Monday, 15 August 2016

Wasted time is blood on the sand; not in the body

"IMO tourniquets are a last ditch effort. If the bleeding is going to result in immediate death use it. But if not, you may be causing a unneeded amputation. Get educated on medical before using it please." ~posted by a nursing student in a tactical forum

After decades of evidence to the contrary including thousands of real world case studies and papers, these MYTHS still exist. Let us deal with each statement individually.

“IMO tourniquets are a last ditch effort.” This statement lacks context and is, therefore, incorrect. Tourniquets like any medical device have their place plugged into a treatment protocol or paradigm according to need and context. When time is of the essence, or there is danger to the casualty or rescuer, rapid application of a tourniquet is paramount. If you are alone without immediate support or waiting for help to arrive and you have a severe extremity hemorrhage, this constitutes a risk of imminent death. You will bleed out before help arrives. Why would you not self-apply a tourniquet straightaway in this case?  In a safe situation with plenty of time, other methods may be preferred. But, any extremity trauma with severe arterial hemorrhage may call for immediate first line use of a tourniquet.  A trained and experienced medical operator can make this assessment without wasting time. Wasted time is blood on the sand; not in the body.

A photo posted by CTOMSInc. (@ctomsinc) on

“If the bleeding is going to result in immediate death use it.” The goal in trauma is to restore hemostasis or keep every drop of blood possible in the body. Period. Procrastinating application of a viable proven medical device until just before a casualty will expire will only resulting life threatening surgical complications, increased risk of allogenic reactions from transfusions and prolonged costly recovery. The wound modality (type and location) will be the deciding factor on first line tourniquet use in situation when time and safety are not a concern. An excellent example is traumatic amputations. During a life and death struggle, adrenaline will trigger vasoconstriction as a defensive mechanism. Traumatic amputations, usually, do not hemorrhage heavily while the sympathetic nervous system is ramped up. The parasympathetic nervous system (PNS) will counteract the sympathetic nervous system (SNS) once the threat has dissipated or definitive help arrives. Casualties will start to bleed significantly once the PNS tamps down the SNS. Why would you not use a tourniquet early in this case? Exactly.

 “But if not, you may be causing a unneeded amputation.” Tourniquet application DOES NOT mean amputation of the affected limb. I will say this again; tourniquet application DOES NOT mean amputation of the affected limb. This statement demonstrates a very limited understanding of the basics of human physiology.There have been many case studies with prolonged tourniquet application times before evacuation to definitive care with no post recovery complications.  As a general rule, application of a tourniquet to an extremity will increase the medical priority of the casualty with a preferred evacuation time of less than two hours. This is due to the anaerobic cellular metabolism that kicks in once the nourishment from red blood cells has been occluded. Same basis a fractured limb with no distal vascular signs is a higher evacuation priority. There are side effects of this cellular metabolism that are best treated in a trauma center. However, extended evacuation times beyond two hours DO NOT necessitate a limb amputation.

A photo posted by CTOMSInc. (@ctomsinc)  

“Get educated on medical before using it please.” I do agree with the last comment. Stop using the wealth of human knowledge on the Internet for porn and crazy cat videos. Do get educated on medical subjects especially before posting incorrect information on the Internet.

Reprinted with additions from WarDoll

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