Severe Hemorrhage Control Application of the Sof-T Wide Tourniquet

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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 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 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 Don’t wait!

Application of a tourniquet before the patient goes into shock has been shown to improve outcomes in military studies 4

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.

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The Sof-T-Wide Tourniquet

Constricting Band Triangle Ring Windlass Quick-Release Buckle Loose End

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Procedure

 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 10

Procedure

 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 12

Procedure

 Lock the windlass in place by slipping the triangle ring over the end of the windlass

Triangle ring End of windlass

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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 14

Notify all caregivers involved in the care of the patient that a tourniquet has been placed http://www.bdems.com/med3.htm

ALS Ground Intercept news.legalexaminer.com

ALS Air Intercept

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www.postindependent.com/article/20050621/VALLEYNEWS/50620012 Emergency Room Report 15

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 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 17