Episode 231 S6-31
Tourniquets & Stop the Bleed
The Endless Night Ch 31
Knowing how to use a tourniquet is an essential skill to know when someone is bleeding severely from an extremity. Stop The Bleed skills save many lives. Left with a severe femoral bleed, Nickleton's life dangles in the balance. A tourniquet is his last hope. More and more is being understood about tourniquets and their essential role in saving lives. Here today is the EMS instructor, Tim Johnson, to discuss the proper application.
Knowing how to stop bleeding is essential! The body only has about six quarts of blood, and once too much is lost, catastrophic failure can result. Any injury, such as the gunshot wound in The Endless Night story, where a victim receives damage to the femoral artery can result in loss of life in less than three to four minutes. Because of this fragile time frame, a tourniquet always needs to be accessible and the applier must know of how to fasten it properly.
EMS, firefighters, and law enforcement carry tourniquets in their turnouts and cargo pockets for immediate access. When you need it, you need it now., not in the minute or two that it takes to get it, if you can get to it at all.
Tourniquets are not the scary things depicted in amputation stories of the past. There have been lots of advancements recently in understanding their value and proper use. Great studies from Aphganastan and Iraq show it is possible to leave a tourniquet on for sixteen to twenty-four hours with no severe nerve or vascular damage.
In a mass shooting, find protection and cover for yourself first. Then, decide if you want to help others in need. When you encounter wounded individuals, apply a tourniquet, stop the bleed and move on. Perform triage quickly. Attend to those in the most need with the highest chances of survival first.
Bleeding control is the most important thing to do. Even if a patient is not breathing correctly, stopping blood loss is still the primary directive. If there is no hemoglobin to carry the oxygen around, the oxygen makes little difference.
Protective gear and cleanliness are always preferred. If body isolation items like gloves and goggles are not available, it is your choice to help or not without these items. Body isolation items protect the helper from the victim. Blood or other human liquids should not be allowed to get in your eyes. If you have any wounds on your hands, no matter how small, you are putting yourself at risk. Carry gloves with a tourniquet so you have them together all the time.
Speed is of the essence for tourniquet application. A tourniquet only works on the extremities. Always put it on high and tight. The amount of time that you have to apply the tourniquet depends on the length of time that passed before you arrived, where the wound is, and the amount of blood loss that has already occurred.
To ensure quick application, remove the packaging as soon as the tourniquet is purchased. In an emergency, bleeding can make the packaging difficult to open. After buying a tourniquet, unpack it, open it up, fold it, and then store it in an easily accessible area.
A tourniquet should be opened all the way and wrapped around the extremity. Do not try to slide it on. Remove as much clothing as possible and apply directly to the skin. Thin clothes may allow for maximum effectiveness but thick clothes will not. Cut them away.
If one tourniquet does not work, another may be applied. Apply the seconds an inch or two above or below the first.
Tourniquets are very easy to apply. Wrap it around your arm and slide the tail through the buckle. Pull it as tight as you can. Use a wrenching motion to ensure maximum tightness. Then Velcro the tail down to itself. After that, use the windless, the little stock on top of the tourniquet, and crank it so the tourniquet tightens. The maximum amount of times you can turn it is only about three times. The tourniquet strap needs to be very tight so the windless can be successful in less than these three turns.
A belt does not work as they depict in the movies and they are not as effective as a tourniquet. They do not get tight enough. However, if that is all you have, it is better than nothing.
When a tourniquet is applied, it hurts! Whoever is the unlucky receiver of having a tourniquet applied will not be happy. Expect them to reject the idea. The initial pain will reside after a few minutes. However, after about another half hour, the pain will return and the patient may attempt to remove it. When you train with your tourniquet, it should hurt. You need to practice real application so it will be painful. Remove it quickly — practice self-application as well as application on a partner.
After a tourniquet is applied, mark the time. “C-A-T” tourniquets have an area available to record the time and date. The rescuing medics will want to know how long the tourniquet has been on for, and you will not remember.
A C-A-T tourniquet will work for all sizes. Children often have smaller extremities but the C-A-T will work. The elderly often have smaller extremities as well as thinner skin. Light clothing or gauze can be applied to prevent the skin from tearing when a tourniquet is applied. However, if they are bleeding bad enough to need a tourniquet, a little torn skin is of little consequence.
After a tourniquet is applied, pack the wound. The material on hand dictates the process. Quick Clot is a popular choice. It comes in an impregnated gauze. To stop the bleeding, stick your finger in the wound and find where the bleeding’s origin. Put the tail of the dressing right there. Then, while maintaining pressure, push in more gauze with the other finger. Alternate the digits over and over to pile in more dressing and keep applying pressure. When the wound is fully packed, apply pressure for two minutes or until bleeding stops. The patient will be pissed when you put your finger in the wound. It is excruciatingly painful! Explain to them how it will save their life.
The patient may also go into shock. Shock is the body’s reaction to traumatic blood loss. It will pull the blood into the vital organs. Keep the patient warm and try to maintain blood pressure. If the patient goes into decompensated shock, it is tough to bring them back. Then the cascade of death ensues. This condition makes it difficult for the blood to clot and the patient will bleed out. Always keep a severely injured person warm. Have them lay down and try to calm down and prevent as much blood loss as possible.
March is Stop the Bleed month. Local fire and EMS departments will host Stop the Bleed classes. The Federal Government supports this program so all of their agencies host courses as well. It is highly recommended that everyone attends a Stop the Bleed class, owns a tourniquet and is familiar with how to use it efficiently.
The Changing Earth Series
EMS instructor, Tim Johnson, started his career in 1998, working with the US forest service. Realizing his passion for assisting those in need, Tim enrolled in the jack program, training at the fire academy in 2000. In 2002 he became an Emergency Medical Technician (EMT) with the Sacramento Sierra Valley EMS Agency. Expanding his horizons, he ventured into other medical fields become an ER tech and lab assistant at Mercy Hospitals in 2004. His desire to remain on the front lines drove him to recertify as an EMT and return to fire service as a volunteer for a private ambulance service in 2011. Always ready to further his knowledge, Tim started paramedic school in 2012. In 2013 he graduated third in his class and started working for Riggs Ambulance. Then in 2016, Butte county EMS hired Tim to assist patients in their ambulances. Wanting to do more for the industry, Tim decided to pass on his skills to others with the same passion and opened Johnson’s EMS training in 2017. Johnson’s EMS launched successfully and in 2019, Tim started working for the California Regional Fire Training Authority as the primary EMS instructor, where he is still working hard preparing new medics to respond to those in need.