Tourniquet Anyone?

quote

Quote from a 2019 Incident Report

By Bre Orcasitas

We have received several chainsaw cut reports this fire season, which has gotten us talking, so of course we want to bring you in on the conversation.

Since the Dutch Creek incident (ultimately resulting in the implementation of the 9-line, now 8-line protocol) the greater fire community has become steadfast about providing more thorough patient assessments and getting our folks to definitive care in a timely manner and that deserves a high-five, no question.

So are we done? Do we have it all figured out? What about controlling rapid blood loss? I’d say we’ve still got some ground to cover there.

As your crew geared up for the fire season and ran through medical training scenarios did you discuss rapid blood loss? If not, let’s cover a couple of the big-ticket items that are worth knowing about.

You may be familiar with the ABC’s of patient care but if not, they are as follows:

  1. Airway
  2. Breathing
  3. Circulation

Remembering the ABC’s will provide a quick and easy tool to follow in a time of high-stress. The use of this method has certainly saved countless lives. However, not all injuries are the same and they shouldn’t be treated as such; to be more specific, traumatic injuries, which have the potential to generate massive blood loss.

The fire community is especially susceptible to injuries such as these due to the nature of our profession. Even with the best training and safety measures in place, the tools we use to do the job and the environment in which we work provides us with ample opportunities for serious injury.

One entity that is exceptionally well versed at dealing with massive blood loss in the field is the military, so perhaps we should tear a page or two out of their playbook. It certainly wouldn’t be the first time we’ve adapted their lessons to suit our operations. What tricks do the armed forces have up their sleeves? Well for one thing, the use of tourniquets for massive blood loss is common practice.

If even thinking of a tourniquet leads you to envision limbs falling off due to a lack of blood flow it’s time to retrain your brain to the new school of thought on the matter, which is simple: Tourniquets can save lives.

In regards to excessive blood loss, the military has thrown an additional tool into their gear bag, the acronym MARCH. Much like the “ABC’s” this too has saved countless lives:

Massive Hemorrhage

Airway Support

Respiratory

Circulation

Hypothermia

(Want more info? Click here.)

Essentially, the thinking behind this method is simple; if your patient bleeds out, airway and breathing issues are irrelevant.

This quote speaks to that point:

“Massive hemorrhage may be fatal within 60-120 seconds. Treatment should not be delayed and controlling major hemorrhage should be the first priority over securing the airway.”

-UNITED STATES MARINE CORPS FIELD MEDICAL TRAINING BATTALION FMST-402

Do we use tourniquets in the fire service? Sure do! As a matter of fact, if you click here, or here you can read about some of those incidences where they were utilized. If you look on page 107 of the IRPG you’ll see reference to using a tourniquet to stop bleeding, so it is a supported practice but the trouble is, it’s not a common practice.

Practice Makes Perfect

There are all sorts of tasks that we should be able to perform at the drop of a hat but if you rarely use or practice a skill set it allows the rust to build-up in turn, making folks feel less confident about performing that task, especially something as critical as applying a tourniquet.

“Personnel had also undergone a locally developed training and had been extensively trained in tourniquet use and placement, as well as Israeli Bandage use and placement.”

Pagosa Ranger District Chainsaw Cut–Rapid Lesson Sharing Report–8/21/2019

So what’s the solution? Practice! It just so happens we found a video that offers a clear and brief tutorial about tourniquet application and you can watch it here.

Now you’ve got some info to go forward and that’s all fine and dandy, but tourniquet use isn’t the only game in town. When dealing with excessive bleeding prior to using a tourniquet, direct pressure is the go-to method… enter: “The Israeli Bandage.”

EmergencyBandage

Screen Shot from video

If you’ve never seen or heard of the Israeli Bandage I’d recommend looking into it. Many fire folks know about these bandages and even carry them in their line gear or med-kits which is the best first step but how often do you practice with the Israeli Bandage? Just as with the tourniquet, this too is a skill set where you can get rusty, leaving that less than confident feeling when the moment comes to use it. Fortunately, the internet has yet again helped our cause. We found an instructional video on how to use an Israeli Bandage, which you can access by clicking here.

How Far is Too Far?

Now that we’ve covered some of the best options for controlling blood loss let’s talk about accessibility and proximity.

“All crewmembers discussed the importance of always having life-saving trauma bandages and equipment on their person when engaging in project work. It’s one thing to have gear on the truck, but it’s another thing to have the gear on your pack
right there at the work site.”

Pagosa Ranger District Chainsaw Cut–Rapid Lesson Sharing Report–8/21/2019

A crew could have all the best trauma equipment available but if it isn’t accessible when you need it what’s the point in having it?

As mentioned above in the quote, a person could lose enough blood for it to be fatal within 120 seconds. That’s two minutes people! So the question is, how far is too far when it comes to a trauma-kit? Does your crew keep a med-kit within arm’s reach? What about your personal med-kit, what are you packin’? Each year firefighters time one another to ensure we are capable of getting into our fire shelters fast enough, but how quickly can we deploy these other life saving pieces of equipment?

To put a little twist on a Louis Pasteur quote:

In the field, real time, fortune favors the prepared mind.

 

 

 

 

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