Tourniquets two, a Video, and bleeding control

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    I got this in one of my inboxs the other day, along with a bunch of other stuff, and thought that it might be nice to pass it on. This video is only a couple of minutes long…though a bit dry…and discusses the use and application of the tourniquet, including a demonstration of the CAT tourniquet now included in many military IFAKs.

    http://paramedictv.ems1.com/Media/1176-Insights-on-Innovation-Tourniquets/” onclick=”window.open(this.href);return false

    I wish that the speaker would have gone a bit further and demonstrated an improvised tourniquet, but to make one like he described is easy. Encircle the extremity with a broad (1-2″, no wire, no rope if you can help it…narrow stuff is more damaging to the skin and tissues) loop of fabric. He gave the example of a neck tie with its ends tied together. Slip some kind of sturdy bar (a stick, knife handle, etc) between the skin and the fabric, then twist. Keep twirling the fabric by spinning the bar, tightening the tourniquet (this is the Spanish Windlass), until the bleeding is controlled. Then secure the end of the bar (can use the loose ends of the tie).

    As he discussed, tourniquets should be considered a measure of last resort. Other steps to take to control bleeding, before going for the tourniquet:

    1–Get the person to sit/lay down. Yes, difficult to do if the zombies are approaching, but they will be able to follow the blood trail anyway as long as the victim is bleeding. The heart of a person at rest beats slower than a standing/walking person, so less blood flow to the cut if the cuttie is lying down.

    2–Apply direct pressure to the wound. Put a bandage on it, preferably folded in half a couple of times so that you are able to push directly against the wound. Get ready to hold pressure for awhile (easily 15 minutes or more), or use a pressure dressing (wrap an Ace wrap tightly over the dressing). Try and leave that first dressing in place for an hour or so…when you pull it away you can pull apart any clots that have formed to naturally stop the bleeding. Direct pressure can stop most bleeding.

    If you have a long laceration, roll several gauze dressing up and line them over the wound, and then push down with the heels of your hand. I have controlled bleeding from a machete assault like this before.

    3–Elevate the cut extremity above the level of the heart. The higher it is, the less blood flow to the area and the easier to stop the bleeding.

    If the dressing and pressure and elevation have not stopped the bleeding after about 3-5 minutes (much shorter if there is a lot of blood being lost) then:

    4–Apply pressure to a pressure point. There are about 20 different pressure points on each side of the body, these are where an artery is close enough to the skin that you might be able to push it closed with your fingers between the site of bleeding and the heart. You can find a listing of the different areas here: http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/Manuals/Standard1stAid/chapter3.html” onclick=”window.open(this.href);return false I have had very good luck stopping bleeding to the hand by holding pressure to the radial and ulnar arteries by just squeezing both sides of a person’s inner wrist with my thumbs. Once bleeding is controlled, get a good pressure dressing on the spot and slowly release pressure after a couple of minutes. If the bleeding starts up again and goes through the dressing, resume pressure. All of these measures are cumulative, so for an arterial bleed from a finger I would squeeze a dressing over it, wrap it up tight, raise it up, and then start pushing on pressure points while the hand is in the air.

    If you control bleeding to an extremity, or if you are having trouble controlling it, consider splinting it. For example, if someone keeps bleeding from the wrist every time they move their hand, splint the wrist and the bleeding will be easier control. Such a splint should be left on for at least 12-24 hours for major bleeding that has not been stopped with sutures or such.

    If, after all of these measures, you still can’t control the bleeding, consider using a hemostatic/blood clotting agent like Celox and/or a tourniquet. Celox should not be generally and immediately used for several reasons, the first being that the stuff is expensive. Second, there is the possibility that it can clot too well, and could cause blood clots so severe in the extremity that the flow of blood could be cut off like a permanent tourniquet. To the best of my knowlegde this is a hypothetical risk…I know of no actual case where Celox caused the loss of a leg or arm…but to be safe you might not want to use it unless you have exhausted your other options. If the Celox doesn’t work, or is unavailable, go for the tourniquet.

    In a tactical situation, where raiders and/or cannibals are bearing down upon you, you would not be wrong for going straight for Celox and/or a tourniquet if the bleeding is obviously significant.

    Littledoc has a great posting on tourniquet tips: tourniquet-tips-how-to-avoid-mistakes-t515.html Please check it out, if you haven’t already.

    And, of course, the above is for informational purposes only. In the event of an emergency, I urge you to seek professional assistance.

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