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Tourniquet Best Practices: How to Prep, Store and Apply a TQ
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- Опубликовано: 14 авг 2024
- Caleb Causey of Lone Star Medics joins Bryan to explain the proper application of Tourniquets and some best practices.
Visit Lone Star Medics: www.lonestarmed...
a friend of mine fell, hit his head and got a nasty cut on his forehead. He was bleeding so i quickly applied a TQ to his neck. But unfortunately, I think that the hit was too severe, because after 3-4 minutes he turned blue and died. I am kinda feel responsible because I didn't reacted quick enough. Poor bastard.
How can you apply a TQ on someones neck. You killed your friend buddy. How will you feel if someone strangle your neck? Why do you think he turned blue?
patricke... the only area you should apply a tourniquet is arms and legs. You should have used quikclot or some form of gauze with a hemostatic agent.
The bleeding could have been controlled by firm pressure and a hemostatic gauze. Applying a tourniquet to the neck cuts off blood flow and oxygen to the brain. Thats why he turned blue. Lack of blood flow (oxygen).
In one sense you did stop blood flow to that area but you also cut off the blood flow and oxygen to the brain.
I fell and cracked my head before. The head is very vascular (meaning it has a lot of blood). Even a small cut to the head or scalp it can bleed a lot. Got it to stop within about 3 minutes with quikclot and then was rushed to the ER to be stitched up.
Wow! They really thought you were serious. We have lost our common sense.
patricke lmao
Ya did the best you could!! Those head injuries are serious!! LMAO
Mambo Dave, the reason why we apply a TQ first is due to the fact that it works. It stops the blood from leaking out the body quickly, effectively and efficiently.
It doesn't matter if help is three minutes away or three days away. We've got to keep the blood in the body in order for it to continue to work. The human body only has about 5-6 liters of blood in it. Once that blood is lost due to a traumatic wound, the body can't make more new blood on its own quick enough to replace what was lost. In the past the standard was to apply direct pressure; if that didn't work then elevate the injury. If that didn't work, then use pressure points. If that didn't work, and you've tried everything else... then apply a TQ. So we used to "try" things that really didn't work at all. But a TQ does! It stops the bleeding or makes it more manageable to deal with. Also, while we're "trying" to stop the bleeding with those outdated procedures; we're wasting valuable time and blood.
There is no real difference between moderate to severe bleeding on the battlefield or out in the woods. Granted that in Iraq (Baghdad for example) their response times and transport times from the point of injury to the point of surgery is a lot shorter time-frame than even some major cities here in the US.
In Afghanistan, those time-frames are extended due to terrain and being a little more spread out from immediately available resources as compared to in Iraq.
When we're talking about medicine after we've stabilized the patient; that is a different type of medicine. Now we're talking about things like wound management, continued medical support for the patient. Think ICU type of care, but without the entire hospital, staff, or resources immediately available. That in itself is a whole other ballgame.
Hope that helps?
-Caleb
Lone Star Medics I
Caleb I work for a law enforcement agency and I've been trying to get them to issue tourniquets for a couple years now. I want you to know I'm going to steal your comment on here to try to help convince them.
There is a major difference between 3 hours and 3 days, after 6 hours you could lose anything below a TQ. There is a major difference between severe and moderate bleeding as well as arterial and venous bleeding the latter can usually be stopped with direct pressure. Have you ever spoken to someone in a TQ, TQs Hurt. You are stopping all blood flow to a limb, your body is screaming for you to take it off. Also if you do put every TQ "up as high as possible" you are making a lot of ABK amputees out of people who could have lived a life as a low BTK amputee.
www.ncbi.nlm.nih.gov/pmc/articles/PMC2660095/
After your finally finished watching this elongated video these Tourniquets will be antiques and better versions developed.
Thank you for making this video. It was recommended to the participants of Shelley Hill's The Mingle 2021. I personally can attest it should be mandatory to carry at least one in all vehicles. Mom and I were hit by a car going 70mph, well car vs pedestrian.. we didnt win. By the grace of God 2 gentleman stoped and placed tourniquets on us. They were praised by EMS and then we heard that they had saved our lives when we ended up in the ER
I've been reading a lot of good questions, but some of the answers others have posted are incorrect.
I highly recommend that everyone go get some CURRENT training from a solid instructor/company that teaches MODERN techniques in field and tactical medicine. Techniques we were all taught even five years ago is outdated. Medicine changes by the hour. I beg of you, please go get in a class. I don't care if one of ours or someone else's.
The one dislike leaves his tourniquet in the package.
I did a search for sof t y tourniquets sof-t-y tourniquets and then I realized that you said "SOF T Wide tourniquet. Great video. Thanks!
I picked up two tips I had not been told. Thanks.
I was actually about to head over to its to purchase one. What great timing.
Great video guys, I wish B-con was taught like CPR in schools. I wanted to bring up one point on what is a misconceptions about TQ use. Before the data came out. Old boy scouts training said to release the pressure every so often to keep blood flow in the limb. I would just say DO NOT remove the TQ after application. This can release toxic/septic blood into the body and make bad things worse.
Even after 1-2 hours there has been proof of a safe window to have a TQ in place. There has been a recorded case of a (SEAL I think) having one one for 16 hrs and still has the limb confirmed. And unconfirmed another person was 30 hours. Just Do Not Remove. Add another one no problem. Also during practice be careful if you are taking body thinners.
Artsian local Good advice on blood thinners. They did mention the 111 rule of thumb on application times and said it could be stretched out to 2 hours. That said, I have also heard of those extreme times. They are addressing best practices.
Now part of my 5.11 Tactical pant EDC ! The pant is held up by the SOE EDC w/Cobra belt buckle that has two hairbands that hold the tourniquet. This is handy for dangerous sports and not just shooting paper targets. tjl
Please put a link to the flat-fold video. Thanks for the vid.
This was a beyond excellent presentation from you two. Great job! One question: Caleb states that the tourniquet is no longer the last resort 1:08, but is that due to the presence of organized transport and medicine? Is it still more of a last resort in a situation where medical help isn't hours, or even a day, away? I know we have comprehensive data from the fronts we've been involved with, but what of different wilderness situations where organized medical transport and help may be a week or more away?
OMG! 4:42 in and moving on. Cut to the chase! YAWN!!!
Well done, thanks Brian. Thanks to both, I should say!
just checked out a couple of your vids thanks good info guys!
Can someone please give me a link to the tourniquet on the video cover?thanks!
With the femoral artery, about how long do I have before I'm too weak to self-apply the TQ?
can you do a vid on stretching? lol
I just received two in the mail today. I will be carrying one in My get Home pack
Joto. One of my favorite cause never used it.
they make a different model for the acid blood I heard. Great video, thanks for the instruction.
Why is there no link, no card, to the video on folding? You are a content provider, I would think you want to make it easy for your viewers to view more of your content.
Great vid, thank you guys.
Great stuff, thanks.
5 Minutes in and I'm losing the will to live! Why take a hundred words when you can use a thousand!!!
great vid guys; thank you very much-
aluminium windless with a plastic clip holding it in position?
Why do you prefer the SOFTT tourniquet over the CAT tourniquet?
I got a tourniquet that has a metal clamp for the band with serrated teeth and a screw to lock it down. It is bulky as hell and I wanted to know what brand you used and where to get one that will lie flat like that.
+Stephen Merrette That is the same brand. You have the Gen I SOFT. The one they are using is the Gen III, also known as the SOFTT-W.
Can you use a trap from a gym bag or like a gun back ?
Don't date/time that on the tourniquet. That way if I am walking by and quickly triaging and the dude (or dudette) is in a hypowrap (which they should be) I cannot easily identify they have a tourniquet applied. Where as if the date and time are on the forehead I can easily identify what is wrong.
+David Black to me this depends on a few things, tell me what you think....In a military application, (never served, NOT FROM EXPERIENCE) I'd assume many times it is mass casualty, so forhead is a good way to go, though I would think BOTH couldnt hurt. Civilian, (I Have Expreince) Single Pt, single Medic crew, direct Pt Care Hand-off, I'd say on the strap is sufficient, and potentially less "scary" to onlookers/Family/alertand oriented Pts? Interested in other perspectives on this.
+jtmonsman it isn't always for a mass casualties. If you don't give a good patient hand off and you can't see it in the hospital or if there was confusion you can have a bad time. But also if you have a tourniquet removed for some reason.
+jtmonsman it isn't always for a mass casualties. If you don't give a good patient hand off and you can't see it in the hospital or if there was confusion you can have a bad time. But also if you have a tourniquet removed for some reason.
+jtmonsman it isn't always for a mass casualties. If you don't give a good patient hand off and you can't see it in the hospital or if there was confusion you can have a bad time. But also if you have a tourniquet removed for some reason.
+David Black yeah, I could see that. especially the part about pt confusion. The level one centers I've seen tend to get pretty crazy at times, and i could see that detail getting lost in the shuffle. I'd say that if i didn't give a good Pt hand-off in the civilian paramedic role, i wouldn't be very good at my job. but the whole game of "telephone" that is pt care hand off comes in to play.
Well done guys.
Is there a way to use this if you are struck in the very top of your thigh, like a femoral hit near your groin? or are you pretty much screwed?
Tregeta
If the wound is too high to apply the TQ, then the next best thing is to pack it with Quikclot Combat Gauze and apply a pressure bandage like the Isreali Emergency Bandage. The next higher level of care would likely have a junction TQ that could be applied. but that is not something to be found in an IFAK or Medic Pack.
+Tregeta That's called a junctional hemorrhage. Google for it. There's been a few studies (VERY informative) published recently showing that these injuries are EXTREMELY dangerous and almost always fatal if not treated IMMEDIATELY. TQ's don't work. Period. You'd have to put the TQ distally and it just doesn't work. You pretty much have to use pressure/pressure dressings along with a hemostatic agent to control the bleed. Great question, man. Good to see people thinking of this stuff!!
The new kid on the block is the "Inflatable Tourniquet" that cover strange areas. More info on RUclips ! Like if shot or bleeding from the pelvic area... And even showing up in the OR. And a woman was one of the First to set up a MASH unit with a brand new idea the "X-Ray" machine. This was in The Great War to end all wars... tjl
Tim Lipinski is that similar to MAST (military anti shock trousers)?
Why as high as possible? Why not just above the highest point of the wound? Thanks for video and for any reply.
+BLAST if the artery is ruptured in other places that you cant see then putting it higher will probably go above all ruptures, also there is usually more muscle the higher you go, more muscle makes it easier to pinch the artery off instead of just shoving it into a bone
+xArkAngelx Placing the tourniquet as high as possible the new standard according to any governing body in the medical field?It is been a number of years since I went through a Combat Medic course but they taught us just above the wound/amputation to potentially preserve as much of the limb as possible should the limb be damaged or lost due to loss of circulation.
+Incog Incog our view of tourniquets has changed drastically, we use them in EMS almost always if it is an arterial bleed, study's have shown over and over again that you will not loose the limb because of a tourniquet, as long as you get them to a hospital, you could probably leave a tourniquet on all day and you would be fine
+xArkAngelx I know about having several hours to get the patient to a higher level of care before the tourniquet can cause a loss of limb. I just don't see the value of sliding one on so high above the immediate wound. Because if something prevents you from the getting them to a hospital then his limb is compromised. I am looking at it from a Combat Medic view versus a civilian Paramedic.Do you know whether this is now the standard for the NREMT?
+Incog Incog yes, this is what they are now teaching in school, if direct pressure isn't stopping the bleed then immediately goto a tourniquet, the whole study from the military was kinda flawed, all of the statistics from limb loss with a tourniquet were almost all due to the limb being so mangled that it was amputated, not because of a tourniquet
So if you got shot in the forearm or the calf you will put the tourniquet on the upper arm and the femur?
high as possible. in the forearm, go up to arm pit. if it's the leg, up to the groin. the idea is that an artery is elastic and it could have retracted
New evidence shows good results with putting the TQ on a few inches above the wound.
The idea of "high and tight" for TQ use came from combat where there may be more injuries than just the one you can see (forearm gunshot wound as well as an upper arm wound). In a non "tactical" environment, ensure the TQ is 3-4" above the highest wound that has arterial bleeding.
Also, go get training somewhere. TQ use is a "once in a lifetime" event, but you can/will use other medical treatments much more regularly.
yes.
I heard somewhere that you are supposed to remove pressure every so often to avoid death of the limb. is this true? if so how often? is this something a med pro should be doing?
Myhron Mahgainez
sounds fine by me. some of the crap you hear can get you killed. thanks for clarifying
I have been taught that you can loosen it up to 10-15 mins after applying. Anything longer than that, requires a doctor, because they have to be ready to fight blod clots and other nasty stuff.
Never remove a TQ after it has been applied. Let the surgeon or trained specialist take care of it. The main cause of death in combat situations is blood loss. Fuck the limb, save your brothers life.
Julio, you want keep the TQ on tight until the medics get there. Recent studies have shown that you can safely leave a TQ applied for up to 6-8hrs. After that time-frame, tissue starts to break down and becomes necrotic or "dead tissue". The problem with that is those dead cells become toxic and can wreak havoc on the rest of the healthy body/cells. So if we loosen up that TQ and allow blood back to that limb; we run the risk of circulating those toxins throughout the body.
Not to mention the fact we also run the risk of circulating small blood clots as well. And that is bad.
The debate on releasing it or keeping it tight after 6-8hrs is still ongoing even with high level healthcare providers. Now as a healthcare provider, they can assess the patient taking in consideration their vitals, level of consciousness, environment, ETA to appropriate healthcare facility, the severity of the wound itself, available resources (equipment & personnel), and other factors to determine if loosening or removing the TQ is the best procedure at that time. No matter if that time is before or after that 6-8hr window.
We're not so much worried about "loosing the limb" as we are about loosing the entire patient.
Great question.
-Caleb
Has a trained combat medic I can say that every 15 min you should open it a little in order to save som of the meat. But only if you have bandage the wound, this is also to see if the bandage fits good on the wound.
You know what if SOFT and these guys made a TQ then that would be a ver good one. The problem with SOFT is the velcro. The problem with tgis is the sinch mechinism. Put the 2 together. Perfect TQ
Why would you place a tourniquet as high on a limb as possible?I was taught as a Combat Medic to place a tourniquet 2-3 inches above the wound or amputation. The reason for that is if in fact getting the victim to a higher level of care is delayed and the person does in fact lose the limb due to loss of circulation the victim keeps as much of their limb as possible.The higher you go with the tourniquet means the potential for that much more of the limb to be lost.
+Incog Incog nowadays- we dont worry about "more of the limb being lost", as we've proven that a tourniquet can be in place for 8 hours before tissue necrosis sets in. You go as high as you can for 2 reasons: 1. More muscle mass means it'll tighten down/occlude the artery much, much easier. 2. Arteries RETRACT when injured/severed. Going higher helps eliminate the possibility of that artery "shrinking up through the tourniquet." I'm a Combat Medic veteran, current Firefighter Paramedic. HOPE THIS HELPS.
What is the Purpose of dating, and Time stamping it?
Leaving a tourniquet on for too long can cause problems due to the lack of blood flow. Date/Time-ing it will let medical professionals know exactly when you applied it so that they know how much time they have to work with before it needs to come off.
AnomalyTea I was kind of thinking that......Thanks !!!
Like others have stated here... healthcare professionals need to know how long that TQ has been applied. As long as it's within 6-8hrs, everything is good to go.
Check out my comments above for a little more of an answer.
-Caleb
It would've been really nice if you just showed one consistent technique of folding instead of sort of starting in the middle, then the other guy chiming in with a completely different technique, etc.
What's with the lac of uploads
Bla bla bla bla bla !!!! Love IT
You guys talk to much . Just show us how to use it. I couldn’t finish it.
People like you are cry babies and think the world revolves around you to the point everybody should do things to suit you apparently. When they don't you throw a hissy fit.
Good video guys. LOL@ 'orientate'... I think orient is what you're looking for Caleb. :)
10:31
We usually just date the Marines forehead with all that info. And of course we'll let the CASEVAC know via the 9 line.
Its acutally better that way, more visible. I once saw a leg tourny get missed on a quick assesement because the guy had torn up black pants with a black tourny jumbled up over it. Very easy to miss..
nisher15
My doc back in our old bn told me this was what they preferred. I'd probably do the same after triage in a civilian situation.
We teach our students to date & time stamp on several places.
1. On the TQ itself.
2. On the casualty collection card or patient report document. Whatever that may be at your level of care.
3. Verbally to the responding medics/EMS.
4. On a patient's forehead is a good place as well.
Documentation is a pain in the butt. However it is vital that information gets passed down correctly.
Basically anywhere you think to put it... put it there. More the merrier.
-Caleb
Is it just me or is this tourniquet utter garbage? I have seen other people try to use it, and also bought one myself. Nowhere near the ease of use and holding power of a CAT. I do however love how compact it folds since it doesnt have the winlass retainer buckle
Garbage? No, I applied one and saved the life of someone with a lower leg amputation.
In the fire zone you had them attached to your limbs already not strapped to your weapon or vest. He needs to do not talk about it.
too much talking
CAT seems overall much better
Good example of how NOT to apply the CAT. First of all they are putting it on backwards. The cinching pull is done AWAY from the body and then, the "tail" is wrapped around the outside of the arm and then pulled up through the armpit in plain view; leaving it free for adjustment without having to completely loosen it for repositioning. This will leave the windlass catch/lock in plain view and on the "easy side" for easier lock down.
If you put it on correctly you won't have to do a lot of "practising" to lock it down because the windlass will be on the "easy side" and in plain view. In extreme conditions when several minutes may pass before you can be in a safe place - putting it on backwards and having to fight with the windlass lock before your MedEvac buddies get there could cost you your life.
"Oh, we found him with the CAT on backwards and he didn't have enough "practise" doing it wrong to lock down his windlass so he bled out." ... ( or maybe he just watched the wrong RUclips vid... sorry mom, RUclips idiots killed him, Oh, well... )
45 basics stopped by and thumbs down cause they didn't learn it the first time lmfao
Tourniquet - pronounced Torn eh Kay
8years ago.... Are y'all boys still alive😁😁😁
If you have difficulty putting tourniquet while you are NOT injured, you will not be able to put this tourniquet when you are hypovolimic and in pain! This version of tourniquet should be avoided!
DO NOT USE A TOURNIQUET FOR A SMALL WOUND. I heard Caleb mention getting shot in the arm, 10:40, while explaining application and it immediately set off a red flag for me. It's really important to also educate WHEN to use, not just HOW to use. Tourniquets are only used for missing limbs. Also, do not use a tourniquet on a fracture or break.
Your medical knowledge is about 15 years out of date brother
That's not accurate at all unfortunately
Jonathan Cook .......only for missing limbs? Hahahahahaha
Tourniquet - pronounced Torn eh Kay