Proper Use of Tourniquets – 2018


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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Critical Care Checklist


Volume 26 Number 1

Critical Care Check List

 By Frank Hubbell, DO

The Big Idea is that, occasionally, significant life-threatening injuries do occur, and when they do, we have to be able to quickly react to them. The last time that we did a review article on these life-saving skills was in 2007.


The life-saving, critical care skills are not used nearly as often as the more common non-critical care skills. The vast majority of the time our patients are conscious, coherent, and can tell us exactly what happened, when it happened, and where it hurts. They usually have only one primary injury, and it is rarely life-threatening.


Because of this, our critical care skills tend to get a little dusty. It is well worth it to every once and a while to take the time to blow off the dust and polished these skills.


What follows is a concise, step-by-step review list to help practice and remember these life-saving skills, so they will come to mind when they are needed. For life-saving skills to be effective, the life-threat has to be recognized quickly and dealt with effectively. Time is of the essence, but it is also equally important not to miss anything.


To make this task as efficient and accurate as possible, it is best to use a step-by-step list, trying to avoid any detours that will only result in confusion and the possibility of missing a critical step and diagnosis.


These are the Principles of Rapid Critical Care Evaluation for Detecting and Managing Life-Threats:

Change in Level Of Consciousness – CVA, diabetes

Shortness of Breath – asthma, chocking, anaphylaxis, pneumothorax

Chest Pain – acute coronary syndrome

Shock – hypovolemic, neurogenic, cardiogenic, obstructive


(aka the primary survey)

This rapid action sequence proceeds once the SCENE IS SAFE.

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Special Issue for the People and Rescuers in Haiti

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.


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Reducing a Dislocated Patella

September/October 2004  ISSN-1059-6518  Volume 17 Number 5


By Frank Hubbell, DO

A relatively common sports injury, a dislocated patella typically occurs when a force is applied to the medial side of the patella forcing it laterally out of the femoral groove in which it rides. The groove, produced by the femoral condyles of the patella, is held in place inferiorly by the patella tendon and supported on the sides by the medial and lateral patella femoral ligaments.

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