1. MSA Training Weekend Saturday 18 th Sunday 19 th January 2014 Royal Lancaster Infirmary Education Centre Presented By Paramedic Mr Dave Stubbs COMBAT APPLICATION TOURNIQUET C A T

2. OBJECTIVES Update of forthcoming MSA Blue Book medical equipment list for 2014 – 15 To understand the importance of haemorrage control To have an understanding of C A T tourniquets To have practical use & application of a C A T tourniquet

3. BRIEF HISTORY OF TOURNIQUETS Introduced by the ancient greeks to the romans First reported use in 1674 during Siege of Besancon in eastern france (Laffin 1999) Used in american civil war 1861 – 1865 Used in conflicts & medicine to date Currently used by the military, uk ambulance services & police forces

4. CATASTROPHIC HAEMORRAGE Uncontrolled haemorrage commonest cause of preventable death in trauma patients ( Hollcomb et al ann surg 2008) Priority changed from A B C – C A B C military treatment A B C Catastrophic bleeding 1st Catastrophic haemorrage should be arrested 1 st Secondly airway, breathing & then back to circulation The idea is to prevent exsanguination & death while airway is being assessed & maintained

5. CAUSES OF HAEMORRAGE Many mechanisms Blunt trauma, causing internal haemorrage ie: pelvic injuries organ lacerations less obvious in some cases Penetrating Trauma, to the head, neck, torso & limbs

6. COMBAT APPLICATION TOURNIQUET

7. TO TOURNIQUET OR NOT TO TOURNIQUET ? THAT IS THE QUESTION !

8. THAT IS THE QUESTION !

10. SOME TRAUMATIC GRAPHIC IMAGES NOW FOLLOW

11. TOURNIQUET REQUIRED ?

12. BI LATERAL C A T TOURNIQUETS IN USE

13. TOURNIQUET IN USE

14. BOSTON MARATHON BOMBING IMPROVISED TOURNIQUET IN USE

15. SUMMARY Catastrophic serious haemorrage is a leading cause of death in major trauma & rapid attempts must be made to control bleeding 1st Motorsport Doctors & Paramedics may have further interventions to combat major haemorrage such as Celox Gauze, Olaes & Blast Dressings, & Tranexamic Acid (TXA)

16. THANK YOU

17. ANY QUESTIONS ?

18. REFERENCES Emergency Nurse June 2010 Vol 18 Emergency Nurse November 2013 Vol 21 Google Images JRCALC 2013 Motor Sports Association 2014 Yearbook NWAS NHS Trust Pre Hospital Trauma Care Training 2013 PHTLS Manual 7 th Edition 2011 PHTLS Manual Military 7 th Edition 2011 Zipp Photography Richard Danby 2013