emr tourniquet education_revised_april_11_2013
TRANSCRIPT
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Tourniquetsfor the EMS
ProviderConnecticut EMS Advisory BoardEducation and Training Committee
Revised April, 2013
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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
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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
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Introduction Hemorrhage control
Previous Technique Direct pressure Pressure dressing Elevation Pressure point compression
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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)
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New Recommendation
Hemorrhage control Direct pressure Pressure dressing Tourniquet (PHTLS, 2011)
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Indications
Hemorrhage from an extremity that cannot be controlled with direct pressure or a pressure bandage
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Contraindications
There are NO contraindications to
tourniquet application when faced with the appropriate clinical situation
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REMEMBER…
Tourniquets can be used for: Life threatening extremity
hemorrhage When direct pressure or pressure
dressing can not be applied
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•Not all bleeding wounds require tourniquet application!
Tourniquets Not Necessary when..
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Bleeding that Requires a Tourniquet
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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
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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
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Improvised Tourniquet
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Improvised Tourniquet
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Various Types of Commercial Tourniquets
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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
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Application (1of 3)
2-3 inches above the wound
Watch for other sites of bleeding above the wound
Multiple bleeding sites proximal application
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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!
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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
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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
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Questions ?
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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
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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