Post Tourniquet application questions.

seeth07

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So in prep for my upcoming Kodiak Elk hunt, my wife and I have been researching and practicing/role playing certain scenarios we might possibly come across requiring first aid. One item we have gone very much in depth on is a deep wound.

Both of us feel pretty good and confident that in the event one of us needs to have a tourniquet, we can get it done and stop the bleeding.

Assuming things go well and we are able to get the tourniquet on, wound packed with bleed stop and gauze/bandage wrap applied, what is next? I wasn't able to use the internet much to find answers to these questions and everything pretty much goes from stopping the bled to call 911 or go to the hospital. Not helpful.

Obviously step one is hit that inreach sos button at this point in time. Immediate extraction is going to be required if a tourniquet is applied. Here are my specific questions though:

1) At what point, if any, should we consider removing the tourniquet. About 2 hours in, it appears serious damage can occur to the limb. If we get the bleeding to stop, can we try to slowly loosen the tourniquet and monitor to make sure it stays stopped?
2) It may not be easy for S&R to get access to us. Moving with a tourniquet applied isn't easy. I applied one to my leg and it doesn't take long before your leg goes numb and limp from lack of blood. Do you just sit tight and wait for S&R to come and assist or do you do whatever it takes to get to an easier accessible spot?
3) Overreaction. What if you applied a tourniquet and after the adrenaline ends and your mind clears you realize that maybe this isn't that bad. What would be some ways to recognize that it's just a bad wound and not a life-threatening one?
 
Not super helpful here from a technical standpoint, but the guys at MeatEater had an ER doctor on an episode and they discussed this (I think episode 192 maybe). I believe the conclusion was that you could leave the tourniquet on for a much longer time, like 6-8 hours, without long term impact. Even that timeframe might not be helpful depending on weather and S&R access. Good for you guys thinking through this and practicing!
 
Obviously not medical advice, here are my thoughts on tourniquet.

As you noted, this would be a medical emergency necessitating an evacuation.

A tourniquet should be used once other methods of bleed control (wound packing, pressure dressing, elevation) have failed, not in place of.

Generally thought to have 8 hours before long term damage to limb may occur.

Correct application of a tourniquet is quite painful and self-extraction should not be counted on. If it isn't painful, it isn't on tight enough.

Loosen at your own risk. A tourniquet is applied over concerns of bleeding out resulting in death. Don't choose limb over life.

A bad wound that isn't life threatening would be one that you can stop the bleed using other methods. Leave original dressing on wound, keep packing on top.

There is also a point (recommend follow up with MD) in which the tourniquet should not be loosened or removed except in a hospital as uncirculated blood rushes back into the system/heart.



Edit to add link to literature I reviewed after initial post.
Wilderness Medical Society Practice Guidelines for Application of Current Hemorrhage Control Techniques for Backcountry Care: Part One, Tourniquets and Hemorrhage Control Adjuncts: https://www.wemjournal.org/article/S1080-6032(14)00279-8/pdf
 
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I asked my medical resource, she said once the tourniquet is on, it shouldn't be removed until a medical professional can help. In the event of delayed help, taking over 2 hours the recommendation is to leave it on. Better to risk losing a limb than bleed out and die.



Source sent:

Photo is better in the article
sc_112846618557159.png
 
TacticalCombatCasualtyCareHandbook gives some good information. I am a former SAR, Ski Patrol,EMT-B, with military training. The "Golden Hour" in the backcountry is often shot to craps. In the end it is still "life or limb" and permeating one's brain with first aid information is never a waste of time! I am sure some first responder professionals will weigh in, as I am out dated!
 
Correct application of a tourniquet is quite painful and self-extraction should not be counted on. If it isn't painful, it isn't on tight enough.
In our practicing we took this to the limit to really know what it should feel like. Like I mentioned, it basically became impossible to walk on my leg after it was applied for only a few minutes. I took this as a good sign that my wife did it correctly.
A tourniquet should be used once other methods of bleed control (wound packing, pressure dressing, elevation) have failed, not in place of.
Good point but I could see one of us overreacting rather than underreacting in one of these scenarios
 
permeating one's brain with first aid information is never a waste of time!
Exactly! The more prepared you are and the more horrible scenarios you've played through your mind the more likely you are to do the right thing when called upon
 
In our practicing we took this to the limit to really know what it should feel like. Like I mentioned, it basically became impossible to walk on my leg after it was applied for only a few minutes. I took this as a good sign that my wife did it correctly.

Good point but I could see one of us overreacting rather than underreacting in one of these scenarios

I understand the concern for potential overreacting. I would recommend more literature consultation and more gaming of potential scenarios. More discussions on when the use would be appropriate.

The screenshot below is from this link:

Screenshot_20230910_113755_Adobe Acrobat.jpg
 
My thought process regarding removing a tourniquet after you've calmed down & think you overreacted would be: what if you didn't?

The bleeding will almost certainly resume and you'll be less likely to have the ability to reapply the tourniquet. Yes, you may risk limb loss but you'll look better alive with one less twig than you will in a casket. In my opinion applying a tourniquet is one of those decisions you make and LIVE with the consequences.
 
It’s been a while, but Iwas trained that once a tourniquet goes on, it doesn’t come off until the patient is in the OR.

Full stop.

If you put it on, it’s last ditch effort. Don’t touch it, other than maintain.
I have been trained in the same way. If you are applying a tourniquet you have some serious bleeding going on that direct pressure and packing isn't gonna stop. Think squirting arterial type bleeding. Also an important rule is to have it super accessible. If you have to dig for a minute through a pack it may be to late in an emergency situation and expect shock to set in. It's going to be an extraction situation most likely.
 
Great questions! I’ve wondered the same.

I would think that if I was bleeding enough to apply a tourniquet, and decided it wasn’t life threatening, it’s still probably bad enough to want to get the heck out of there. Better to over react than be in denial.
 
Thankfully I’ve never had to put one on myself, but I have either applied them to others or been there when they were applied to others a few times in the real world.

1) Never, ever take it off. If you need to put it on it does not come off until a doctor takes it off. Often they will leave them on during the beginning stages of surgery to control the bleeding in the ER. It can stay on for several hours without damage to the limb even being a possibility.

2) I’d be inclined to stay put, but it depends on the situation I guess.

3) Torniquets are only for controlling massive arterial bleeding, as in blood that is visibly spurting from the wound or bleeding that cannot be controlled by any other method.

Good for you for being ready, I carry one every day for work and I carry one in my hunting pack too.
 
Thankfully I’ve never had to put one on myself, but I have either applied them to others or been there when they were applied to others a few times in the real world.

1) Never, ever take it off. If you need to put it on it does not come off until a doctor takes it off. Often they will leave them on during the beginning stages of surgery to control the bleeding in the ER. It can stay on for several hours without damage to the limb even being a possibility.

2) I’d be inclined to stay put, but it depends on the situation I guess.

3) Torniquets are only for controlling massive arterial bleeding, as in blood that is visibly spurting from the wound or bleeding that cannot be controlled by any other method.

Good for you for being ready, I carry one every day for work and I carry one in my hunting pack too.
When we teach tourniquet use in active shooter class we tell the class once it's on keep it on. We also stress high and tight. Remember when you put it on it should hurt. By going high you are able to use another one if the blood flow hasn't stopped. If it's in the budget I recommend a gauze with a clotting agent to be used in addition to tourniquet application.

The North American Rescue website has good information on it. This is not a plug for them, it helped me a lot when I was pushing for tourniquets at work as we have a marina and exposure to boat props was cause for concern.

I prefer a CAT tourniquet over most as I have bigger hands and they are simpler to deploy in an emergency when the loss of fine motor skills may go out the window.

Hope this helps. Everyone has given great advice!! It's awesome that you and wife are practicing on each other. I taught my son and daughter how to use them. I wish they would teach it in First Aid Courses.
 
Definitive care is the next step.

Get there. Period.

Tourniquet placement is there for a reason: You’re going to bleed to death without it.

These are for massive hemorrhage. Arterial bleeding.

Direct pressure and pressure dressings control A LOT of significant injuries from severe trauma without the application of a tourniquet. That said, if in doubt, place the tourniquet and seek definitive care as soon as possible.
 
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A tourniquet is one of the tools that should be in your first aid kit. My personal FA kit is a trauma kit that I added some basic FA (band aids, Tylenol, ibuprofen, 81mg aspirin, Benadryl). Trauma kits should come with gauze, hemostatic dressing, occlusive (sucking chest wound) and a CAT or SOF-T tourniquet.

As previously mentioned, tourniquets are after all else fails. The basic principle of most tourniquets is a wrap that stops arterial bleeding by tightening with a windlass. You already have a makeshift tourniquet with a length of nylon webbing, bandana or a belt and a stick. Most important is that the tourniquet is placed proximal (closer to the heart) rather than on the injury or distal (closer to the end of the extremity).

It’s good that you have applied a tourniquet to yourself to understand the degree of pressure. If properly tightened on your thigh it ought to be really difficult to feel a pulse on the top of your foot. I like the CAT tourniquet because it’s Velcro, the windlass fits into a a bracket and you can sharpie the time applied on that Velcro tab that secures the windlass in the bracket.

In the event of any traumatic injury, the person should be covered and kept warm. Shock should be expected and hypotension is part of that. They can throw off blankets if they get too warm.
 
Great thread!

Earlier this summer I got a couple CAT tourniquets, one went in our work truck, and one will be with me all fall on my hunts. I appreciate the info some of you have posted.
 
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