Why do you need medical skills and tools?

[275RLTW]

We just had a medical class for work where we trained with tourniquets (applying them) with live fire.

The "Golden hour" is the key to survival. One hour after being shot and tourniquet is applied you should be in surgery to increase chances of survival. Beyond that, it's not a good day...

No such thing anymore. Survivability is more dependent on where the wound is, severity of the wound(s), amount of blood lost, etc... Nowhere in trauma medicine is there a "1 hr" survivability time line for extremities. Obviously the quicker you can get to definitive medical care the better the probable outcome, and getting shot anywhere is already not a good day.

[Mick-Boy]

Coloccw - Do you have a source for that? I was just browsing through the latest TCCC bulletin to try and find something on how long TQs can/should be left on. I didn't see any hard and fast timelines.

[275RLTW]

There is no time limit anymore for how long you can leave TQs in place. Removing a TQ is not a current TCCC task (Just checked the DoD courseware). I've seen permanent damage after only a few hours in one individual and an extremity completely recover after 24+ hours of TQ placement. We finally realized there are too many other factors in medicine than a watch. Good wound care (bleeding and infectious control), medics who know their shit, and lots of replacement fluids/blood cells/meds are what's saving extremities now. Good pre-hospital care is key.

[Mick-Boy]

Rgr. I've been taught both to leave them in place until you reach a higher level of care and to try reducing them after 30min. Since I'm a fan of simplicity, I ere on the side of "let someone better trained take it off".

For those of you (us) who get their geek on reading about this stuff. Here's the link.

[Mick-Boy]

OK. So looking at this PPT on tactical field care (specifically slides 71-78) it appears that the TQ should NOT be reduced if

- There is a traumatic amputation

- Casualty is in shock

- TQ has been on more than 6hrs

- Higher care will be reached with two hrs of applying

- Other considerations make reducing the TQ a bad idea.

Reduce only if

- Bleeding can be controlled by other means (slowly loosen and observe for renewed bleeding)

- You're a medic/doc

[275RLTW]

For those of you reading along and not familiar with TCCC/NREMT stuff I'll expand briefly: In the field, we cannot TREAT traumatic injuries (EMT-Ps excluded), only try to prevent further harm and package them up for transport to a Doc. This applies CONUS as well as OCONUS. If bullets are flying it doesn't matter if you are here or there: it is combat and combat proven protocols should be used. Stopping the bleeding, however you can, should be the main priority. If you think that pressure and elevation will work, then go at it. However, if it doesn't work then you just wasted all that time for nothing. Properly placing a TQ takes 10 seconds and works almost every time. Now you can take all the time you need to make a nice pretty pressure dressing and have the patient remain calm, etc... Taking off a TQ is not part of preventing further injury; it is treatment. A licensed Doc (CONUS) is needed to legally treat traumatic injuries. Whether a bystander on the range or an EMT-B, we cannot treat traumatic injuries. Basically, we can only stop bleeding, use basic methods to maintain an open airway, control hypothermia/shock, check and record vitals, and keep the patient calm. Get proficient at those basic skills and you can do a lot of good after an incident. Think of those as medical fundamentals: if your pre-hospital care or fundamentals are good, then the outcome should be better. Shitty fundamentals= shitty results.

[275RLTW]

OK. So looking at this PPT on tactical field care (specifically slides 71-78) it appears that the TQ should NOT be reduced if

- There is a traumatic amputation

- Casualty is in shock

- TQ has been on more than 6hrs

- Higher care will be reached with two hrs of applying

- Other considerations make reducing the TQ a bad idea.

Reduce only if

- Bleeding can be controlled by other means (slowly loosen and observe for renewed bleeding)

- You're a medic/doc

Pretty much sums it up. Loss of blood volume or pressure is shock, hence the reason for a TQ. Let the smart guys who pay lots of insurance handle reductions.

[Mick-Boy]

I'm a big fan of keeping treatment simple at my level (expired EMT-B with occasional follow on trauma training). Injuries to the extremities get TQs. Pelvic and shoulder girdles will likely get hemostatic agents. Anything from navel to the clavicle gets a chest seal. Head trauma's get disarmed unless they're clearly still with us. I let the brains worry about the details.

[cmailliard]

Thanks Mick and coloccw - good stuff

[rbeau30]

I need to spend some money and get some real training. The Red Cross First Aid is not enough.