1. 1 Severe Hemorrhage Control Application of the Sof-T Wide Tourniquet

2. Medical Director Approval  Before using tourniquets, all services must have:  Patient care guideline (protocol) signed by the medical director  Training, approved by the medical director, on the use of tourniquets  State EMS Unit approval of the protocol and training  Before using tourniquets, all services must have:  Patient care guideline (protocol) signed by the medical director  Training, approved by the medical director, on the use of tourniquets  State EMS Unit approval of the protocol and training 2

3. Objectives  Discuss the indications, contraindications and considerations in the use of a tourniquet for hemorrhage control  Identify the steps required to control major hemorrhage with a Tactical Medical Solutions Sof-T Wide tourniquet  Review documentation and communication requirements of the procedure  Discuss the indications, contraindications and considerations in the use of a tourniquet for hemorrhage control  Identify the steps required to control major hemorrhage with a Tactical Medical Solutions Sof-T Wide tourniquet  Review documentation and communication requirements of the procedure 3

4. Indications  Severe bleeding of an extremity that is not controlled with direct pressure  Severe bleeding of an extremity when resources to provide direct pressure are limited  MCI, tactical situation, difficult extrication  Severe bleeding of an extremity that is not controlled with direct pressure  Severe bleeding of an extremity when resources to provide direct pressure are limited  MCI, tactical situation, difficult extrication 4 Don’t wait! Application of a tourniquet before the patient goes into shock has been shown to improve outcomes in military studies

5. Contraindications  There are no true contraindications to the use of a tourniquet when used to control life- threatening hemorrhage when direct pressure has failed or is not practical 5

6. Considerations  Tourniquet application will likely be painful  Tourniquet application has been associated with tissue damage but this is generally minor and often temporary  Tourniquets are typically safe for up to two hours.  A tourniquet should never be removed without medical control consultation.  Tourniquet application will likely be painful  Tourniquet application has been associated with tissue damage but this is generally minor and often temporary  Tourniquets are typically safe for up to two hours.  A tourniquet should never be removed without medical control consultation. 6

7. The Sof-T-Wide Tourniquet 7 Quick-Release Buckle Windlass Triangle Ring Loose End Constricting Band

8. Procedure  Remove clothing and expose wound  Do not remove previously applied direct pressure  Remove clothing and expose wound  Do not remove previously applied direct pressure 8

9. Procedure  Disconnect the quick release buckle 9

10. Procedure  Route the band around the injured extremity  Place the band 2 – 3 inches above the wound  Do not place it over a joint  Route the band around the injured extremity  Place the band 2 – 3 inches above the wound  Do not place it over a joint 10

11. Procedure  Reconnect the quick release buckle  Remove the slack by pulling the loose end of the band  Reconnect the quick release buckle  Remove the slack by pulling the loose end of the band 11

12. Procedure  Turn the windlass to tighten the tourniquet  Tighten until major blood flow stops  Slight seeping may still be present  Turn the windlass to tighten the tourniquet  Tighten until major blood flow stops  Slight seeping may still be present 12

13. Procedure  Lock the windlass in place by slipping the triangle ring over the end of the windlass 13 Triangle ring End of windlass

14. Procedure  Note time of application  Keep tourniquet visible  Do not cover with blankets  Ongoing re-assessment for return of active bleeding  Tighten windlass, then  Apply 2 nd tourniquet if bleeding remains active  Note time of application  Keep tourniquet visible  Do not cover with blankets  Ongoing re-assessment for return of active bleeding  Tighten windlass, then  Apply 2 nd tourniquet if bleeding remains active 14

15. Notify all caregivers involved in the care of the patient that a tourniquet has been placed 15 http:// www.postindependent.com/article/20050621/VALLEYNEWS/50620012 news.legalexaminer.com ALS Ground InterceptALS Air InterceptEmergency Room Report http://www.bdems.com/med3.htm

16. Documentation  Indication for tourniquet  Severity of bleeding  Failure of direct pressure  Time of placement  Tourniquet location  Change in patient condition  Provider performing skill  Complications  Communication to hospital about tourniquet  Indication for tourniquet  Severity of bleeding  Failure of direct pressure  Time of placement  Tourniquet location  Change in patient condition  Provider performing skill  Complications  Communication to hospital about tourniquet 16

17. Complications  Consider placing a second tourniquet above the first one if severe bleeding continues  Generally, tourniquet application is safe for up to 2 hours  Contact medical control before loosening or removing a tourniquet  Consider placing a second tourniquet above the first one if severe bleeding continues  Generally, tourniquet application is safe for up to 2 hours  Contact medical control before loosening or removing a tourniquet 17