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NousDefionsDoc
04-11-2004, 13:31
Are we going to use them? Which one? Why? under what conditions?

Jimbo
04-11-2004, 14:03
You hit on something that I have been thinking about lately. I was at Walter Reed the other day and saw a number of amputees. I saw one guy learning to walk again who was a triple amputee. While this soldier's MOI could have been anything, it got me thinking about tourniquets and their rate of employment on the battlefield. I saw a thread somewhere about new, earier to use tourniquets and that recalled someone's quote about when all you have is a hammer, all problems looks like nails.

So, are Hemorrhagic Control Agents a better alternative to a tourney? Does the level of basic first aid training need to be addressed?

NousDefionsDoc
04-11-2004, 14:33
From the Special Operations Forces Medical Handbook (2001).

Circulation: Uncontrolled hemorrhage is the leading cause of preventable battlefield deaths. Rapid identification and effective management of bleeding is perhaps the single most important aspect of the primary survey while caring for the combat casualty.
Obvious external sources of bleeding should be controlled with direct pressure initially followed by a field dressing or pressure dressing. If bleeding is not controlled by the previous measures or if gross arterial bleeding is present, an effective tourniquet should immediately be applied. Clamping of injured vessels is not indicated unless the bleeding vessel can be directly visualized. Blind clamping of vessels may result in additional injury to neurovascular structures and should not be done.

NOTE: The current ATLS manual discourages the use of tourniquets in the pre-hospital setting because of distal tissue ischemia, tissue crush injury at the tourniquet site, which may necessitate subsequent amputation. This admonition is based on the civilian model of trauma care where most penetrating injuries are low velocity in nature and rapid evacuation to a trauma center is available. Withholding the use of tourniquets on the battlefield for patients with severe extremity hemorrhage may result in additional death or injury that might have otherwise been prevented.
---
NDD note - if you have a Palm and don't have this book in it, you should get it. It is searchable and you can cut and paste to memo and print. It is an absolutely excellent tool. The only complaint that I have is that the images don't show up on mine - the anatomy plates, etc. Small price to pay to have this reference in my hands at all times. No, I'm not telling you where I got mine. The dude did me a favor and I won't abuse him. If you seek, you shall find.

Surgicalcric
04-11-2004, 16:52
NDD:

Who would be the "we" you are referring to in your initial post 18-D, 91W, civilian medics, etc...?

And... The pictures do not show up for me either. I have been working on it though and will advise if I figure it out.

NousDefionsDoc
04-11-2004, 16:58
We, the members of this board. Under what conditions would cover "I might use this in UW, but not in my ambulance rescue unit truck thing." all points of view are valid.

I think the pic thing is a memory issue at point of origin. I have my book on a 128MB chip, so its not an issue there. No big deal, much better to have without the plates than not have. Great resource. It even has a SOAP note section with examples. :munchin

Surgicalcric
04-11-2004, 17:49
Originally posted by NousDefionsDoc
Are we going to use them? Which one? Why? under what conditions?

1.) Yes I think we will/should, but only after every other avenue of treatment has been utilized.

2.) TraumaDEX is 1st choice with Quickclot second.

3.) TraumaDEX can be used on both adult and peds w/o the complication of burns that Quickclot tends to produce. Not that I would not use Quickclot, I would. I firmly believe a 2nd or 3rd degree burn is better than losing a limb or a life.

4.) After bandaging, direct pressure, pressure points, and elevation has proved unsuccessful in hemorrhage control leaving the only other alternative, a tourniquet.


Jimbo:

Hemorrhage control agents are a much better alternative to the tourniquet. It controls the bleeding without denying tissue distal to the injury of much needed oxygenated hemoglobin.

The additional training necessary to use HCA's is not very extensive.

Surgicalcric
04-11-2004, 17:50
Originally posted by NousDefionsDoc
...It even has a SOAP note section with examples. :munchin

Just had to bring that back up did ya.

Jimbo
04-11-2004, 18:09
Originally posted by Surgicalcric
Hemorrhage control agents are a much better alternative to the tourniquet. It controls the bleeding without denying tissue distal to the injury of much needed oxygenated hemoglobin.

Right. But I don't know if basic battlefield first aid has reflected this advance. I see new, easier to use tourniquet devices being marketed to troops. I think under stressful conditions, a non-medic type might be less able to distinguish hemorrhagic bleeding from severe bleeding and just slap a tourney on it. The result is more amputations than necessary. That is bad.

NousDefionsDoc
04-11-2004, 18:18
Jimbo,
Arterial bleeding is a - fairly easy to distinguish and b - very impressive. In my modest experience, there is very little doubt about when to apply a tourniquet. The problem is people usually wait too long, not apply it too soon.

Crip, how long do you have after applying a touniquet before you start having irrepairable damage?

Surgicalcric
04-11-2004, 21:55
Jimbo:

I cant comment on battlefield training. But use of either adjuncts, HCA or tourniquet, is only considered after the other methods (bandage, direct pressure, pressure point, and/or elevation) have failed to stop the bleeding here in the EMS world. Whether to use it would not be dependant on whether it is venous or arterial in nature, but by the degree of hemorrhage.

The only problem I see with the HCA's is them being used as a first level treatment of hemorrhage instead of as a next to last resort.

Maya
04-12-2004, 01:16
As I understand the promo for these agents, they are best used in partiatial amputation, hard to control area (groin), and as a last resort to the ABCD's, pressure/elevation/arterial pressure, warmth, and packing. Has there been a change in that algorythem? In an emergent situation has the thinking changed as to new tech products like TraumaDex/QuickClot replacing the above mechanics of hemorrhage control.

I was taught the touniquets were the means of hemmorage control only while in an emergent/tactical condition or if no other means could control blood lose, once removed from direct action/controlled location/time, the ABCD's would be applied, pack/warm/fluid, and transport ASAP. Always looking for better ways of treating the pt, is this a better way?

Looking to the pros for answers. Thanks.

Maya

Surgicalcric
04-12-2004, 07:41
Maya:

I can only speak from what I have read and from my expereince on the civilian streets.

That being said, the algorhythm for hemorrhage control is the same with the addition of the HCA's before application of a tourniquet.

Maple Flag
04-12-2004, 07:47
Originally posted by NousDefionsDoc

Crip, how long do you have after applying a touniquet before you start having irrepairable damage? [/B]

I thought I would chime in here , seeing as I just learned the answer to that in a class a month ago. I was taught (by WMA) that it takes about 2 hours for a limb to become unsalvagable. I believe that the "unsalvagability" (new word - put it in Webster's) is due to tissue necrosis.

The other danger with removing a tourniquet is reintroducing blood with lots of waste products back into the system. I'm not sure how long the waste build up needs to become a life threat on re-introduction. I'm guessing here, but the toxic blood threat may be the real reason for the civilian EMS rule of "never remove a touniquet".

Cheers.

Surgicalcric
04-12-2004, 08:42
NDD:

My apologies. I somehow looked over that question. Knocking them out for lack of ATD.


Maple flag:

Your reasoning for not removing the tourney once applied is what I was taught.

NousDefionsDoc
04-12-2004, 09:32
How long does it take for somebody to bleed out from say a severed femoral?

pulque
04-12-2004, 13:07
Originally posted by NousDefionsDoc
How long does it take for somebody to bleed out from say a severed femoral?

1 minute. But you can use pressure until you decide whether or not to tourniquet or HCA, no?

sorry for the intrusion.

18C/GS 0602
04-12-2004, 13:55
My understanding was that tourniquets were very effective in controlling hemorrhage in limb injuries and that HCA’s should primarily be used as a last resort with respect to limb injuries. From what I have read HCA’s best application is in complicated groin injuries and other injuries where a tourniquet can not be applied and where direct pressure is not stopping the bleeding.

18C/GS 0602
04-12-2004, 13:58
Journal of Trauma
Volume 54(5) Supplement May 2003 pp S219-S220
The Tourniquet Controversy
[COMBAT FLUID RESUSCITATION ORIGINAL ARTICLES]

Navein, John MRCGP; Coupland, Robin FRCS; Dunn, Roderick FRCS
From the Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences (J.N.), Bethesda, Maryland, International Committee of the Red Cross (R.C.), Geneva, Switzerland, and Department of Plastic Surgery, Caniesburn Hospital (R.D.), Glasgow, Scotland.

Describing a tourniquet as “an instrument of the devil that sometimes saves a life”1 encapsulates the considerable risk to a limb when a tourniquet is applied to arrest life-threatening extremity hemorrhage. The use of tourniquets is widespread in both military and civilian environments, particularly in the developing world; however, the balance of risk is unclear, and its efficacy is controversial and unduly influenced by folklore and dramatic Hollywood images. The tourniquet controversy remains unresolved and has not, to our knowledge, reached the pages of medical journals since 1940. 2 The clinical questions that remain unanswered are as follows:
* Under what circumstances should a tourniquet be applied?
* Relative to the number of tourniquets applied:
* How many lives are actually saved?
* How many limbs are lost or left with ischemic contractures?
* How long can a tourniquet be left on without risking loss of limb or limb function?
* How does the risk of crush syndrome increase with time?
* When can a tourniquet be released safely?
* How much damage is done to the tissues under a tourniquet?
* Are some tourniquets safer or more effective than others?
* How urgent is the inevitable amputation for a tourniquet that has been left on for more than 6 hours?
* How does the application of a tourniquet influence the priority for movement?

Little evidence exists to resolve these questions; however, the following points appear uncontroversial and represent first principles to support a coherent strategy:
* Most extremity hemorrhage, including that from traumatic amputation, can be controlled with direct pressure and elevation.
* Tourniquets have saved lives.
* It is accepted military practice to apply a tourniquet to move an injured person from the point of injury to a place of relative safety (or to continue fighting).
* The tourniquet should be broad, tight enough, and as low as possible, but not over a joint.
* Narrow, improvised tourniquets can crush the underlying tissues but may be unavoidable at the point of injury.
* An improvised tourniquet should be removed or replaced as soon as possible.
* Tourniquets lead to more (possibly many more) ischemic complications and unnecessary amputations than lives saved.
* Severe hemorrhage may not reoccur when an effective tourniquet is released after 2 hours.
* The “tourniquet time” for extremity surgery is 2 hours. 3
* Surgical doctrine holds that if an occlusive tourniquet has been applied for more than 6 hours, the limb should be amputated above the level of the tourniquet without it being removed.
* When a tourniquet has been applied for a large wound or traumatic amputation and left in place for 12 hours or more, there is a high risk of gas gangrene that increases with time.
* A tourniquet is very painful.

It seems there are few, if any, exclusively clinical reasons to apply a tourniquet to arrest extremity hemorrhage. For instance, in the admission room of a hospital, control is achieved by other means such as direct manual pressure. However, as injured people move from the point of injury to a surgical hospital, other factors come into play that may impact on and in some circumstances override purely clinical considerations. In the military context, the point of injury is a very dangerous environment, with considerable risk of injury to the care provider and of further injury to the injured person. There may be neither the time nor the materials to control hemorrhage, and it is rarely feasible to extract injured people from danger while maintaining manual pressure and keeping the injured limb elevated. The initial imperative must be to move people to relative safety; applying a tourniquet to expedite this clearly outweighs the clinical risk.

The nonclinical factors that must be considered when deciding whether to apply a tourniquet may pertain to situations other than at the point of injury. Moving injured people toward definitive care means that manual pressure and elevation may be impossible. There may be insufficient materials to apply adequate dressings or insufficient hands to apply manual pressure. Multiple casualties may accentuate this. This relative lack of resource can make conventional care impossible and so tourniquets become an appropriate and pragmatic solution.

Accepting that tourniquets may have to be applied, there are some universal rules that state that tourniquets should only be applied if hemorrhage is genuinely life-threatening, all feasible conventional measures have failed, and the consequences of applying a tourniquet can be managed adequately. Beyond these rules lies the question of how to manage tourniquets once they are applied. First principles suggest two key points in time that represent either end of a spectrum of risk. At one end, removing a tourniquet at 2 hours has minimal risk of ischemic complications and hemorrhage may have been controlled. Beyond 6 hours, the risk of arrhythmias and crush syndrome is so high that amputation above the level of the tourniquet is mandatory. Between these time points, the likelihood of serious complications including death increases with time and the chance of salvaging the limb decreases toward zero. These risks have not been quantified.

We feel that the controversy can be resolved as follows. It is unlikely that there are any exclusively clinical situations in which a tourniquet must be applied to arrest hemorrhage. Outside the surgical hospital, nonclinical constraints may override clinical considerations. A strict, safe, and generic strategy for the use of tourniquets has been published pointing to the need for further research. 1 It accepts the occasional need for tourniquets to arrest hemorrhage and proposes three concepts governing their application, as follows: the tactical tourniquet, a trial of tourniquet, and a tourniquet of last resort.

The “tactical tourniquet” is a short-term, usually improvised tourniquet applied at the point of injury either by a care provider or by the injured person. Its specific aim is to arrest life-threatening hemorrhage while the injured person is moved to a place where initial care can be given in relative safety. At this point, the need for the tourniquet ceases and best possible care begins.

The “best possible” initial management of hemorrhage must always be application of a pressure dressing and elevation of the limb. In some circumstances, nonclinical factors mean that hemorrhage cannot be controlled in this way. A “trial of tourniquet” involves both correct application of a tourniquet to the limb and the most effective pressure dressing possible on the wound. The tourniquet is released after 2 hours (or 2 hours after application of a tactical tourniquet if one was applied). In many cases, hemorrhage will have ceased and there remains a chance of retrieving a functional limb in the long term. If serious hemorrhage recurs and it still cannot be controlled by a pressure dressing and manual pressure, then the trial has failed and the tourniquet must be reapplied.

A “tourniquet of last resort” is applied if the trial of tourniquet fails; unless the injured person reaches a surgical hospital within minutes, he or she is likely to require surgical amputation of the limb above the level of the tourniquet without the tourniquet being removed. Decisions about the priority for movement to hospital are complicated by many factors including time, resources, and the condition and number of others injured. In some cases, there may be no realistic possibility of a wounded person reaching a surgical hospital; not applying a tourniquet of last resort in this situation may be the kindest option.

We believe that strict adherence to these guidelines will result in fewer tourniquets being applied but in a safer manner. Application of tourniquets should not be taught in occasional first aid courses.

Of the questions above, three remain. Answering each will help to refine the guidelines further. They are as follows: Is it true that all extremity hemorrhage can be controlled without tourniquet given adequate skills and resources? Is it true that a trial of tourniquet is usually successful? What is the spectrum of risk of removing a tourniquet beyond 2 hours? We hope these questions will guide research in the future.

Maple Flag
04-12-2004, 15:24
Great article! Where I work, I don't usually see the kind of extremity trauma that causes one to reach for a tourniquet, so I respect the decisions of those that deal with that kind of trauma on a more regular basis. That said, I've always been concerned about how many limbs are lost where a tourniquet may not have been needed.

The above seems to be a good start towards going beyond the life over limb equation and moving towards a protocol that saves both lives and limbs.

Surgicalcric
04-12-2004, 15:41
Originally posted by Maple Flag
Great article! Where I work, I don't usually see the kind of extremity trauma that causes one to reach for a tourniquet, so I respect the decisions of those that deal with that kind of trauma on a more regular basis. That said, I've always been concerned about how many limbs are lost where a tourniquet may not have been needed.

The above seems to be a good start towards going beyond the life over limb equation and moving towards a protocol that saves both lives and limbs.

Enters HCA's.

Maple Flag
04-12-2004, 15:58
HCA's definately have a role to play in hemorrhage control, and I look forward to new developments in HCAs.

That said, it's good to see more study being put into tourniquet protocols that allow for a quick stop to blood loss without committing to leaving the tourniquet on and sacrificing the limb.

Between HCAs and newer TQ protocols, there will hopefully be a lot less amputees out there.

Cheers.


P.S. I'm curious, never having worked the ER side of things, what assessment and treatment protocols are used when receiving a Pt. with a tourniquet? There must be assessment criteria that call for removal of the tourniquet vs. amputation. Any insight into the specifics there?

pulque
04-12-2004, 16:35
Originally posted by Surgicalcric

2.) TraumaDEX is 1st choice with Quickclot second.

3.) TraumaDEX can be used on both adult and peds w/o the complication of burns that Quickclot tends to produce. Not that I would not use Quickclot, I would. I firmly believe a 2nd or 3rd degree burn is better than losing a limb or a life.


I was curious about this so I looked the products up. Quickclot is a synthetic derivative of volcanic rock, and TraumaDEX is an engineered microporous polymer derived from plants.

The part relating to differential burns is probably the physics.. QuickClot works electrostatically. TraumaDEX works osmotically. I am not smart enough to figure out what this means today.

The cool thing about TraumaDEX is that it not only adsorbs water.. it also seems like it lets the platelets etc adhere, acting as a central clotting point.

Doc T
04-15-2004, 22:19
i was asked to respond about protocols for tourniquet removal in the ER...

we don't have one...

most tourniquets placed in the field are on for such a short time in the EMS system that none is needed except the ability to control bleeding when they come off.

the closest thing I can think of to compare to a tourniquet on for a very long time would be when we take an aortic cross clamp off that has been on for a while... lots of badness gets released and we usually prepare anesthesia. They will pretreat, if able, with things like mannitol and bicarb to help with the free oxyen radicals and metabolites that have built up and the acidosis that will often ensue.

Surgicalcric
04-15-2004, 22:31
Thank you Doc T.

NousDefionsDoc
04-15-2004, 22:38
Thanks Doc T

I voted for Qucikclot. If I can't stop it with pressure, I want the strongest stuff I can get.

Surgicalcric
04-15-2004, 22:42
Thats interesting NDD.

I thought about QC, but I started thinking about Peds and chose TraumaDex.

Have you had any experience with Hemicon dressings?

NousDefionsDoc
04-15-2004, 22:45
Negative.

Haven't run into too many bleeding babies on the battlefield either - although legs tend to cry like babies. :D

Surgicalcric
04-15-2004, 22:51
I was not questioning your rational, but rather stating the reason for my decision.

Legs huh...

Maple Flag
04-16-2004, 08:18
Originally posted by Doc T
i was asked to respond about protocols for tourniquet removal in the ER...


Thanks for the insight.

DoctorDoom
04-20-2004, 07:05
x

Maple Flag
04-20-2004, 15:25
You're right, my question was worded poorly. I agree, all tourniquets must come off eventually.

I was interested in learning about how the complications of a long duration tourniquet were assessed and managed pre and post Tq removal, which Doc T kindly provided.

Thanks.

DoctorDoom
04-20-2004, 19:56
x

NousDefionsDoc
08-15-2004, 17:22
Doc T,
Are your EMS guys using HCAs in the field?

Doc T
08-15-2004, 17:44
no...I am not aware of any groups using them except experimentally... following protocols and such.

doc t.

NousDefionsDoc
08-15-2004, 19:03
Thank you. I was wondering what the clean up was like.

Roguish Lawyer
08-15-2004, 19:21
4-month-old poll with only 5 votes? Sounds like we need to recruit some more 18Ds . . .

Doc T
08-15-2004, 20:28
Originally posted by NousDefionsDoc
Thank you. I was wondering what the clean up was like.

at a conference I heard a talk about the different agents...the gentleman giving the talk said he wouldn't want quick clot used on him with any other alternative available... he stated on the animals it destroyed too much in its path...muscle, nerve, etc...

so again....probably the LAST alternative but better than nothing.

NousDefionsDoc
08-15-2004, 20:30
Must have worked for traumadex...

Doc T
08-15-2004, 21:16
lol...nope...they have to come clean on that kind of stuff at the start of any talk....

but good try. I take it you voted for quick clot?

NousDefionsDoc
08-15-2004, 21:19
Its all I've got, but I would use it.

The Reaper
08-15-2004, 22:08
Concur.

This is meatball trauma management, frequently by un/under-trained personnel, not professional care at a Level 1 Trauma Center.

Hmm, die in 15 minutes from exsanguination, or use a dangerous clotting agent or a tourniquet till they can get me out of here?

I have seen the former with a friend of mine, he sucked up 13 bags of IV solutions till he was circulating pink Kool-Aid and died enroute to a hospital, I'll take my chances with the latter, please.

Just my untrained .02.

TR

Doc T
08-15-2004, 23:59
Originally posted by Doc T
he wouldn't want quick clot used on him with any other alternative available...
so again....probably the LAST alternative but better than nothing.

you all seem to read what you want rather than what is written...

again... he said he would not use it if there was an alternative, not that he wouldn't use it at all....

and as i wrote...better than nothing.

His point was its not an alternative to pressure or possibly a tourniquet because the damage seen may ultimately lead to an amputation based on the treatment. As was written earlier in this thread, it should be a last line of treatment..not the first.

doc t.

swatsurgeon
08-17-2004, 09:27
for more accurate literature, get hold of this months Police magazine (not sure of the exact name) We published a review on all of the products. I can email a longer version of the article to anyone that wants to read it. It was not funded/influenced by any company.
I have used traumadex in the OR....worked very well. The reported problems both as listed here as well as from their own video/literature...I would stay away from it. Traumadex is relatively inexpensive, inert and functional as advertised (I have no affiliation with them)

swatsurgeon
08-17-2004, 09:28
last post wasn't clear....the problems with the video/literature was with quik-clot........

NousDefionsDoc
02-12-2005, 09:50
QuikClot (http://www.socnetcentral.com/vb/showthread.php?threadid=24543&perpage=20&pagenumber=2)

I have known this man for 20 years. He was an SF Medic and my mentor as a PA during my rotation before graduation. This is all I need to know about this HCA.

swatsurgeon
02-12-2005, 12:53
a few good points here.....first, tourniquets DO NOT work when there is a bone in the way, it needs circumferential soft tissue and when places above the ankle and around the popliteal fossa, the tibia at the anke and the patella or tibia at the knee will prevent the tourniquet from performing its intended duty.....need to refresh the anatomy and placement of tourniquets with the medics!!
IMHO, a touniquet over gauze at the site of injury 'most likely' would have taken care of this. Yes, quik clot will stop the bleeding and he didn't sustain a burn most likely because the field was very dry...it remains as he describes a LAST DITCH EFFORT/PROCEDURE. That is the most important point

NousDefionsDoc
02-12-2005, 12:58
Agreed sir. Last resort.

BMT (RIP)
03-29-2005, 17:37
http://www.1starmy.com/viewproduct.asp?productno=1622

BMT

NousDefionsDoc
03-29-2005, 19:29
Yeah, I have tried to order some of those for the Boyz here. We'll see if we get them.

Do we know that company BMT?

Surgicalcric
03-29-2005, 20:41
Sarnt:

Brad has the QC in stock here at Bragg. I am sure he has them on the site as well.

HTH.

Crip

vsvo
12-08-2005, 13:34
Is this product similar to TraumaDEX?

http://www.biolife.com

My niece has Glanzmann's Thrombastenia and frequently gets nosebleeds, sometimes severe. My sister is checking with her Pediatric Hematologist, because they've never recommended any kind of HCA, just packing, and recombinant factor VII when she goes to the ER.

It's not battlefield trauma, but I can never get used to how much she bleeds out through her nose, and anything to stop it faster would be great.

swatsurgeon
01-06-2006, 09:27
VSVO, yes the products are made by the same company, packaged differently.

on the quik-clot subject (figured out I'm not a fan of its use?)
I couldn't remember where I read this until I came across it again looking for something else.....
Oct 2005, Journal of Trauma, study done by US army institute of surgical research: "Comparison of Hemorrhage Control Agents Applied to Lethal Extremity Arteial Hemorrhages in Swine"

to summarize...
animal model developed that had 100% motality if used standard gauze (army field bandage) application and manual compression.
3 products: hemcon (chitosan dressing), fibrin sealant dressing, and quikclot each applied twice with 3 minute comprssion time. All applied on active bleeding site through a pool of blood (realistic, unlike the quikclot video which has a DRY field to apply through...very UNREALISTIC).
Results: fibrin sealant dressing superior. hemcon showed "some hemostatic benefit. The exothermic reaction of quikclot was significant and resulted in gross and histologic tissue changes of unknown clinical significance...it showed NO hemostatic benefit"
Until another product comes out I believe this thread merits no more time spent discussing Quik clot: it doesn't work unless the field is dry (I haven't seen too many (none) wounds that have an exsanginating injury that are dry...if they were, my technique to stop the bleeding is working so why would I apply quikclot.
Gentlemen of all biases and beliefs....leave quikclot out of the picture....the last ditch effort I mentioned in a previous post means I have tried EVERYTHING else available to me and I have nothing to loose and oh, by the way, we could try quikclot for lack of ANYTHING else to try.

ss

swatsurgeon
01-06-2006, 09:34
I forgot to mention....you give me 1 week and alot of animals and a cadaver, I can teach the 18D how to control just about every vascular bundle in the body...think back to the vascular injury portrayed in 'Blackhawk Down', if the medic knew how to get into the retroperitoneal space, the iliac artery and vein are right there and can be compressed or clamped....or split the inguinal ligament and clamp there....there are other ways that in the civilian world we would not teach to non-docs, but for you guys I would be willing, as should your medical superiors, teach you these methods...they can and do save lives.
Don't mistake what I'm suggesting as teaching to every 'regular' soldier, this is for the combat medic.

ss

ss

vsvo
01-06-2006, 11:14
VSVO, yes the products are made by the same company, packaged differently.



Thanks, Doctor!

SRT31B
04-22-2006, 08:12
I know this is a really old thread, but was looking around and came across it.

The new stuff being put out by Eagle First Responder (the new CLS. At least at Campbell) is to tourniquet FIRST for any major hemhorrage i.e. GSW, major avulsion, big lac, amputation, etc. Their thought process being there have been too many fatalities due to blood loss that the benefits of immediate tourniquet outweigh the potential risks. Also, suppossedly, there has been a significant advance in the ability to save the limbs distal to the tourniquet.

Has anyone else seen this put out yet? This seems bassackwards to what I was taught and I had a hard time wrapping my head around it, but they say it works better this way. Also, as far as the CLS stuff they're putting out, they're shying away from having CLS guys start IV's in the field. The most they want them to do is start the port but don't push any fluids till they've been evaluated by a medic.

Any thoughts?

Surgicalcric
04-22-2006, 08:48
Wow, talk about a necro post...

This past week was spent discussing hemorrhage control here in class. The current line of thinking here in the SOCM/18-D/IDC world is place a tourniquet on the guy (provided the bleeding is bad enough ie: large veins or arteries...) til the wound can be bandaged and dressed. Then remove the tourney slowly and examine the wound/dressing for signs of bleeding. Easier to see what you are working with when you dont have squrters hitting you in the face. Its also easier to place the tourney on a guy under fire than bandage and dress a serious wound.

In the next few weeks we will be seeing all the HCA's in use. I will get back to this thread after I watch a few of them at work.

Crip

NousDefionsDoc
04-22-2006, 13:28
My how things change.

The Reaper
04-22-2006, 13:46
In the next few weeks we will be seeing all the HCA's in use. I will get back to this thread after I watch a few of them at work.

Crip

Make the wound as dry as possible before using them.

TR

Monsoon65
04-22-2006, 16:13
We had an updated combat first aid class prior to my rotation in the desert. We were issued will all sorts of new gear, like the quikclot, airways and one handed tourney's (which are also in our survival vests now).

The medic giving the class had told us about keeping the area dry before using the quikcot to prevent burning. I asked about traumadex, and she said she'd read about it, but hadn't used it yet.

The AF is still teaching us to use the tourney as a last resort when all else fails.

NousDefionsDoc
04-22-2006, 16:52
Keeping the "area dry before applying" sounds a lot like "do a tactical reload during a lull in the fight". I've never seen either a dry field or this lull of which they speak - at least not in cqb.:)

Monsoon65
04-22-2006, 17:28
Keeping the "area dry before applying" sounds a lot like "do a tactical reload during a lull in the fight". I've never seen either a dry field or this lull of which they speak - at least not in cqb.:)


Exactly! That's what the medic said. She said how are you going to manage this? Your hands are probably wet with water and blood, the area of the wound is covered in the same, and you have to dry up any excess before using the quikcot.

Her advice is just do your best. Get the bleeding stopped, be careful and get the job done.

NousDefionsDoc
04-22-2006, 19:15
I think the early tourniquet is a good idea. It should help dry the field a little.

docbuxton
04-23-2006, 20:43
Hello every one! I'm a new member and I recently worked with a few doctors at portsmouth naval hospital in VA. we had 24 pigs and tested the quick clot powder and the new ACS. The ACS had a spike of 150 degrees F. on innitial contact. acording to my class I attended, it is a last resort. A lot of people don't know how to properly use this.

The Reaper
04-23-2006, 21:05
Hello every one! I'm a new member and I recently worked with a few doctors at portsmouth naval hospital in VA. we had 24 pigs and tested the quick clot powder and the new ACS. The ACS had a spike of 150 degrees F. on innitial contact. acording to my class I attended, it is a last resort. A lot of people don't know how to properly use this.

Doc:

Thanks for the input, we have a couple of trauma surgeons here and some pretty good PAs and SF medics as well, so you will be in good competent medical company.

You need to do some reading of the stickies and intros and introduce yourself in the proper place before posting again.

Thanks.

TR

Invictus
04-24-2006, 12:22
It has taken a little while for us here in the UK to push the principles of early massive haemorrhage control, but we are getting there. Although there are many HCA products on the market, I still find that the best solution to haemorrhage control is the same as any other aspect of soldiering - 'basic skills done well'. That is to say, a fast application of a combat arterial tourniquet with elevation, giving further attention to the wound ie. direct pressure dressing, as you naturally progress through the primary survey. We are looking at hemcon and quickclot as a means to give the soldier on the ground a further option when he is faced with a non-compressible haemorrhage to the abdomen, or any other wound where a tourniquet cannot be applied. They are most certainly not to be considered as an alternative to good, basic skills.

Hope this helps.

Basicload
04-24-2006, 12:22
I'm a little out of my lane since I am not a dedicated Doc but only a first responder. However I have friends that are 91W1's and 18D's to include SOMC instructors and I have discussed this with them several times in an effort to educate myself on another "tricky internet topic".

Quick Clot was reciently added to the standard medical kit to be carried by SOF units in USSOCOM. This is IN ADDITION to the Hem-com dressing that was already required for carry by every SOF member.

In a recient SOF evaluation, QC stopped 9 of 10 live tissue bleeds and Hem-com stopped 10 of 10 bleeds.

According to what I was told QC and Hem-com stop bleeding in different ways and that there is no thermal reaction with Hemcon.

According to the new USSOCOM policy, QC is to be applied AFTER a TQ(if would site allows) and Hemcon dressing have failed to stop the bleeding. As stated before, it is meant as a last resort after other methods have failed to stop an uncontrolled bleed.

As a senior 18D stated to me last week. "QC works and I would use it if I had to, but I know that if somebody used it on me I would have the ass.....That S**T gets HOT!"

Proper QC usage has been added to SOF paramedic refresher.

Hope this helps,

Cheers

docbuxton
04-26-2006, 15:36
Hello,
Sorry for the improper intro. I'm a navy corpsman with a Marine corps company (support) in NH as a reservist. I'm currently a National Registry EMT-Intermediate with 11 yrs and have been in the navy for 7.5 yrs. I love the medical field and love supporting the special teams for different evolutions. I have attended CONTOMS tactical medic program, Corpsman combat casualty care course, various other trainings and will be attending OEMS this September. I'm always telling people that i'm like a sponge and absorbing as much med. info as I can. I hope this is enough info. If anyone wants more info, just let me know.

doc buxton

Monsoon65
04-26-2006, 18:32
I think the early tourniquet is a good idea. It should help dry the field a little.

I spoke to the medic that gave the class yesterday when I went in to fly.

She threw a monkey wrench into the works:

"What if it's raining?"

She really teaches a great class and gets you thinking about what to do in emergency situations. Has a lot of first hand experience thru her civilian job and combat deployments.

Razor
04-26-2006, 22:15
Uh, you pull out a poncho, or rain parka, or anything else you can use to cover yourself and the wound site (caveat: this is an idea coming from someone untrained in medicine)?

SRT31B
04-27-2006, 00:10
Adapt, improvise, and overcome...

I think Razor's idea would work just fine, but I'm not an expert.

Monsoon65
04-27-2006, 15:05
Uh, you pull out a poncho, or rain parka, or anything else you can use to cover yourself and the wound site (caveat: this is an idea coming from someone untrained in medicine)?

That's what I suggested. Or if you don't have that, lean over and try to cover as much as you can with your upper body.

Guy
04-27-2006, 16:59
Grab the "fuckin" thing first! The protocols of treating a bleeder are out there...

Loss of blood+time=OH FUCKIN SHIT!

Take care.

Monsoon65
04-27-2006, 17:15
Grab the "fuckin" thing first! The protocols of treating a bleeder are out there...

Loss of blood+time=OH FUCKIN SHIT!

Take care.

I definitely have to use that equation at my next class! It's perfect!

Guy
04-27-2006, 20:34
I definitely have to use that equation at my next class! It's perfect!Don't use this shit in an "academic" world.:D


Take care.