What do your protocols say you use for bleeding control? I know some standards have went to: direct pressure straight to tourniquet. Does anyone use quickclot type products? And also, what type of turniquets do you use?
The standard direct,elevate, more pressure dressing and a whole lot of praying.. If this does not stop it then tourniquet..... By then you and figure out that you have a problem.. no quick clot stuff here in Ny
I have had very few bleeds which require a tourniquet, (over the last 30 years). I'm sure in a combat situation it would be different. Most bleeding can be controlled with direct pressure, even if you are using an air splint or BP cuff. My medical director would stroke out, (as most area Trauma docs) if we applied any kind "clotting stuff".
In NYS, they teach that you almost never need to use a tourniquet. Direct pressure, elevation, pressure point, in that order. I'm pretty sure "quickclot" isn't allowed either.
If you pinch off a pressure point, you limit the flow of blood but you don't cut it off completely so the limb is still getting some oxygenation. If you cut off the supply of oxygen, tissues "down stream" start dying and that can't be undone.
We had one instructor who's mantra always was, "do no further harm."
Now, in saying all that, our definition of a tourniquet might be different. I'm talking about completely cutting off bloodflow to a limb, the "boy scout" kind. You do that, you basically just performed an amputation in the field which will be cleaned up by surgeons in an OR later on.
I'd rather not have that responsibility looming over my head. I'm not sure I'd even use pressure points unless it was severe arterial bleeding. I've seen direct pressure used effectively often enough on a variety of severe trauma.
WE have been carrying tourniquets for over a year now. Our med control doc is a doc in the reserves and has written them into out protocols since his last couple of trips overseas. This is the one that we use. http://www.mat-tourniquet.com/about-mat/
I could not agree more. Paramedics think a little different than most when it comes to tourniquets. I would much rather someone lose a limb than lose their life. Tourniquets are not always a bad thing. I totally agree with your comment. Due to the USA not having a full on cambat war since Vietnam, the War on Terror has seen huge deveolpments in truama care. You would not believe some of the things that they are doing and are hugely successfull with. If you have been trained in EMS within the last 30 years, you were basically taught the methods and critical thinking that medics/doctors used in the late 60s and early 70s. When the info starts trickling down from the War on Terror, I think some folks boats will be rocked. This isn't your Daddy's EMS anymore!
This is what they teach in New York State. Tissues do start dying when deprived of oxygen. There are methods you can use to minimize the destruction but it does happen. If I can stop the bleeding without using a tourniquet I will, but that is a last resort.