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howdy wrote:Looks like Houston Police will soon carry tourniquets:

http://www.chron.com/default/article/Me ... 211687.php" onclick="window.open(this.href);return false;

Mostly because they are easy to use as NYJ said, they are effective in stopping bleeding or reducing it on an extremity and under short time use are not really that bad, also in consideration is the fact that in metro areas the time its on is usually very short, combat medics aside because the impetus is different between combat/long distance travel and police/fire usual evac time. yes a few have had good results long distance with a qualified person supervising the TQ but not as good as other methods. The other bad thing is that MD's in metro areas tend to just rip them off and SQUIIIIIRT here comes da bluuuuuud same as pasg or air filled pants cause hemolytic compromise because the receiving facility just removes them without thought as to why they are there and the patient will either bleed out or just crash because the auto transfuse is now gone.

howdy wrote:Getting back to the original subject, I am curious what JP171 and NYJ think about the syringe thing filled with little sponges?

Ok to answer your question, I see just a couple of problems, thoracic penetration into the lung. Gonna have a newb fill a lung full of sponges with little to no effect same with abdominal penetrations. All of the hemostatic preparations have in the instructions to NOT use in probable lung/abdominal penetrations but it still has happened too many times and will happen again because the medic really needs the valium first so that they can relax and think before making a bad decision. It seems it might be something that could be good for extremity use as in arm/leg buttocks but not thoracic or abdominal penetrations, needs to be studied in the field under guidelines to judge efficacy as well as when it should be used, then a basic protocol written be informed medics and MD's as a standard of care. and yeppers that's gonna change bout 40 times a week as NYJ said the standards are continuously changing and not always for the better

nyj wrote:

JP171 wrote:

nyj wrote:

JP171 wrote:

nyj wrote:

JP171 wrote:In the field we always carried tampons and maxi pads, and tea bags, great stuff. Chew worked in a pinch too. Tourniquets went out in the dark ages as the limb they are used on will be amputated, we also have really kewl stuff made from shrimp shells that stops bleeding in most all cases. for arterial bleeds that we can ID as such, a tampon, then a maxi pad then wrap aggressively to stop the bleeding NEVER use a tourniquet unless you don't like the guy. Tobacco is used as a last resort and sparingly as too much can cause secondary effects in a hemo compromised individual, clotting agents of any type are NEVER used in thoracic injuries as they WILL cause big problems. As far as taking the soldiers weapon yes we do, and often tie them down or use other soldiers to sit on them, no I don't want to get shot stabbed or hit and yes I have been there done that on all accounts. oh and YES I am a practicing Paramedic and CLS/Corpsman

The bad rep that tourniquets got are long in the past. TQ's are the main go-to-tool in any uncontrollable extremity hemorrhage. They can be left on for a surprisingly long time. And with all do respect, if you are a currently certified paramedic, you should know that this is a national registry standard.

NR is over rated and yes I do know and I know the results after being a paramedic for over 30 years, yep I know how it works. the standard has so many limitations on it its not funny and not worth thinking about within most metro areas as it causes too much damage, Dr. Paul Pepe refused the use of them in the 1990's because the cause more damage then benefit, Dr. Mark Blanchette refuses to allow them any where near his EMS system, should I go on? the NREMT is an abortion that needs to go away. Also Dr. Mark Rigo refuses to allow them on any of the 3 Houston area EMS systems he is medical director for nor will Dr. Jerry Wassertein. hmmm yep that says something to me, and I knew all of them before they became Doctors except Dr Blanchette

I completely respect your experience, but you just said "1990's." You know that things change every year in medicine. The definitive answer is that TQ's in pre-hospital care is the standard of care. We simply do not have patients long enough for prolonged application to be an issue.

ummm gee did you miss the part about being currently licensed and practicing?

What does that have to do with a doctor not using them in the 90's?

And while you may dislike NR (who doesn't?), there is an infinite amount of research that goes into the things they implement as national standards.

They are still not used except as a last resort and I just read a report that came out and PHTLS protocols still make them a last resort tool and by then your at the receiving facility that begets the term OF NO USE most transport times in a metroplex is under 10 mins and controlling bleeding is normally 5 to 7 mins so that says to me in extremis they have a use but not in a normal trauma system, ergo when left on too long without relief or hospital not remembering that they are there causes tissue necrosis and amputation. as far as national standards under texas law there is no such thing that may be relied upon, and local protocols as signed by your medical director are always in precedence no matter what national standards may exist. Do we use them on the battle field yes we do, but when a soldiers leg or arm has been blown off there isn't much to loose. oh and NREMT also still has MAST/PASG on its list of stooped things to do, and yep the hospital just cuts em right offa there, so yep lets give the ED nurse that knows everything one more way to cause our PT to become a statistic

nyj wrote:

JP171 wrote:

nyj wrote:

JP171 wrote:In the field we always carried tampons and maxi pads, and tea bags, great stuff. Chew worked in a pinch too. Tourniquets went out in the dark ages as the limb they are used on will be amputated, we also have really kewl stuff made from shrimp shells that stops bleeding in most all cases. for arterial bleeds that we can ID as such, a tampon, then a maxi pad then wrap aggressively to stop the bleeding NEVER use a tourniquet unless you don't like the guy. Tobacco is used as a last resort and sparingly as too much can cause secondary effects in a hemo compromised individual, clotting agents of any type are NEVER used in thoracic injuries as they WILL cause big problems. As far as taking the soldiers weapon yes we do, and often tie them down or use other soldiers to sit on them, no I don't want to get shot stabbed or hit and yes I have been there done that on all accounts. oh and YES I am a practicing Paramedic and CLS/Corpsman

The bad rep that tourniquets got are long in the past. TQ's are the main go-to-tool in any uncontrollable extremity hemorrhage. They can be left on for a surprisingly long time. And with all do respect, if you are a currently certified paramedic, you should know that this is a national registry standard.

NR is over rated and yes I do know and I know the results after being a paramedic for over 30 years, yep I know how it works. the standard has so many limitations on it its not funny and not worth thinking about within most metro areas as it causes too much damage, Dr. Paul Pepe refused the use of them in the 1990's because the cause more damage then benefit, Dr. Mark Blanchette refuses to allow them any where near his EMS system, should I go on? the NREMT is an abortion that needs to go away. Also Dr. Mark Rigo refuses to allow them on any of the 3 Houston area EMS systems he is medical director for nor will Dr. Jerry Wassertein. hmmm yep that says something to me, and I knew all of them before they became Doctors except Dr Blanchette

I completely respect your experience, but you just said "1990's." You know that things change every year in medicine. The definitive answer is that TQ's in pre-hospital care is the standard of care. We simply do not have patients long enough for prolonged application to be an issue.

ummm gee did you miss the part about being currently licensed and practicing?

nyj wrote:

JP171 wrote:In the field we always carried tampons and maxi pads, and tea bags, great stuff. Chew worked in a pinch too. Tourniquets went out in the dark ages as the limb they are used on will be amputated, we also have really kewl stuff made from shrimp shells that stops bleeding in most all cases. for arterial bleeds that we can ID as such, a tampon, then a maxi pad then wrap aggressively to stop the bleeding NEVER use a tourniquet unless you don't like the guy. Tobacco is used as a last resort and sparingly as too much can cause secondary effects in a hemo compromised individual, clotting agents of any type are NEVER used in thoracic injuries as they WILL cause big problems. As far as taking the soldiers weapon yes we do, and often tie them down or use other soldiers to sit on them, no I don't want to get shot stabbed or hit and yes I have been there done that on all accounts. oh and YES I am a practicing Paramedic and CLS/Corpsman

The bad rep that tourniquets got are long in the past. TQ's are the main go-to-tool in any uncontrollable extremity hemorrhage. They can be left on for a surprisingly long time. And with all do respect, if you are a currently certified paramedic, you should know that this is a national registry standard.

NR is over rated and yes I do know and I know the results after being a paramedic for over 30 years, yep I know how it works. the standard has so many limitations on it its not funny and not worth thinking about within most metro areas as it causes too much damage, Dr. Paul Pepe refused the use of them in the 1990's because the cause more damage then benefit, Dr. Mark Blanchette refuses to allow them any where near his EMS system, should I go on? the NREMT is an abortion that needs to go away. Also Dr. Mark Rigo refuses to allow them on any of the 3 Houston area EMS systems he is medical director for nor will Dr. Jerry Wassertein. hmmm yep that says something to me, and I knew all of them before they became Doctors except Dr Blanchette.

oh and one more thing, the machine kicked me out after 22mins 17 seconds on my last test

Chemist45 wrote:VoiceofReason wrote:

I know from experience that if I don’t have a cup of coffee first, I usually shave myself while cutting.

Uh, VOR, maybe you should have that coffee before you post.

OH MY

In the field we always carried tampons and maxi pads, and tea bags, great stuff. Chew worked in a pinch too. Tourniquets went out in the dark ages as the limb they are used on will be amputated, we also have really kewl stuff made from shrimp shells that stops bleeding in most all cases. for arterial bleeds that we can ID as such, a tampon, then a maxi pad then wrap aggressively to stop the bleeding NEVER use a tourniquet unless you don't like the guy. Tobacco is used as a last resort and sparingly as too much can cause secondary effects in a hemo compromised individual, clotting agents of any type are NEVER used in thoracic injuries as they WILL cause big problems. As far as taking the soldiers weapon yes we do, and often tie them down or use other soldiers to sit on them, no I don't want to get shot stabbed or hit and yes I have been there done that on all accounts. oh and YES I am a practicing Paramedic and CLS/Corpsman