Presentation on theme: "The Benefits of Commercial Tourniquets “The fate of the wounded lies in the hands of one who apply the first dressing” Nicholas Senn, MD."— Presentation transcript:
The Benefits of Commercial Tourniquets “The fate of the wounded lies in the hands of one who apply the first dressing” Nicholas Senn, MD
Bleeding from the Arms and Legs Bleeding from wounds to the extremities can be controlled by direct pressure and/or a commercial tourniquet
Stop the Bleeding A victim who is bleeding from an artery can die in as little as 3 minutes Serious bleeding from an extremity is the most frequents cause of preventable death from injury. If you can do only ONE thing for the injured patient: stop him or her from bleeding to death.
The Commercial Tourniquet A commercial tourniquet is a device that stops the flow of blood. If applied correctly, the tourniquet stops arterial blood flow
Tourniquet Pain Tourniquets HURT when applied effectively Does not necessarily indicate a mistake in application Does not mean you should take it off! Manage pain prehospital with analgesics when the situation allows. 5
Tourniquet Mistakes to Avoid! Not using one when you should Using a tourniquet for minimal bleeding Putting it on too proximally Taking it off when the casualty is in shock or has only a short transport time to the hospital Not making it tight enough to eliminate the distal pulse Not using a second tourniquet if needed Waiting too long to put the tourniquet on Periodically loosening the tourniquet to allow blood flow to the injured extremity 6 * These lessons learned have been written in blood. *
Tourniquets in Action Fort Hood Shooting – 12 dead; 31 wound – Officer Kim Munley The hero of the Ft. Hood shooting, she was shot in both legs and had major bleeding. Her colleagues applied pressure to the wound to try to stop the bleeding, but it was not effective. Ultimately, an Army medic used a combat application tourniquet (C-A-T) to stop the bleeding and save her life.
Commercial Tourniquet Types Studied by the U.S. Military and have shown to be efficient and effective
Other Tourniquets The SOF ® Tactical Tourniquet (SOF®TT) by Tactical Medical Solutions, Inc. Photo courtesy TMS, Inc.
Parts of the Tourniquet The Combat Application Tourniquet (C-A-T) (Patient Pending) is a small and lightweight one-handed tourniquets that can completely occlude atrial blood flow in an extremity
Vietnam Over 2500 deaths occurred in Vietnam secondary to hemorrhage from extremity wounds. These casualties had no other injuries.
Tourniquets in U.S Military Mid-1990s Old strap-and-buckle tourniquets were still being issued. Medics and corpsmen were being trained in courses where they were taught not to use them.
Causes of Death in Combat Viet Nam: – Casualties suffered in ground combat 9% died from bleeding from extremity wounds 5% died from tension pneumothorax 1% died from airway obstruction
Tourniquets – Beekley et al Journal of Trauma 2008 31 st Combat Support Hospital in 2004 165 casualties with severe extremity trauma 67 had prehospital tourniquets placed; 98 did not 7 deaths 4 of the 7 deaths were potentially preventable if a commercial tourniquet had been placed.
Safety of Tourniquet Use Kragh - Journal of Trauma 2008 15 Combat Support Hospital in Baghdad 232 patients with tourniquets on 309 limbs CAT was best field tourniquet No amputations caused by tourniquet use Approximately 3% transient nerve palsies
Impact of Tourniquet Use Kragh - Annals of Surgery 2009 16 Ibn Sina Hospital, Baghdad, 2006 31 lives saved in this study by applying tourniquets prehospital rather than in the ED Better survival when tourniquets were applied BEFORE casualties went into shock Survival if applied before shock develops – 96% Survival if applied after shock develops – 4%
Deaths in the Global War On Terror Factors That Might Have Changed Outcomes Study evaluated 82 fatalities – 12 were potentially survivable Commercial Tourniquets (3) Hemostatic dressings/direct pressure (2) Airway management (1) Needle Thoracostomy (1)