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WMN Editors

Proper Use of Tourniquets – 2018

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ISSN-1059-6518

Proper Use of Tourniquets – 2018

By Jeff DeBellis

Illustrations by T.B.R. Walsh

SOLO recently updated its tourniquet curriculum to incorporate the latest evidence. A growing trove of research in recent decades has confirmed that tourniquets are extremely effective at stopping massive bleeds. When used appropriately, they have minimal complications. Tourniquets have been a contentious piece of the pre-hospital medical kit for thousands of years. The emergency medical community has swung back and forth on their merits and drawbacks during that time. The era of evidence-based medicine itself is relatively new. It’s only since the war in Vietnam that researchers have begun to study tourniquets systematically. This research has led to improved education and much greater success.

A tourniquet is still a last resort to stop severe extremity bleeding in the wilderness setting. Only use one if there is a traumatic amputation, obvious arterial bleeding, or if direct pressure will not stop the bleeding. They should never be used on minor bleeds. Using a tourniquet on minor bleeds or shoddy improvisation by inadequately trained caregivers are some of the reasons that many surgeons vilified tourniquets for so long.

The major change in the curriculum is that tourniquets are no longer just for life-over-limb situations. They are a life-saving technique that should be used without hesitation. So long as the tourniquet can be removed within a couple of hours, patients are unlikely to lose the limb. One recent study looked at 232 patients who had tourniquets applied to 309 limbs. Not a single limb was lost to amputation because of the use of tourniquets.

How to Apply a Tourniquet:

There are a number of commercial tourniquet models available. The two that the US Army Institute of Surgical Research identifies as being 100% effective are the Combat Application Tourniquet (CAT) and the SOF Tactical Tourniquet (SOFTT). A properly improvised and placed tourniquet can work just as well as a commercial model.

Evidenced-based medical research has shown that the proper position for the tourniquet is two to three inches above the site of bleeding. It is important to take a few seconds and locate the site of bleeding and then place the tourniquet. You cannot place a tourniquet over a joint, the knee or the elbow. If necessary, move just proximal to the joint and place the tourniquet.

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WMN Editors

MASS CASUALTY INCIDENT (MCI) and Triage

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ISSN-1059-6518

MASS CASUALTY INCIDENT – 2014

Aka Triage – Are you hurt?

By Paul MacMillan, AEMT

Cover photo courtesy Dundar Sahin and AKUT

I have been asked to write an article on triage and Mass Casualty Incidents (MCI). You might ask why are we writing an article on triage and MCI? Given the world we now live in, it is a good time to review these topics. With mass casualty incidents happening more frequently in schools, malls, political gatherings, and on mass transit systems it is important to know how to respond to save lives. Often when we teach these topics it is at the end of the course and we quickly cover them because of time constraints.

There is a wealth of data on these topics. You might recall one of the most famous studies. It focused on the Avianca, Flight 52, plane crash in Cove Neck, New York. It happened on a foggy and windy night on January 25, 1990. A number of volunteer fire and rescue units responded to this incident where 8 out of the 9 crew members of the aircraft were killed and 65 out of 149 passengers were killed. You may recall that during this event there was a huge problem with all the responders’ vehicles and equipment parked on either side of a narrow road which made it impossible for ambulances to get to the scene or turn around. This incident has changed how we now stage resources at MCIs.

Unfortunately, we have a wealth of data on triage and evacuation coming from the Iraqi and Afghanistan war. For example the battlefield injury survival rate for U.S. military personnel in Iraq reached 90%. This was 10 points higher than what was seen in the 1991 Persian Gulf War. Maj. Gen. George W. Weightman, commander of the Army Medical Department’s Center and School at Fort Sam Houston in San Antonio, Texas, cited a number of things that have changed in treating battlefield injuries which have improved survival. These include improved trauma care moments after the injury and a large number of soldiers trained as combat lifesavers.

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WMN Editors

What is a SOAP Note?

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November/December 2011 ISSN-1059-6518 Volume 24 Number 6

 

What is a SOAP Note?

By Frank Hubbell, DO

Illustrations by T.B.R. Walsh

 

When providing patient care you have a lot of information to gather about the patient including; their past medical history, the chief complaint, vital signs, injuries, and treatment plan. As this information is gathered, it has to be organized, recorded, and able to be mobile. (Mobile in that it has to be able to travel with the patient as they move from the location of the crisis, into an ambulance, and delivered to a definitive care setting.)

 

The SOAP Note was developed years ago, and today it is a standardized method for organizing all of the patient’s medical information. For many years the SOAP Note has been recognized as the standard for collecting and recording patient data. As a result, it is universally recognized by pre-hospital as well as hospital-based personnel.

 

Use of the SOAP Note also makes it much easier to communicate, as everyone is using the same template, knows how the information will flow, and where data will be located within the structure of the document.

 

The SOAP note is organized into Subjective, Objective, Assessment, and Plan.

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WMN Editors

Special Issue for the People and Rescuers in Haiti

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The November/December issue of the Wilderness Medicine Newsletter was originally to be an issue dedicated to Celiac disease. However, due to the magnitude of the disaster in Haiti, we felt that the most direct way that we could help was to pull together a number of articles that pertain specifically to disaster management and make those article available to anyone who might be involved in the rescue and recovery efforts in Haiti. Therefore, our regular subscribers will recognize the contents of this issue as a compilation of past articles.

ISSN-1059-6518

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