phildsmith69
Well-Known Member
100% Just never occurred to me that would be the case.
"Anyone got a tourniquet?"
- Thread starter Stalker62
- Start date
That’s a little bit of old thinking , it used to be if a tourniquet was on for more than 15 minutes the limb would be dead from no blood supply , not current thinking , use a tourniquet to save a life at the very worst they lose a limb, but that can be on for up too 70/80 minutes with no complications, permanent muscle damage can occur after 2 hours , complete muscle damage can be around 6 hours . All this is approximate and dependant on conditions and who you talk too .
Work this out with ambulance response times and 90% of time you’re under medical care inside of 30 minutes , for what we do and where we go those times can be stretched for help to arrive
Things continually change with 1st aid practices as knowledge improves, along with medical advances.
My first 1st aid course some 30+ years ago tourniquets were coverd with the advise that they should be loosened every half hour or so. They then vanished from the training falling out of favour.
Now they have returned, with advise not to remove, just to mark the date and time applied.
I'd rather risk losing a limb than be pushing up daisy's.
My first 1st aid course some 30+ years ago tourniquets were coverd with the advise that they should be loosened every half hour or so. They then vanished from the training falling out of favour.
Now they have returned, with advise not to remove, just to mark the date and time applied.
I'd rather risk losing a limb than be pushing up daisy's.
Most up too date thinking on severe wounds is first pressure , not working or if severe bleed pack wound with gauze , or clotting gauze , and I do mean pack not wrap as in push into wound as you unroll it packing it in then cover with pressure bandage ie Israeli bandage , if still leaking the red stuff then it’s tourniquet time as tight as you can get it , mark with time of application and seek medical professionals asap
Rocky Peak Outdoors
Active Member
Sorry, I think we're agreeing on the same thing? You say 'old thinking', I was making the point that you won't necessarily lose the limb, which seems to be the same point you're making.
My follow up to that still holds true, that by applying one you have to be thinking that you're prioritising a life over a limb. Whilst it's less likely, that is still a recognised complication, and you are making that decision.
Medical care within 30 mins is great, however that doesn't mean it's at that point you can take a tourniquet down. A paramedic isn't likely to take one down in the field. In the Emergency Department too, you might or might not. The safest place where possible is in theatre with a surgeon scrubbed to deal with the subsequent bleeding.
It's an interesting discussion though and should be talked about.
Due to the surgeries we do, we regularly apply arterial limb tourniquets in a timed manner which is effectively achieving the same thing.
I agree with you , at the end of the day it’s in the name “ first aid “ until you get that casualty to an operating room you do what ever needs doing , priority is always to save a life , it’s the same thinking with cpr , people don’t realise the pressure you should exert on the chest , there are cases of breaking ribs doing cpr but if the patient is still alive when you can get a defibrillate on to them or the ambulance drives away it’s a win !
As with everything it’s knowing what to do so any sort of first aid training is good as is carrying a basic ifak !
As with everything it’s knowing what to do so any sort of first aid training is good as is carrying a basic ifak !
Rocky Peak Outdoors
Active Member
Definitely. Training and having a kit that is actually good quality and small enough to carry with you are vital.
That's why we sell our own. Rather than add fancy stuff that people won't/don't know how to use, we keep it as small as possible with the vital stuff that is actually needed. Putting it in a high quality pack means it'll stand up to the abuse of actually being carried!
Someone needs to have a word with the majority of the first aid training providers.
I’ve taken 4 two day courses in the last 6 years (requirements for work). All aimed at outdoor situations, field work, youth groups in remote locations etc.
Every one has spent over 65% of the time dealing with conditions that are (a) rare in people under 50 (heart attack, stroke etc); and (b) not survivable unless the ambulance arrives within 30 minutes. So completely inappropriate.
I’ve only had one course that actually went into any depth on dealing with severe cuts and life threatening bleeds. And yet it was obvious that this was somewhere that you could make an enormous difference as a first aider. CPR is completely useless if the ambulance is over an hour away - in fact, is actively dangerous if it’s cold and wet and there are other people in the group who need to be extracted. But getting control of a bleed could even mean the person walks out.
I really don’t understand it. For young people doing active things (adventure sports, forestry, stalking etc) it’s far, far more likely you’ll have to deal with a bleed than a heart attack, but it’s barely mentioned on first aid courses.
I’ve taken 4 two day courses in the last 6 years (requirements for work). All aimed at outdoor situations, field work, youth groups in remote locations etc.
Every one has spent over 65% of the time dealing with conditions that are (a) rare in people under 50 (heart attack, stroke etc); and (b) not survivable unless the ambulance arrives within 30 minutes. So completely inappropriate.
I’ve only had one course that actually went into any depth on dealing with severe cuts and life threatening bleeds. And yet it was obvious that this was somewhere that you could make an enormous difference as a first aider. CPR is completely useless if the ambulance is over an hour away - in fact, is actively dangerous if it’s cold and wet and there are other people in the group who need to be extracted. But getting control of a bleed could even mean the person walks out.
I really don’t understand it. For young people doing active things (adventure sports, forestry, stalking etc) it’s far, far more likely you’ll have to deal with a bleed than a heart attack, but it’s barely mentioned on first aid courses.
Pleased to say that’s not always true.
There are proper outdoor / work related courses out there but you will have to seek them out , most of the St. John type courses which people do through work to tick the boxes required just give a general view of first aid ! But even this can be a help in situations , any type of first aid training is a bonus
phillc
Well-Known Member
Actually, I don't think that's quite right. I do agree that the priority is to save a life, but it's not always only "first aid" until the operating theatre. If you're not in an urban environment, perhaps you're in the mountains on a hunting expedition, or camping in some remote region, then "first aid" could easily transition to "prolonged field care" well before an evacuation to the operating room. When this situation arises it is important for people to understand how to convert a tourniquet if possible. This is an advanced technique, but if tourniquets are going to be applied immediately for any kind of bleeding, which may or may not be a catastrophic haemorrhage, then it's an important technique to learn.
"The immediate threat to life with an actively hemorrhaging extremity injury is addressed with the liberal and proper use of tourniquets. The emphasis on hemorrhage control has and will continue to result in the application of tourniquets that may not be needed past the Care Under Fire stage. As soon as tactically allowable, all tourniquets must be reassessed for conversion. Reassessment of all tourniquets should occur as soon as the tactical situation permits, but no more than 2 hours after initial placement. This article describes a procedure for qualified and trained medical personnel to safely convert extremity tourniquets to local wound dressings, using a systematic process in the field setting."
Back to the "fake" tourniquet discussion, I also saw this article today:
Counterfeit tourniquets are a serious problem
Counterfeit tourniquets may look legitimate but are not made to the same quality standard. You should not rely on them
www.crisis-medicine.com
Summary:
- The counterfeits generated less than 25% of the force of a similarly applied gen 7 CAT. Both were placed with the slack pulled out and only three windlass turns.
- The counterfeit also had a 4% catastrophic breakage rate (7th gen CAT zero breakage).
phillc
Well-Known Member
Like this one (I mentioned it before, but a repost won't hurt
)
The REMT course provides medical skills and didactic learning for those looking to work in austere, remote and resource poor environments. If you work or spend time in austere environments where access to medical care is often delayed and communication is unreliable, this programme is for you!
Part 1: Online training (75 hours)
Part 2: Classroom training (50 hours)
I think that’s why most first aid courses won’t touch the subject of tourniquets, it’s more the outdoor or forestry courses and them most put it as a last option to use for control of bleeding ,Actually, I don't think that's quite right. I do agree that the priority is to save a life, but it's not always only "first aid" until the operating theatre. If you're not in an urban environment, perhaps you're in the mountains on a hunting expedition, or camping in some remote region, then "first aid" could easily transition to "prolonged field care" well before an evacuation to the operating room. When this situation arises it is important for people to understand how to convert a tourniquet if possible. This is an advanced technique, but if tourniquets are going to be applied immediately for any kind of bleeding, which may or may not be a catastrophic haemorrhage, then it's an important technique to learn.
"The immediate threat to life with an actively hemorrhaging extremity injury is addressed with the liberal and proper use of tourniquets. The emphasis on hemorrhage control has and will continue to result in the application of tourniquets that may not be needed past the Care Under Fire stage. As soon as tactically allowable, all tourniquets must be reassessed for conversion. Reassessment of all tourniquets should occur as soon as the tactical situation permits, but no more than 2 hours after initial placement. This article describes a procedure for qualified and trained medical personnel to safely convert extremity tourniquets to local wound dressings, using a systematic process in the field setting."
Back to the "fake" tourniquet discussion, I also saw this article today:
Counterfeit tourniquets are a serious problem
Counterfeit tourniquets may look legitimate but are not made to the same quality standard. You should not rely on them
Summary:
- The counterfeits generated less than 25% of the force of a similarly applied gen 7 CAT. Both were placed with the slack pulled out and only three windlass turns.
- The counterfeit also had a 4% catastrophic breakage rate (7th gen CAT zero breakage).
We’re lucky in this country as there’s not many areas you’re not out of reach of medical care fairly quickly
Agreed, a lot of courses don't deal with it at present, but there are lots of public access bleed control kits being put alongside AED's in towns and cities which include tourniquets so I don't give it too long until it is on the syllabus.
About 10 years ago AED use wasn't included, but is now.
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Not a very good one then, depends how long and where the tourniquet is applied, also depending on the injury, it could be the first resort
Stalker62
Well-Known Member
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Fn5
Well-Known Member
Aye, i've got a pretty comprehensive FAK in the car including a trauma pack, which (the trauma pack) also goes with me when i'm shooting, because you just never know when someone is going to do something stupid/an accident occurs. Call it a hangover from a previous career, but i feel odd not having it in the wagon just in case.
tackb
Well-Known Member
your most useful bit of first aid kit is your training and attitude which is with you all the time , after that there is a few bits and pieces you can carry to make better use of your skills but ultimately if you don't have a proper torniquet i bet you could fashion one if push came to shove , yes it's better to have the kit obvs but the knowledge and attitude is the most important thing
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