is profuse there are really only two options: direct pressure or a tourniquet. If direct pressure won't do it, or you can't manage it (like you have to treat more than one wound and you can't tie up your hands holding pressure), tourniquet.

The part about "guarantee loss of limb" is ancient lore now. It was shown in Iraq that limbs could be saved for several hours after a tourniquet was applied. That's not a guarantee either, but still, a properly applied tourniquet is not a guaranteed limb-loss.

The important part is stopping the bleeding. Doesn't help to "save the limb" if you lose the patient.

(And I have a hard time imagining an EMD protocol that does not include "tourniquet" for "loss of limb." ??)

 

[iChokePeople]

The US Military has changed their tune on the use of tourniquets. They USED to really preach the "last resort" thing, but recently they're a lot quicker to use them. I'll try to find documentation and citations, but I've just recently had this conversation with a couple of military docs, so it's pretty fresh in my mind. Don't get me wrong, it's still not for a little shaving booboo, but the attitude is definitely more accepting than when I used to teach and learn common tasks.

 

[shibumiseeker]

Current Indiana EMT training is Direct Pressure, Elevation, Tourniquet (I am an EMT instructor). This changed about four years ago from where the tourniquet was the last resort to only be used if loss of life due to bleeding was probable.

Some considerations for a tourniquet: You use a wide (>1") band when possible. You only tighten until bleeding stops. It is used on the area of a limb where the artery is close to a bone to be compressed against. Over tightening can crush tissue and cause limb loss regardless of how long it was applied. Properly applied the patient has several hours before the limb is compromised. Applied to the forearm and you may have to tighten it enough to crush tissues, applied just above the elbow and it works much better. Same with the lower leg and upper leg.

 

[iChokePeople]

The return of tourniquets - For Medical Professionals - Mayo Clinic

Here's a pretty credible source of information surrounding the discussion and the military's change of attitudes about them.

 

[MCgrease08]

The return of tourniquets - For Medical Professionals - Mayo Clinic

Here's a pretty credible source of information surrounding the discussion and the military's change of attitudes about them.

I was going to link to that as well.

To those referencing military applications and war time use, the thinking changed because the military developed a specific pre-packaged type of tourniquet. The new design eliminated most of the damage caused by homemade tourniquets.

From the link:

Attitudes about tourniquets began to change in the 1990s, but the real turnaround came during the later years in Iraq and Afghanistan, explainsDavid S. Morris, M.D., of Mayo Clinic in Minnesota. "One of the biggest threats in Iraq and Afghanistan were roadside bombs, which cause traumatic lower and upper extremity injuries and amputations but aren't as devastating to the torso. Injured soldiers would survive to the aid station, but then couldn't be saved, so the military began using more tourniquets. And what they found was that the type of tourniquet dramatically affected outcomes."

The tourniquets that proved effective were commercial devices, especially the Combat Application Tourniquet (C-A-T), which many studies have found to safely and effectively occlude blood flow with a low incidence of adverse events.

Beginning in 2004, the U.S. Army Institute of Surgical Research began studying mechanical tourniquets. A paper detailing the benefits of the tourniquets and strongly advocating their use appeared in the February 2008 issue of the Journal of Trauma Injury, Infection, and Critical Care. Since then, C-A-T devices have become standard military issue and all soldiers are trained to use them.

Because beach-goers presumably didn't have those mechanical tourniquets handy, the dispatcher was likely advising the caller not to fashion a homemade tourniquet.

I will certainly defer to BBI, shibumiseeker and others with experience, but I want to defend my original content a little bit.

 

[iChokePeople]

I'll clarify MY original post -- I know NOTHING about fixing oopsies. I'm much better at causing them. I'm only parroting what someone smart told me.

 

[SSGSAD]

Current Indiana EMT training is Direct Pressure, Elevation, Tourniquet (I am an EMT instructor). This changed about four years ago from where the tourniquet was the last resort to only be used if loss of life due to bleeding was probable.

Some considerations for a toruniquet: You use a wide (>1") band when possible. You only tighten until bleeding stops. It is used on the area of a limb where the artery is close to a bone to be compressed against. Over tightening can crush tissue and cause limb loss regardless of how long it was applied. Properly applied the patient has several hours before the limb is compromised. Applied to the forearm and you may have to tighten it enough to crush tissues, applied just above the elbow and it works much better. Same with the lower leg and upper leg.

The way I was taught, MANY years ago, was LIFE, or LIMB SAVE a LIFE .....

 

[Trigger Time]

Modern medicine has finally evolved to the understanding that a tourniquet is not a last resort thing. Better be safe than sorry.