In survival medicine there has been a huge discussion over the years. What comes first?
The Airway or bleeding.
Lets go over some facts.
- Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 – 6 minutes later.
- From a cut femoral artery you will lose conscious in 30 seconds and death is in between 60 to 90 seconds after that.
So what is the first thing to get to. We teach ABC’s Airway, Breathing Circulation. But that is geared to a CPR class environment. If a person ain’t breathing they are dying, If a person is bleeding out they are dying.
Pop quiz hotshot. What do you do first? (I love that movie)
The correct answer is, Bleeding. How long does it take to slap a tourniquet on? If you have a big hole or are missing a part of your patient, you have 3 minutes to get air to them. You have under 1 minute to stop the bleeding.
In the Journal of Emergency Medicine (Jems) 1 It is shown that
Ischemic complications from tourniquet use have been found to be related to the amount of time the tourniquet is left in place Extensive experience with operative tourniquet use has demonstrated that the incidence of injury is very low with tourniquet times of two hours or less; military experience has confirmed the safety of this two-hour limit in the field. But JEMS still stands with if it is a short transport time then tourniquet the wound if it is long transport then find another way
We have always taught that a tourniquet is a life or limb item. You put it on and you have commended the patient to a life with out a leg or arm.
Or so we thought.
In my experience as a medic, and using studies that have come out of the “Sand Box” have shown that one of the reasons soldiers died from blood loss was hesitation was made on applying a tourniquet.
We hesitated . We had to calculate how much blood in a set time before we put it on. We had to exhaust other methods. As the war wore on some smart and brave medics said HEY he is bleeding. And they put a CAT on and then moved to the next. IT was then found that the poor grunt fell through the cracks and 8, 10, 16 hours had passed and some hospital medic said OH S*^# He has a tourniquet on!!!! And he was rushed to surgery, repairs were made. Prayers said. And he walked out of the hospital.
So another study was made 2
So what do you do? Really. What is a humble Ditch Medic to do?
What ever is needed to save the patients life.
If you are in the woods and Bob stabs himself in the thigh with his Bowie Knife and cuts his femoral artery. Put the tourniquet on it. Really direct pressure on a lacerated femoral artery is not easy. I poke 6, 8 and even 12 French holes in femoral arteries. (1 french is .3 mm) So I am holding pressure on holes between 1.8 and 3mm in diameter, And it takes all I got to keep control of the bleeding. So imagine a artery that is cut completely though that is ½ inch in diameter. Put. A. Tourniquet. On. It.
One rule of thumb that I teach during our Battle Field Medic Class is if you THINK you need to put on a tourniquet, PUT it on. You can always remove it. To many lives are lost by delaying it.
Now the BAD part of the tourniquet.
It can break bones. Getting it tight enough to stoop the bleeding can break the bones. It can also damage the muscle skin and other structures of the area.
It HURTS. Getting it tight enough to stop the bleeding means lots of pressure. I tell folks in our classes that if your patient isn’t complaining about the pressure you are holding to stop the bleeding there are 2 reasons. 1, he is unconscious, and 2. You are not pushing hard enough. Now take that pressure and multiple it by say 5 to 10 times. That’s what a tourniquet puts out.
This little Tip of the week isn’t a class on tourniquet placement. Its about what to do first.
You have 4 minutes to get someone breathing or to help them breath. You have 60 to 90 seconds to stop the bleeding.
Remember when SHTF, YOU are the Medic. YOU need to make the hard choices of Triage. There is no ER no Advanced Life Support Ambulance. No trauma surgeon on call.