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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Simple Rescue Knots


ISSN: 1059-6518

By Paul MacMillan, EMT

Illustrations by T.B.R. Walsh

If you do any research on knots you will find that thousands of knots have been discovered over the years. Many people in different occupations and the trades have favorite knots they use everyday on the job. For example sailors use certain types of knots compared to a weaver or someone who is doing search and rescue work.

If you are the average person you do not use different types of knots all the time. Knot tying is a perishable skill. In other words “if you do not use it you lose it.” On occasions you might need to tie something down or secure something using rope or webbing.

As an average person who does not tie a lot of knots it is important to learn a few basic knots that are easy to remember in case of an emergency. If you learn these few basic knots and you pull out a length of rope from time to time to practice them you will have this skill to use when you need it most.

Basic Rope Information

Remember every rope has a “breaking strength,” which means you put enough tension on the rope it will eventually break. In boating safety they generally consider a safe working load of a rope to be one-fifth of the ropes breaking strength. It is important to note that knots and the age of the rope tend to lower the strength of the rope. Most ropes that you buy in a hardware store have a safe working load of 300 pounds or less.

For example you need to lift injured man using ropes. The man weighs approximately 200 lbs. You have to tie a knot in the rope, and the strength of the knot is rated at 60%. Using this knot it has reduced you safe working load from 300 pounds down to 180 pounds. Now the rope that we are using is now beyond the safe working load to lift this 200 lb. man to safety.

There is very little research out there that clearly defines the strength of different knots. Because there is so little information on knot strength we are going to rely on two professions that use ropes and knot in life and death situations. Emergency services rescue operations and rock climbing. These professions provide us with simple knots that can be used in almost any type of situation.

Basic Terminology for Tying Knots

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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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Interview with Gordon Giesbrecht, PhD



Gordon Giesbrecht, PhD is a professor of thermophysiology and the Director of the Laboratory for Exercise and Environmental Medicine at the University of Manitoba. He has authored over 100 articles on cold physiology. An excellent speaker and educator, considering the number of times he has been intentionally hypothermic, he also has a great sense of humor. He has been known to refer to the Alaskan Panhandle as “ U.S. occupied British Columbia.”


WMN: Was there an event in your personal life, or education, that sparked your interest in what happens to the human body when it begins to cool below our normal core temperature?

GG: Well, in the late 1970’s and early 80’s I was a wilderness instructor in the Rockies. Mountain climbing, rock climbing, white water canoeing, ski touring and stuff like that, and getting cold, or staying warm I should say, becomes very important when you are pursuing those activities. Then when I returned to Winnipeg to do a Masters at the University of Manitoba I found a physician named Gerry Bristow who was willing to provide medical oversight while we actually made people hypothermic. I didn’t think we would be able to do that and when I found out I thought I’d died and gone to heaven.


WMN: Dr. Hamlet has postulated for years that growing up in a cold weather environment changes how a person reacts to getting cold and their attitude about cold weather. In essence, if you grew up where it gets cold you more aware of the real dangers and less likely to be frightened of the cold. Do you share that assessment?

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