2. WI Healthcare Emergency Preparedness Program Coalitions

3. Tourniquets for LEOs

4. Who is WHEPP? Wisconsin Healthcare Emergency Preparedness Program Coalitions – Members from EMS, Trauma, Hospital Preparedness, Emergency Management, and Public Health Preparedness – In coordination with WI DOJ, Law Enforcement Standards Board, and State Trauma System Goal: provide a tourniquet for every Wisconsin law enforcement patrol officer – Provide free tourniquet, training materials, and supportive resources 10,000 tourniquets purchased & distributed!

5. What This Class Covers Part of “Tactical Emergency Casualty Care” – This is not the 8-hour TECC for LEO class – This is when & how to apply a tourniquet When to deliver medical care – The tactical situation determines what care you can provide – “Good medicine” can be bad tactics – Bad tactics = more casualties

6. What This Class Covers How to deliver medical care – Management of severe extremity bleeding with a tourniquet Tourniquets address part of “circulation” – Do not address critical bleeds other than extremity – Do not address airway or breathing issues

7. Causes of Preventable Death Most frequent causes of preventable death: – Hemorrhage – Tension pneumothorax – Airway obstruction

8. Tourniquet Importance Ambulance Response Time – Commonly averages 5 minutes or more How quickly can you bleed to death from a femoral bleed? – Three to five minutes! EMS may be unable to even access scene

9. Treatment of Critical Trauma As soon as possible, evacuate patient to advanced medical care Re-evaluate / re-assess patient every few minutes, and right after every move – Tourniquet may have slipped or loosened – Patient condition may have changed

10. Tourniquet Indications Primary method of stopping a severe extremity bleed Indications: – Amputation – Spurting blood – Large pool of blood Could be caused by – GSW, stabbing, and other penetrations – Lacerations, amputations, or mangled extremities

11. Tourniquets & Blood Loss You have approximately 5 liters of blood Body can compensate for 20%-30% loss Loss of 40% – 2 liters – is life threatening Femoral bleed can lose 2 liters in 3-5 minutes

12. Blood Loss

13. Carrying the Tourniquet Carry the tourniquet on your person – Belt holster – Vest pocket – Cargo pants pocket Location you can access with either hand

14. Tourniquet Nomenclature Running end Windlass Quick Release Buckle Circumferential band Delta clip securing mechanism

15. Buckle

16. Delta Clip Securing Mechanism

17. Storing the Tourniquet Do not store in its plastic wrapper There are also other methods (“flat fold”, etc.) 1.Extend the circumferential band 2.Remove slack from “base” of tourniquet 3.Ensure buckle is fully seated 4.Fold circumferential band & running end to the same length as the “base” 5.Do not secure windlass inside delta clip

18. Tourniquet Nomenclature & Storage Self-adhering band (running end) Friction buckle Windlass Windlass clip Windlass securing strap Circumferential band

19. Tactics Determine Medicine 1.Stop the threat! – You cannot provide medical care unless you can first protect the patient and yourself 2.Seek cover! – If possible, direct the casualty to move to a safe location and/or treat himself/herself – Do not provide care “on the X” 3.Perform life-saving TECC interventions – You may be unable to render any medical care

20. Tourniquet Application Overview Remove any obstacles to constriction (wallet, cell phone, thigh holster, etc.) Apply over clothing Apply as high on limb as possible – “high or die” Apply as tightly as possible before tightening windlass; then use windlass to tighten until bleeding stops Do not loosen tourniquet after initial application

21. Demonstration Video https://vimeo.com/162365658/dc844ba948

22. Apply Over Clothing Remove anything that prevents constriction – Thigh holster, etc. Leg: – Release the quick-release buckle – Slide thin end under leg & slide to groin – Refasten buckle Arm: – Leave buckle fastened – Slide the tourniquet up arm

23. Position as High as Possible “High or Die” Position as high on extremity as possible, at 90 degrees to limb – Not at an angle or over shoulder – At least 2” to 3” above wound

24. Remove the Slack M AKE TOURNIQUET AS TIGHT AS POSSIBLE BEFORE TURNING WINDLASS

25. Tighten the Tourniquet Turn the windlass until bleeding stops – Tourniquet will be painful Secure the windlass to prevent loosening Mark the time Monitor bleeding If bleeding continues – Tighten the windlass further – Apply an additional tourniquet below the first – Do not loosen or remove the first tourniquet

26. Train Realistically Apply so you pull the running end towards the center of your body (for better leverage) Arm – “Splint” your wounded arm against your body - don’t hold it out like an airplane Leg – Release the buckle, slide the strap under your thigh, and securely re-fasten buckle – Don’t bend your leg to slide on the tourniquet—you may have a femur fracture

27. Tourniquets – Guided Practice Recognize threat Draw & move towards cover! Win the fight! Get to cover / get off the “X” Follow-Through Considerations (check for injuries) Re-holster weapon Remove obstacles to tourniquet Position tourniquet high on extremity Tighten until bleeding stops Re-draw weapon and control subject

29. Hypothermia Prevention Hypothermia prevents clotting Can suffer hypothermia even in hot desert!

31. Other TECC Skills Remember, tourniquets only treat extremity bleeds Get more training in other TECC skills: – Patient assessment – Wound packing – Pressure dressing – Nasopharyngeal airway – Chest seals – Hypothermia prevention

39. Questions? Please continue your TECC education – Continue your critical medical training Please thank the Wisconsin Healthcare Emergency Preparedness Program Coalitions – Participate in WHEPP initiatives – Save the lives of officers and community members

40. Region 1 : Aimee Wollman Nesseth (715)379-6664 Region 2: Michael Fraley (715)892-3209 Region 3: Dave Taylor (920)373-1083 Region 4: Greg Breen (608)792-3074 Region 5: Dan Williams (608)576-1843 Region 6: Jason Selwitschka (920)203-8791 Region 7: Jake Dettmering (414) 234-4686 For questions regarding the Wisconsin Law Enforcement Tourniquet Initiative, please contact your Regional Trauma Advisory Council (RTAC) Coordinator:

41. For information on how you and your agency can get involved in regional preparedness, please contact a Healthcare Coalition (HCC) Staff Member for your region: