In the previous post, valued commenter “Jimmy McNulty” made the observation:
This is absolutely true, and I have no argument with Mr. McNulty.
But it did get me thinking.
It has been (mumble mumble) years (soon to be mumble mumble plus one) since I was a Boy Scout. But my recollection of Boy Scout first aid training at the time (as well as the Red Cross first aid training I went through) was that: you should never ever ever use a tourniquet to stop bleeding.
Am I misremembering? Is there anyone else who was a Boy Scout back in the day, or took Red Cross first aid training, and remembers being told tourniquet = bad?
I know medical knowledge grows and changes. I remember the wisdom on snakebite treatment has changed over time as well. I’m just wondering when and why this changed.
This might be one of those discussions I need to have with some authority like Ambulance Driver over a couple-three beers if we’re ever in the same place at the same time.
I know someone that took an EMT training course. She told me that tourniquets are not recommended, because they cut off circulation to the entire limb.
Instead, grab a rag or a shirt or anything else and apply pressure to the wound.
Disclaimer: I have not taken the course, and I may be misremembering. Yes, I am not a doctor.
Vascular surgery and the rapidity of the EMS system means that limbs that have arterial bleeds, (that’s why you put the TQ on, right?), and a tourniquet to arrest the bleed have successful outcomes. If you have an arterial bleed with a TQ EMS will get you to an ER, hopefully a level 1 trauma center, and you will be okay.
If direct pressure will stop the bleed, great. No TQ.
If direct pressure and holding a pressure point, (femoral or brachial artery), will stop the bleed, great. No TQ.
But if they don’t work, TQ.
Eagle Scout, former EMT, Combat Lifesaver and Tactical Combat Casualty care q’d.
I am just agreeing with Bones. In the past, a tourniquet was not recommended for laypersons, due to the danger of loss of a limb due to cutting off of circulation. But now, with the speed with which most trauma patients are able to arrive at a hospital with someone equipped to deal with the injury, it has become routine.
It became routine in the military over in the middle east, as well, which saved many lives. If places where mass shootings often occur, such as schools, would have people trained, and have trauma kits available, to stop bleeding, such as an artery bleed, I suspect that the loss of life could also be reduced by a significant degree, as well.
The one thing that I do remember, from my cub scout days, is to never use a tourniquet to stop a nose bleed.
Thank you Joe, Bones, and tim. This is exactly what I was looking for.
Thanks for a great thread. I agree that the rapid response in America now as opposed to my first Boy Scout First Aid course is, oh, like a 55 year miracle and hope that current training reflects that.
Thank you, Det. McNulty.
Thinking about what you said: the audience may be limited to trauma surgeons, EMS people, and me. But I feel like there’s a great book out there to be written about the history and evolution of rapid response and EMS over the past 50 or 60 years.
It’s been a revolution in rapid care and continues to develop. They look at base excess, orthopedic trauma triage with quick spanning external fixators to avoid a second trauma of long bone rodding with reaming.
Maryland Shock Trauma has been a leader.
Sometimes I wish I was 20 so I could see how the story ends, but it never will (I hope).