1 Severe Hemorrhage Control Application of the Sof-T Wide Tourniquet
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
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
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
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
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
The Sof-T-Wide Tourniquet 7 Quick-Release Buckle Windlass Triangle Ring Loose End Constricting Band
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
Procedure Disconnect the quick release buckle 9
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
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
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
Procedure Lock the windlass in place by slipping the triangle ring over the end of the windlass 13 Triangle ring End of windlass
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
Notify all caregivers involved in the care of the patient that a tourniquet has been placed news.legalexaminer.com ALS Ground InterceptALS Air InterceptEmergency Room Report
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
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