civillian vs military trauma treatments

[zmedic]

BP cuffs are not good tourniquet replacements.

I just don't understand why. They work fine in the ER and the OR. Now I understand they they aren't as secure for running around combat and staying in the fight after getting a GSW. But civillian side we are lifting the person onto the stretcher.

 

[Doczilla]

Sorry, I wrote this WAY too late at night, wasn't wording this correctly. I meant PPE resulted in a statistical shift away from areas that protective gear are meant to protect; leaving vascular injuries [extremeties, pelvis, neck, etc] to occupy a greater share of the "pie chart" of trauma surgery.

Looking back at the way I worded it, it was kind of silly.

The last bit was my way of making sure I can work almost anywhere, to let the concept of medicine, and the combination of training/experience serve to work for you, not against you. Don't wanna get caught going "sorry boss, this is how we did it in the Army!"

 

[RocketMedic]

I just don't understand why. They work fine in the ER and the OR. Now I understand they they aren't as secure for running around combat and staying in the fight after getting a GSW. But civillian side we are lifting the person onto the stretcher.

A cuff is dependent on one Velcro strip. A tourniquet is not.

 

[Veneficus]

A cuff is dependent on one Velcro strip. A tourniquet is not.

In surgery the TK is "pneumatic" which is just a fancy way to say BP cuff.

It actually works very well. Velcro strip doesn't seem to be a difference.

 

[Tigger]

The prepackaged TKs are small enough for me to carry in the little bag that I bring on the bench and ice when I cover hockey games. I don't doubt that a BP cuff works as well, I just can't fit a cuff in the bag. Plus they are fairly inexpensive (well free for us) and do not have a "leading edge" than can be accidentally dislodged.

 

[RocketMedic]

In surgery the TK is "pneumatic" which is just a fancy way to say BP cuff.

It actually works very well. Velcro strip doesn't seem to be a difference.

Once again, look at the surface of that so-called tourniquet. Its fresh Velcro, and likely has a buckle or secondary closure. It also has a valve that's not as prone to accidental release, and it will have multiple sets of eyes watching it.

None of these are realistically assets to us in the field. CAT, SOF-T, etc cave the benefit of being portable, non reliant on pneumatics, and much more stable.

A BP cuff may work, but if I'm tourniqueting, I would like to get it done the right way.

 

[Veneficus]

Once again, look at the surface of that so-called tourniquet. Its fresh Velcro, and likely has a buckle or secondary closure. It also has a valve that's not as prone to accidental release, and it will have multiple sets of eyes watching it.

None of these are realistically assets to us in the field. CAT, SOF-T, etc cave the benefit of being portable, non reliant on pneumatics, and much more stable.

I never had an issue using the nondisposable BP cuffs in civillian field EMS.

I have seen people try and fail a few times using a belt. (belts do not work)

A BP cuff may work, but if I'm tourniqueting, I would like to get it done the right way.

There is no wrong way that works.

 

[Aidey]

"If a stupid idea works, then it wasn't a stupid idea". I can't remember who said it right now.

 

[Craig Alan Evans]

Velcro is an amazingly strong and reliable product. I can see a pneumatic tourniquet working very well in the upper extremities. Does one work as well in the lower extremities? A standard tourniquet works very well in the legs if it is applied high enough to compress the femoral artery. The most common mistake with tourniquets in the recent past in the military is not applying them high enough to capture the artery against a bone.

 

[RocketMedic]

Velcro is an amazingly strong and reliable product. I can see a pneumatic tourniquet working very well in the upper extremities. Does one work as well in the lower extremities? A standard tourniquet works very well in the legs if it is applied high enough to compress the femoral artery. The most common mistake with tourniquets in the recent past in the military is not applying them high enough to capture the artery against a bone.

New Velcro, and its still not as good as a buckle.

 

[mycrofft]

CAT relies on a hybrid Velcro plus a windlass with very positive lock/latch, very quick and definitely puts some circumferential pressure to work.

 

[Doczilla]

Yeah, it's a good one, but you need at LEAST two when dealing with a healthy adult male thigh placement.... not a bad thing, mind you. Just something to keep in mind.

 

[mycrofft]

THAT is the sort of info we need to hear about. THANKS!

 

[CCNRMedic1982]

I have worked in civilian EMS for 4 years now and was a medic in the army for 10. I have had to use tourniquets on multiple pts. In the military and have never had an incidence of extremity bleeding that I nor a partner of mine were unable to control with "basic" methods. I personally don't feel like there are major differences between military and civilian medicine with the exceptions of operations of course and the topic extremity trauma. The service I work for only has TQ in place for SWAT medics. The ambulances don't have them on there. With the transport times of civilian agencies I don't feel like they are necessary or cost effective. A lot of times these commercial TQ sit for years with maybe one being used and new packages ordered every year. They basically become like old furniture, just something else to check during the day. When the money set aside for that piece of equipment could be used on seething else beneficial to the service or employees. When I first started this at 18 years old I was taught to use dressings, bandages, direct pressure and good splinting with elevation. And that pressure point nonsense. And since the military that has controlled a lot of really bad extremity bleeding. I think it would be nice to focus on the bleeds that can't be controlled with a tourniquet and are difficult to control manually until hosp. arrival. i.e. groom/axilla. Or what I noticed was similar in civilian and military trauma was concussion and blunt injuries and tx for those. But I think that to try and tx civilian extremity traumas and military extremity traumas the same in every situation is flushing money just to "look cool" just an opinion. Like this post!

 

[kindofafireguy]

Let's face it, we'll always follow what the military finds to some extent. After all, our profession evolved from Navy Corpsmen and Combat Medics. I do like the concept of tourniquets for major traumas like amputations as it is definitely quick and efficient, and based on recent research it's actually safe. But as someone else stated, they're not necessarily cost effective for every service, and the cost-to-benefit ratio is pretty high (I honestly don't remember the last time I've needed to use one, and I work a high volume 911 system).

Plus, at least where I work, we all like to think we're high speed - low drag operator types we even use black nitrile gloves. Hollaaaa.

(That was their bright idea to get us to stop writing on gloves. It failed.)

 

[EpiEMS]

(That was their bright idea to get us to stop writing on gloves. It failed.)

Why would they try and stop glove-writing? It's so darn convenient!

Regarding trauma treatments, I didn't know that you'd need two tourniquets for a thigh. Is that always true? Also, any thoughts on the SWAT-T tourniquet? I've been looking into different TQs, and it came up as an inexpensive, effective alternative to the CAT and MAT.

 

[kindofafireguy]

Why would they try and stop glove-writing? It's so darn convenient!.

Long story. The short version is that it had to do with some Texas Municipal code requiring an actual hard copy of our patient assessment trading hands when EMS arrived to transport.

Another reason is that they said it's just plain nasty.

Fair enough. But I only have two hands, and I'm not wasting one on a notebook.

And EMS didn't care about hard copies any more than we did.

At any rate, you can still see the writing if you tilt the glove just right.

 

[CCNRMedic1982]

Regarding trauma treatments, I didn't know that you'd need two tourniquets for a thigh. Is that always true? Also, any thoughts on the SWAT-T tourniquet? I've been looking into different TQs, and it came up as an inexpensive, effective alternative to the CAT and MAT.[/QUOTE]

I have never had to use two tourniquets on a thigh wound. Depending on how an amputation occurred the bleeding commonly wasn't that bad unless the amputation resulted from a crush injury or blast injury. But different setting. As far as the different types of tourniquets I have had the chance to see the SWAT-T and a few others and if your able to afford them they seem to do the trick. I new a guy that applied a tourniquet with a triangle bandage and a gas muzzle. He was not a medic but the point is you can use just about anything that is able to compress arterial blood flow.

 

[Veneficus]

I have never had to use two tourniquets on a thigh wound. Depending on how an amputation occurred the bleeding commonly wasn't that bad unless the amputation resulted from a crush injury or blast injury. But different setting. As far as the different types of tourniquets I have had the chance to see the SWAT-T and a few others and if your able to afford them they seem to do the trick. I new a guy that applied a tourniquet with a triangle bandage and a gas muzzle. He was not a medic but the point is you can use just about anything that is able to compress arterial blood flow.

Except a belt. Don't try to use a belt.

 

[Veneficus]

Forgive me if I sound unduly harsh, that is not my intent, but I want to be rather forthcoming on this post as I think it is a large area of EMS that needs some reason interjected.

Let's face it, we'll always follow what the military finds to some extent.

Some military things work. Some do not. But doing something the military does "because the military does it," is just stupid.

Some ideas are also followed because there is this crazy civilian idea if the military does or uses something it must be superior.(Law enforcement is notorious for this, but it is not limited to any industry)

I always love these "next best treatment" and "we need to use TK" threads. The military needs these devices everyday. I am willing to bet you would not find more than a handful of cases where all US civilian EMS actually needed a tk last year. (Though I concede there may be times when it was used and not needed for legitimate reasons)

The only 2 times I have used a TK in US EMS a BP cuff worked perfectly.

Many of the combat medics and corpsmen I have spoken with use crics regularly, should we start doing that in the civilian world?

It's quick, easy, tube doesn't dislodge often, there are lots of benefits. (but a few major drawbacks that make it unacceptable too)

When it comes to cost or efficiency the military is certainly not to be emulated.

Civilian EMS does not have billions of dollars to throw at high dollar equipment that can be done cheaper by already existing equipment. Especially when it will rarely ever be needed.

As for medical acumen, while the military does have some amazing contributions to medicine, some of what it finds acceptable, even preferable, is not the minimum accepted standards in developing countries, much less the first world.

Just because some people want to play soldier on an ambulance doesn't mean it is acceptable. If providers fantasize about combat medicine, I know more than a few places hiring for that. I can get you the phone numbers if you really need.

The civilian world is simply not the military.

After all, our profession evolved from Navy Corpsmen and Combat Medics.

EMS is not a profession, it is a vocation.(full stop) It has the potential to be a profession, but blindly implementing military equipment and procedures in the civilian world will not help that.

Professionals (not to be confused with career soldiers) in the military are all officers.

Enlisted rates are all vocations.

If you want to be a professional, you will need many of the same requirements the military requires, like a 4 year degree.

I do like the concept of tourniquets for major traumas like amputations as it is definitely quick and efficient, and based on recent research it's actually safe

.

So do I. But I also have a firm hand and experience on what major trauma is and looks like.

I have also been around a while and enough places to know most civilian EMS providers in many parts of the world do not. They often massively over estimate the seriousness of many traumas.

Overtreatment is a medical error. We don't do CABGs on everyone with chest pain. We should not be implementing surgical intervention (like a TK) on a massive scale when it is not needed. (I accept in emergency medicine some over treatment is required, but not all the time)

A professional understands and practices (to use a military term) economy of force. "Don't use a cannon to kill a mosquito."

Plus, at least where I work, we all like to think we're high speed - low drag operator types

Happens a lot.

But I have noticed the real operators like that are usually rather chill and low key.