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ch45 | Lesson 5 | CT State Protocol 6.17 Tourniquet Application

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EMS Care™ | ch45 | Hemorrhage Control for the EMS Provider

Lesson 5 | CT State Protocol 6.17 Tourniquet Application

Slide 53 | 1 of 9 | Procedure Intro

Thank you Missah and Hello again.   Let’s go through the details of the Connecticut Department of Public Health Protocol six point one seven, for Tourniquet Application.

The source protocol is found on page 148 of the State of Connecticut Statewide EMS Protocols v2017.1.  It is available portal.ct.gov. 

In this lesson, will go through the protocol line by line.  We then will share our references and acknowledgments.  And we finish with the two videos on use of tourniquets.

To get credit for this course, you must watch all the lessons in their entirety and answer the interactive questions.  And if included with your course, you must attend the skills instruction session and demonstrate your aptitude for the covered Hemorrhage Control methods and tools.

Good studying.

Slide 54 | 2 of 9 | 6.17 Tourniquet Application | Indications

So for the next few slides, I am going to read to you the EMT | ADVANCED EMT | PARAMEDIC STANDING ORDERS, from the Connecticut Department of Public Health Protocol 6.17 for Tourniquet Application.  It’s a bit on the dry side – but I’ll do my best:

A tourniquet is a commercial device used to control a life-threatening hemorrhage on an injured extremity to prevent exsanguination.

Indications for use:

  • Life-threatening extremity hemorrhage that cannot be controlled by other means.
  • Serious or life-threatening extremity hemorrhage in the face of operational considerations that prevent the use of less aggressive hemorrhage control techniques.

 

Slide 55 | 3 of 9 | 6.17 Tourniquet Application | Procedure (1 of 2)

The procedure includes:

  1. If hemorrhage is not severe, attempt to control the hemorrhage with direct pressure, bandaging.
  2. With a commercial tourniquet:
  • Place tourniquet proximal to wound on the affected extremity.
  • Tighten per manufacturer instructions until hemorrhage stops and distal pulses are extinguished.
  • If initial tourniquet fails to stop bleeding, ensure proper deployment of the first tourniquet, and consider the placement of a second tourniquet just proximal to first.

This continues on the next slide.

Slide 56 | 4 of 9 | 6.17 Tourniquet Application | Procedure (2 of 2)

Continuing #2 – with a commercial tourniquet: 

  • Document the time of tourniquet application and communicate this clearly with the receiving facility.
  • Do not cover tourniquet.
  • Dress wounds per standard wound care and consider the use of a hemostatic bandage.
  • Reassess for re-bleeding frequently, especially after any patient movement.
  • Proper tourniquet placement often causes significant pain. Consider pain management, see Pain Protocol 2.16.
  • Do not remove or loosen tourniquet once hemostasis achieved.

 

Slide 57 | 5 of 9 | Absence of Commercial Tourniquet

So the procedure advises:

In the absence of a commercial tourniquet which is preferred, an improvised device; for example, a cravat with windlass, blood pressure cuff could be used. The device must be a minimum of 2 inches wide, otherwise, it can cut through the skin.

Slide 58 | 6 of 9 | Pearls

Finally, the procedure offers these pearls of wisdom for the E M S provider when applying tourniquets:

  • Do not apply tourniquets over clothing or joints. If the wound is just distal to a joint, the tourniquet should be placed just proximal to the joint.
  • Delay in the placement of a tourniquet for life-threatening hemorrhage significantly increases mortality. Do not wait for hemodynamic compromise to apply a tourniquet.
  • Transport patients directly to a Level I or Level II trauma center if feasible and provide the earliest possible notification or trauma alert.
  • Damage to the limb from tourniquet application is unlikely if removed in several hours.

So, that’s the Connecticut Department of Public Health Protocol six point one seven for Tourniquet Application. 

It is also the end of this chapter on Hemorrhage Control.  We have a couple of housekeeping slides coming and then the videos.

Slide 59 | 7 of 9 | Acknowledgements

We again acknowledge the Connecticut EMS Advisory Board’s EMS Training and Education Committee.  Thank you for the source material.

Slide 60 | 8 of 9 | References

And this slide references the many supporting contributors who provided guidance to the EMS community.  Thank you.

Slide 61 | 9 of 9 | Demonstration of Tourniquet Application

And finally, we have two upcoming videos on tourniquet application.  The first video covers the use of the Combat Application Tourniquet.  The second one demonstrates the SOF tactical tourniquet.

Remember, to get credit for this course, you must watch all the lessons in their entirety and answer the interactive questions.  And if included with your course, you must attend the skills instruction session.  There you may receive coaching and demonstrate your aptitude for the covered Hemorrhage Control methods and tools.

Please reach out to one of my human colleagues if you have questions.

Thank you for choosing MissionCIT, and Good Studying.

 

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