Tourniquetsfor the EMS

ProviderConnecticut EMS Advisory BoardEducation and Training Committee

Revised April, 2013

Goals Program goals are to:

Provide participants with information regarding bleeding control

Provide participants with alternative methods of controlling bleeding when direct pressure is not effective

Objectives At the end of the program, the student will

be able to: Discuss current techniques for hemorrhage

control Describe indications and contraindications of

tourniquet use Describe the application process Describe the change in the bleeding control

algorithm

Introduction Hemorrhage control

Previous Technique Direct pressure Pressure dressing Elevation Pressure point compression

New Recommendation

“The use of ‘elevation’ and pressure on ‘pressure points’ is no longer recommended because of

insufficient data supporting their effectiveness” (PHTLS, 7th Ed, 2011. p.115)

New Recommendation

Hemorrhage control Direct pressure Pressure dressing Tourniquet (PHTLS, 2011)

Indications

Hemorrhage from an extremity that cannot be controlled with direct pressure or a pressure bandage

Contraindications

There are NO contraindications to

tourniquet application when faced with the appropriate clinical situation

REMEMBER…

Tourniquets can be used for: Life threatening extremity

hemorrhage When direct pressure or pressure

dressing can not be applied

•Not all bleeding wounds require tourniquet application!

Tourniquets Not Necessary when..

Bleeding that Requires a Tourniquet

Improvising…

Although a tourniquet can be improvised, it is recommended that a

commercially available and thoroughly tested tourniquet be used

Input from EMS Sponsor Hospital/ EMS Medical Director may be helpful

Improvised Tourniquet Necessary items:

Tourniquet band At least 2 inches wide

Rigid object Stick that is strong enough to tighten the tourniquet and be

secured

Padding Material placed between the limb and the tourniquet band

Securing materials Material that will secure the rigid object once tourniquet

tightened

Improvised Tourniquet

Improvised Tourniquet

Various Types of Commercial Tourniquets

Commercial Tourniquets Variety of types

Remember ! Must be trained on the specifics of the device Must follow specific manufacturers’ guidelines

for application EMS Sponsor Hospital/ EMS Medical Director

input on tourniquet selection is recommended

Application (1of 3)

2-3 inches above the wound

Watch for other sites of bleeding above the wound

Multiple bleeding sites proximal application

Application (2 of 3)

Should be tight enough to stop bleeding The tourniquet should never be placed

Joint (knee or elbow) Over an impaled object

Extremity should be exposed Document application time

Write on patient!

Application (3 of 3)

A prehospital tourniquet should not be

removed by EMS personnel without authorization from their EMS Sponsor Hospital/Medical Direction

If application exceeds six hours, removal should only be done by the physician providing definitive care

Pearls Time of tourniquet application should be

relayed to each provider that assumes care

Instruct patient to inform every care provider that they come in contact with that a tourniquet has been placed and its location

Questions ?

Special Thanks to Dr. Richard Kamin for his time and effort in the development of this program

Ralf Coler and Terry DeVito for their project coordination

Advisory Board, State of CT Education and Training Committee

ACKNOWLEDGEMENT

Bibliography

Doyle GS, Taillac PP. Tourniquets: a review of current use with proposals for expanded prehospital use. Prehosp Emerg Care.

2008 Apr-Jun;12(2):241-56.

Prehospital Trauma Life Support, Seventh Ed. Mosby, Inc. 2011