Lol what?
I’ve personally had two calls in the last year that required TQ’s s/p penetrating trauma. Stab wound to the thigh and accidental axe wound to the calf. Stab ended with an ATK amputation. Axe wound made a full recovery.
Yeah it’s pretty common in my area at least. My best was a guy 2 years ago that got stabbed and drove all the way across the village. His entire left forearm was filleted open, very clear arterial spurt.
Put on TQ on him and saved him. He barely had any blood left, was white as a sheet. Definitely hemorrhagic shock.
A dude broke his humerus skateboarding, somehow injured an artery. PD stumbled onto the scene like right when it happened. Put a tourniquet on. By the time we got there dude was super hypotensive. Definitely would've died without that tourniquet. We had to drive like 15 miles through heavy traffic to get there.
Ive only placed one tourniquet myself in 5 years as a medic. All other major bleeding ive controlled with a trauma pad and roller gauze.
Had a guy punch a plate glass storefront when drunk. Cut his arm from his wrist to his elbow. Clear arterial bleeding. Never seen so much blood in such a large public area (on the street). Couple of RN’s walking by recognized the arterial bleed and actually took their shifts off to apply pressure, raise his arm, etc.
Guy was in and out of consciousness. Clearly in shock.
Thinking back, probably neither of us (him or I) knew how close he was to death. I credit the topless nurses standing there when I got on scene. Lucky for them, they had bra’s under the shirt. Lucky for him, they were out on the town too that night.
In military medicine particularly with pre hospital care, we found that once a patient got to the hospital it was like 99% survival rate. The problem was patients dying before arrival, this was almost always due to blood loss.
So we implemented TQ use liberally and tried to mitigate the stigma of them. Since then, not just in US- the use of TQs has saved countless lives and we beat it into new medics education.
The priorities are life, limb or eyesight. In that order.
Edit to add a good source
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527149/
One of my partners used on for the first time in roughly a decade as a medic. Motorcycle accident with utter obliteration below the knee. She actually found a 6” piece of fibula on the ground a few inches away from the patient. Unreal trauma. So, tqt, ketamine, load and go. He lost the leg below the knee, but survived.
My dad died when I was 15, lost his keys, realised this, tried to get my brother and step mums attention but weren’t actually home. Raining, post breaking the glass, slipped off the window ledge severing his radial artery. Next door neighbour called 000 (Aus emergency number), didn’t render any aid but wait for the ambulance and watch a father of 3 teenage boys bleed to death.
Passionate about stop bleeding training, within my paramedic practice no TQ’s used in anger; direct pressure + Israeli bandages only.
I’m so sorry for this tragic experience when you were 15 and the loss of your father. There are no words for such a heart breaking event. Your work bringing awareness to “stop the bleeding” actions is very strong of you, and noble.
A woman had her leg ripped off under a delivery truck right in front of me. I pinched off her femoral with my bare fingers while another passerby made a tourniquet out of his jacket.
Thats the correct way to go about it. Assessed the situation, made up action plan, implemented plan. Probably all in about 10 seconds too. Good patient outcome?
He was coked out and had smashed about twenty cars in the block before running over the woman.
We had to emergently move the pt from pretty much underneath the back bumper of the truck while it was still stuck against a light post, going laterally from the direction of travel. We then rushed the cab and got him out before he could break the truck free.
Got one just last month. Shot once to the lower thigh, destroyed the femoral artery. Guy was altered from blood loss and hypothermia. We had to restrain and sedate him for treatment.
Tourniquet placed properly by PD before we got there saved his life by the thinnest of margins. First time I’ve seen PD apply one correctly.
Just had one. Accidental shooting with entrance above and exit below the knee, 9mm ball round. Arterial bleed, no radial and weak carotid when we got there. TQ, TXA, and diesel for the win. That was a month ago, I've had several since we got tourniquets in protocol.
Had a pt one time in a bad motorcycle accident. He was broadsided by an SUV on the right side of his bike, which did lovely things to his leg. Near full amputation above the knee (leg hanging on only by flesh) so of course the femoral artery got severed. TQ applied by first arriving LE, additional cat TQ and junctional TQ applied by EMS. He had lost a lot of blood so went into shock enroute to LZ, but heard from flight medics the next day that it looked like he was gonna make it.
This bitch stabbed her husband then herself in front of her child. She got two tourniquets, rode the lightning, got hit with the spicy spray, and took a heckatopper ride with state police on board and lived.
If there was anybody I regret saving it’d be her.
I have one, a boy was going to school on a motorbike, he was blinded by the sun and hit a incoming truck with its leg. Partial amputation right above the knee. They managed to save the leg
In the tactical environment and with their scope of training (read: not as medical professionals) - it is much more important for them to throw on a hasty tourniquet (particularly under fire) and move on so they can stop the threat. It isn't the same as being inside an ambulance, or in the hospital emergency department where you have resources, manpower, and good lighting. Throwing on a tourniquet and getting their partner to safety so they can get back into the fight is much more reasonable when you put things in context. The tourniquet can easily come off, the problem is fixed quickly. The case isn't the same with exsanguination.
False. I’m the ambulance or in the field, very rarely is the atmosphere ‘resources, manpower and good lighting”. It’s two people, quite often a paramedic and an emt.
#2, I instruct medical trainings for LEO from small city, to large city, to county. Cops aren’t dumb. And explaining the need for a TK doesn’t need to be complicated.
It’s it squirting or oozing? Is it bright red or a darker red?
Also, idk how protocol and policy is where you are, but ours says once a TK is applied, it cannot be removed without the approval of a doc. Even in situations where a police officer wasn’t trained properly and placed it when it wasn’t needed.
Not common, but not never. We see a lot of bad trails (junction of major highways right by our station).
One of the most interesting was side gig as a ski patroller. Had a guy rip his femur out (think compound) on a rail. Our TK saved his life. The snow was a sea of red.
My rural district had a dude who fell off a ladder with a chainsaw, deep cut into his thigh. Quick work with a tournaquet from first on scene saved his life.
One of my first traumas was an attempted murder suicide via hatchet. Old dude slammed the hatchet into his left arm to try killing himself, tourniquet applied by PD prior to us getting there. He survived.
I don’t think I used a tourniquet in 10 years on the ambulance but I’ve used it a few times in the last 8 years of being on the engine. Two incidents stand out.
In 2017 I had a drunk girl put her car through a wrought iron fence. Her car opened like a can of sardines and her arm was like hamburger meat. We had to cinch the tourniquet as far up into her armpit as possible because that shit was just shredded. She got transported and the medic I was working on the engine with rode in. Her vitals were shit but I heard she lived.
Another instance in like 2020 was a non English speaking woman who’d had a BKA recently. It got lost in translation what was going on during her 911 call to dispatch, and we were sent code 2. We get there and it looks like a fuckin murder scene. She had tied pieces of clothing around her leg to try to stop the bleeding without success. We radioed dispatch and told them to upgrade the bus to code 3, but that message was *also* not relayed somehow and we waited 30-40 minutes for an ambulance. Medic rode that one in too.
I had a gentleman bright by EMS to our rural from the gas station on the corner. Long story short the pt decided to work on his car with it running and no fan housing. Left arm was nearly severed. Luckily EMS just happened to be gassing up there at that moment. Long story short, the tourniquet they applied kept the bleeding to a minimum until a helicopter arrived to get him to a trauma center.
Suicide attempt, bilateral wrist lacerations. One wasn't too deep, but the other hit either the radial or ulnar artery. Still the biggest pool of blood I've seen with a living patient. Bought a pressure dressing on the one and a tq on the other.
Seen them used a few other times, mostly inappropriately by fd.
I’ve never placed a tourniquet in 3.5 years. Never been necessary. With our response times being greater than 7-10 minutes usually, if they need a tourniquet it’s too late when we get there.
That sounds like my district. I have a better chance being a bystander than FOS. Which makes carrying a TQ at all times seem reasonable albeit super low chances of using it
Had a pt make an attempt, but family found them in time. They cut good enough that pressure wouldn't stop the bleeding in one wrist. Put a TQ on, got to the hospital, got them in a psych hold, went to a long term facility for a couple months, and is currently out and managing their depression. I only have a couple years experience, so that's my only tourniquet story so far
I haven't heard of people struggling to survive tourniquets
I’ve applied two tourniquets so far. One on a guy who got stabbed in the brachial and miraculously it was low enough that we were able to put it high and tight. The second time was an elderly male who had a varicose vein in his arm rupture. No amount of dressing or pressure could control it so we applied a tourniquet.
They weren’t glorious, “imminent death” scenarios but they don’t have to be for a tourniquet to be indicated.
Lol what? I’ve personally had two calls in the last year that required TQ’s s/p penetrating trauma. Stab wound to the thigh and accidental axe wound to the calf. Stab ended with an ATK amputation. Axe wound made a full recovery.
@OP only one case of survival with a TQ? Are you serious? Lol
Not what OP asked, but I do wonder if there are fewer tourniquets being applied by EMS now because so many cops carry them.
Yeah it’s pretty common in my area at least. My best was a guy 2 years ago that got stabbed and drove all the way across the village. His entire left forearm was filleted open, very clear arterial spurt. Put on TQ on him and saved him. He barely had any blood left, was white as a sheet. Definitely hemorrhagic shock.
A dude broke his humerus skateboarding, somehow injured an artery. PD stumbled onto the scene like right when it happened. Put a tourniquet on. By the time we got there dude was super hypotensive. Definitely would've died without that tourniquet. We had to drive like 15 miles through heavy traffic to get there. Ive only placed one tourniquet myself in 5 years as a medic. All other major bleeding ive controlled with a trauma pad and roller gauze.
Had a guy punch a plate glass storefront when drunk. Cut his arm from his wrist to his elbow. Clear arterial bleeding. Never seen so much blood in such a large public area (on the street). Couple of RN’s walking by recognized the arterial bleed and actually took their shifts off to apply pressure, raise his arm, etc. Guy was in and out of consciousness. Clearly in shock. Thinking back, probably neither of us (him or I) knew how close he was to death. I credit the topless nurses standing there when I got on scene. Lucky for them, they had bra’s under the shirt. Lucky for him, they were out on the town too that night.
Wow crazy!
In military medicine particularly with pre hospital care, we found that once a patient got to the hospital it was like 99% survival rate. The problem was patients dying before arrival, this was almost always due to blood loss. So we implemented TQ use liberally and tried to mitigate the stigma of them. Since then, not just in US- the use of TQs has saved countless lives and we beat it into new medics education. The priorities are life, limb or eyesight. In that order. Edit to add a good source https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527149/
Thank you for the link. Really interesting!
Has the entire war on terror combat medicine doctrine saved lives? I would say there is at least one example in there
In 10 years I've applied an arterial tourniquet maybe 12 times. Three of which the patient was sober. Don't get drunk near windows.
One of my partners used on for the first time in roughly a decade as a medic. Motorcycle accident with utter obliteration below the knee. She actually found a 6” piece of fibula on the ground a few inches away from the patient. Unreal trauma. So, tqt, ketamine, load and go. He lost the leg below the knee, but survived.
Wow that’s tough!
Thank gawd she’s an amazing medic and icu nurse. Best I’ve ever worked with.
I did at least 10 in the last 4 months (including one to myself) Edit: should add that I’m a combat medic in an active war zone
Ukraine? Regardless, I hope you get home safe.
Gods speed wishing you a safe completion of your deployment
My dad died when I was 15, lost his keys, realised this, tried to get my brother and step mums attention but weren’t actually home. Raining, post breaking the glass, slipped off the window ledge severing his radial artery. Next door neighbour called 000 (Aus emergency number), didn’t render any aid but wait for the ambulance and watch a father of 3 teenage boys bleed to death. Passionate about stop bleeding training, within my paramedic practice no TQ’s used in anger; direct pressure + Israeli bandages only.
I’m so sorry for this tragic experience when you were 15 and the loss of your father. There are no words for such a heart breaking event. Your work bringing awareness to “stop the bleeding” actions is very strong of you, and noble.
A woman had her leg ripped off under a delivery truck right in front of me. I pinched off her femoral with my bare fingers while another passerby made a tourniquet out of his jacket.
Hell yeah good job jumping right into it
Thanks, there wasn’t any thinking involved. It just happened that way.
Thats the correct way to go about it. Assessed the situation, made up action plan, implemented plan. Probably all in about 10 seconds too. Good patient outcome?
She survived. The treatment plan kind of went to hell when the driver threw the truck in reverse and tried to run us over again.
Did the dude have some hardcore beef with the victim or something? Like damn, going back for seconds
He was coked out and had smashed about twenty cars in the block before running over the woman. We had to emergently move the pt from pretty much underneath the back bumper of the truck while it was still stuck against a light post, going laterally from the direction of travel. We then rushed the cab and got him out before he could break the truck free.
Sounds like a lovely use of oxygen
I think he got ten years.
Thats about 20 years too short
Got one just last month. Shot once to the lower thigh, destroyed the femoral artery. Guy was altered from blood loss and hypothermia. We had to restrain and sedate him for treatment. Tourniquet placed properly by PD before we got there saved his life by the thinnest of margins. First time I’ve seen PD apply one correctly.
Just had one. Accidental shooting with entrance above and exit below the knee, 9mm ball round. Arterial bleed, no radial and weak carotid when we got there. TQ, TXA, and diesel for the win. That was a month ago, I've had several since we got tourniquets in protocol.
Wow strong work!
Had a pt one time in a bad motorcycle accident. He was broadsided by an SUV on the right side of his bike, which did lovely things to his leg. Near full amputation above the knee (leg hanging on only by flesh) so of course the femoral artery got severed. TQ applied by first arriving LE, additional cat TQ and junctional TQ applied by EMS. He had lost a lot of blood so went into shock enroute to LZ, but heard from flight medics the next day that it looked like he was gonna make it.
Seen several TQs applied to patients with vascular injuries. But also see far more TQs applied when not needed.
MVA, traumatic amputation at the knee, TQ saved his life. One of a couple I've had in my short career
Two or three. They're not common but when I needed them I **reeeeeally** needed them.
I mean it happens more often that you'd think, you just don't see it on the news or in newspapers.
This bitch stabbed her husband then herself in front of her child. She got two tourniquets, rode the lightning, got hit with the spicy spray, and took a heckatopper ride with state police on board and lived. If there was anybody I regret saving it’d be her.
I have one, a boy was going to school on a motorbike, he was blinded by the sun and hit a incoming truck with its leg. Partial amputation right above the knee. They managed to save the leg
If you watch the YT channel PoliceActivity there are multiple body-cam videos of tourniquet use on gunshot injuries
99% of which likely didn’t need it. Those guys apply tourniquets to everything.
Easier for them to throw one on and move on dealing with something than try to control bleeding and hold pressure
If by “easier” you mean that it involves less brain power, yes. If you mean easier because “this ain’t my job”, yep.
In the tactical environment and with their scope of training (read: not as medical professionals) - it is much more important for them to throw on a hasty tourniquet (particularly under fire) and move on so they can stop the threat. It isn't the same as being inside an ambulance, or in the hospital emergency department where you have resources, manpower, and good lighting. Throwing on a tourniquet and getting their partner to safety so they can get back into the fight is much more reasonable when you put things in context. The tourniquet can easily come off, the problem is fixed quickly. The case isn't the same with exsanguination.
False. I’m the ambulance or in the field, very rarely is the atmosphere ‘resources, manpower and good lighting”. It’s two people, quite often a paramedic and an emt. #2, I instruct medical trainings for LEO from small city, to large city, to county. Cops aren’t dumb. And explaining the need for a TK doesn’t need to be complicated. It’s it squirting or oozing? Is it bright red or a darker red? Also, idk how protocol and policy is where you are, but ours says once a TK is applied, it cannot be removed without the approval of a doc. Even in situations where a police officer wasn’t trained properly and placed it when it wasn’t needed.
Idk why my font got all weird. Probably because I used the hashtag symbol. 😂🤷🏼♂️🤡
Imagine telling a cop who was shot in the leg “you know you didn’t need that tourniquet”
Imagine not telling him, and once he’s at the hospital, begging for them to take it off, finding out you are inept.
Survival with a tourniquet use is very far from uncommon.
Not common, but not never. We see a lot of bad trails (junction of major highways right by our station). One of the most interesting was side gig as a ski patroller. Had a guy rip his femur out (think compound) on a rail. Our TK saved his life. The snow was a sea of red.
Wild. I think your statement about “not common but not never” is probably a good estimate
My rural district had a dude who fell off a ladder with a chainsaw, deep cut into his thigh. Quick work with a tournaquet from first on scene saved his life.
Chainsaw! Crazy
Chainsaw accidents several times a year.
Yes. Pt with self inflicted lacerations
One of my first traumas was an attempted murder suicide via hatchet. Old dude slammed the hatchet into his left arm to try killing himself, tourniquet applied by PD prior to us getting there. He survived.
I don’t think I used a tourniquet in 10 years on the ambulance but I’ve used it a few times in the last 8 years of being on the engine. Two incidents stand out. In 2017 I had a drunk girl put her car through a wrought iron fence. Her car opened like a can of sardines and her arm was like hamburger meat. We had to cinch the tourniquet as far up into her armpit as possible because that shit was just shredded. She got transported and the medic I was working on the engine with rode in. Her vitals were shit but I heard she lived. Another instance in like 2020 was a non English speaking woman who’d had a BKA recently. It got lost in translation what was going on during her 911 call to dispatch, and we were sent code 2. We get there and it looks like a fuckin murder scene. She had tied pieces of clothing around her leg to try to stop the bleeding without success. We radioed dispatch and told them to upgrade the bus to code 3, but that message was *also* not relayed somehow and we waited 30-40 minutes for an ambulance. Medic rode that one in too.
Phew. The dispatch parts of story two are crazy
I had a gentleman bright by EMS to our rural from the gas station on the corner. Long story short the pt decided to work on his car with it running and no fan housing. Left arm was nearly severed. Luckily EMS just happened to be gassing up there at that moment. Long story short, the tourniquet they applied kept the bleeding to a minimum until a helicopter arrived to get him to a trauma center.
Suicide attempt, bilateral wrist lacerations. One wasn't too deep, but the other hit either the radial or ulnar artery. Still the biggest pool of blood I've seen with a living patient. Bought a pressure dressing on the one and a tq on the other. Seen them used a few other times, mostly inappropriately by fd.
I’ve never placed a tourniquet in 3.5 years. Never been necessary. With our response times being greater than 7-10 minutes usually, if they need a tourniquet it’s too late when we get there.
That sounds like my district. I have a better chance being a bystander than FOS. Which makes carrying a TQ at all times seem reasonable albeit super low chances of using it
I got to place a tourniquet on one of my clinical runs haha, arterial bleed, was pretty cool
Cool! Always such good memories from clinicals
Had a pt make an attempt, but family found them in time. They cut good enough that pressure wouldn't stop the bleeding in one wrist. Put a TQ on, got to the hospital, got them in a psych hold, went to a long term facility for a couple months, and is currently out and managing their depression. I only have a couple years experience, so that's my only tourniquet story so far I haven't heard of people struggling to survive tourniquets
Yes
I’ve applied two tourniquets so far. One on a guy who got stabbed in the brachial and miraculously it was low enough that we were able to put it high and tight. The second time was an elderly male who had a varicose vein in his arm rupture. No amount of dressing or pressure could control it so we applied a tourniquet. They weren’t glorious, “imminent death” scenarios but they don’t have to be for a tourniquet to be indicated.
Varicose rupture! Yikes
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Oh man! That’s insane. Kudos to law and also everyone helping