'Cult’ of tourniquets causing thousands of unnecessary amputations and deaths in Ukraine, say surgeons

[RyanT26]

I have not, prayers sent!

Have you hunted a western Oregon General elk tag? Opening morning it's like Verdun out here.

 

[Blurry1]

Good article. I have always argued strongly that when it comes to pre hospital emergency medicine knowledge and a cool head is better than the biggest med bag. The reality is that in a true wilderness emergency, such as a major trauma, you will never have enough so knowing what can be improvised or substituted is essential. I never carry a tourniquet per se but at any given time I probably have at least 3 options to make one. Not as clean or fast but still works. For my money and the weight I’m carrying I would bring something that I can’t improvise like a hemostatic dressing. Good middle option that decreases the risk of tissue damage and is helpful on non compressible sites.

 

[Blowdowner]

The whole purpose of the war is to get tough men out of the way the real so the estate/money printing class can do whatever they want. I also bet the belt and road initiative will go through there now. So the tourniquets are working perfectly.

 

[7mm-08]

This is good information. Thanks for sharing the article.

 

[Silver Wings]

I worked for a very busy, big city fire department for 35 years. Ran 1000s of trauma calls with 100s of GSWs in the mix. Saw less than 10 tourniquets applied. This current emphasis on them is laughable.

 

[mtnbound]

It's well accepted that death from significant blood loss can occur in about 2-5 minutes, depending on the severity and location of trauma. The average heart at rest pumps 5 liters of blood per minute. We have 5-6 liters of blood in our system; the loss of 30-40 % of it leads to hypovolaemic shock. While the body performs some remarkable actions to help control bleeding, once our plumbing system springs a major leak, a clock is started, and one must stop the leak before one becomes unconscious and dies.

The biggest issue I see is that even a small leak in our plumbing can create a significant mess and often appears worse than it actually is. However, the knowledge and skills to determine that are not what people want to spend their time on. They instead want to carry their TQ like a merit badge for everyone to see, so that they are perceived as that person, when in most cases, they are not that person. Or in the case of this article, its combat with limited leadership, poor training, and prolonged access to higher medical care..

TQs do save lives and have a place, but they are simply a tool that needs to be used correctly.

 

[JohnJohnson]

Semi-related, people put tourniquets on venomous snake bites and it's monumentally stupid. Doctors tell people not to.

 

[ThorM465]

It's well accepted that death from significant blood loss can occur in about 2-5 minutes, depending on the severity and location of trauma. The average heart at rest pumps 5 liters of blood per minute. We have 5-6 liters of blood in our system; the loss of 30-40 % of it leads to hypovolaemic shock. While the body performs some remarkable actions to help control bleeding, once our plumbing system springs a major leak, a clock is started, and one must stop the leak before one becomes unconscious and dies.

The biggest issue I see is that even a small leak in our plumbing can create a significant mess and often appears worse than it actually is. However, the knowledge and skills to determine that are not what people want to spend their time on. They instead want to carry their TQ like a merit badge for everyone to see, so that they are perceived as that person, when in most cases, they are not that person. Or in the case of this article, its combat with limited leadership, poor training, and prolonged access to higher medical care..

TQs do save lives and have a place, but they are simply a tool that needs to be used correctly.

That's incorrect. You can bleed out from a arterial bleed within seconds. In Combat Life Savers course (USMC Combat Triage for non-medics) we're taught to stop the bleed, then start the breathing.

That being said we're unlikely to suffer a wound that we would bleed out from while hunting, but it's not impossible. It's not a bad practice to apply a tourniquet when in doubt, but it absolutely should not be the only tool in your tool belt.

FWIW, this is what my hunting pack IFAK (<9ozs) consists of:
Tourniquet - North American Rescue
Israeli Pressure Dressing
Zip Sutures Butterfly Bandait Kit
Super Glue
Sanitizer - Purell
Mole Skin - KT Tape
Nitrile Gloves
Advil
AMB Powder
Extra Chapstick

I keep extras with Lotramine Ultra and Betadine Antiseptic Dry Power in my Truck.

 

[24valve]

In the US, for hunters and recreationists, while I'm sure there are instances where it would be impossible to have rescue/trained medical care within 12 - 24 hours, it would be interesting to see what the stats would be for time to medical care in SAR situations.

Teton County SAR is the busiest in WY and publishes biannual report of their missions, with durations: https://www.tetoncountysar.org/rescue-reports

However, it should be noted that they are on the faster side of teams in the state due to the geography of the area and the fact that they have their own helicopter.

The mission duration is also likely measured as the time from SAR activation to mission completion, so keep in mind the time necessary to call for help in the first place.

 

[yfarm]

“That's incorrect. You can bleed out from a arterial bleed within seconds.”
Only arterial vessel I know of that meets that criteria is the aorta and if thats lacerated you may be toast and no way a tourniquet is useful. Common femoral lacerations will give you more time and again are not accessible to a tourniquet, same with axillary. Don’t think you want a tourniquet on both common carotids. All others have much lower flow rates. Using for peripheral venous bleeds, would like to see the data on that indication.

https://www.sciencedirect.com/science/article/pii/S2589845021000257

Some nice pictures, again making the point tks are for arterial injuries, ie pulsatile flow.
Knew an ortho guy doing a lumbar diskectomy took a bite out of the back wall of the aorta with a bone rongeur, pretty exciting, happened to be a general surgeon nearby, flipped the patient opened the belly and sutured the hole shut. Patient survived asked why he had stitches in the front.

From a case report of the same injury in another patient, on the sagittal ct recon you can see the dye blowing out the back wall of the aorta. This patient was operated on 10 hrs after the injury and survived without other complications.

 

[RockAndSage]

The biggest issue I see is that even a small leak in our plumbing can create a significant mess and often appears worse than it actually is. However, the knowledge and skills to determine that are not what people want to spend their time on.

Completely agree. Would like to see recognition and bleed assessment as a more fundamental part of TQ training. Especially if the consequences of mistakes are understood to possibly, literally, be death or dismemberment. There's a big difference in what you see in the bleed of a tiny arterial puncture vs a severed artery, vs the mess of blood from a big muscle gash or even non-lethal gunshot wound. Even just an hour or two of training on that in a TQ portion of a class could reap big rewards, especially if done with real-world footage.

They instead want to carry their TQ like a merit badge for everyone to see, so that they are perceived as that person, when in most cases, they are not that person.

Absolutely nailed it.

Or in the case of this article, its combat with limited leadership, poor training, and prolonged access to higher medical care..

One of the big takeaways for me with the article, is that the US experience has simply masked our own poor training - allowing us to get away with mistakes that are killing and amputating people with less support structure to rely on. Same exact application of TQs, different, less-forgiving circumstances. Given how remote some of us hunt or even live (I'm personally an hour from a hospital by ground, and I live fairly 'close to town'), that's part of why I shared the article.

 

[RockAndSage]

“That's incorrect. You can bleed out from a arterial bleed within seconds.”
Only arterial vessel I know of that meets that criteria is the aorta and if thats lacerated you may be toast and no way a tourniquet is useful.

Great points. And as you pointed out, even aortal bleeds aren't insta-death. Many years ago I personally dealt with a dude who had a pinprick leak in his aorta - abdominal area slowly kept growing until he looked pregnant, but after the bleed was recognized he was taken care of and survived. The bigger issue with him in the moment was lack of O2, not blood.

 

[ThorM465]

Great points. And as you pointed out, even aortal bleeds aren't insta-death. Many years ago I personally dealt with a dude who had a pinprick leak in his aorta - abdominal area slowly kept growing until he looked pregnant, but after the bleed was recognized he was taken care of and survived. The bigger issue with him in the moment was lack of O2, not blood.

Almost 20 years of combat triage in GWOT taught us that your assertion that the lack of O2 was more critical is almost certainly incorrect.

 

[RockAndSage]

Almost 20 years of combat triage in GWOT taught us that your assertion that the lack of O2 was more critical is almost certainly incorrect.

The paramedic and attending ER physician disagreed with your assertion. The fluid in his abdomen was impinging on his lungs, and he was one of the most cyanotic patients I've ever seen. His body had no problem keeping up with the blood loss though.

 

[ThorM465]

The paramedic and attending ER physician disagreed with your assertion. The fluid in his abdomen was impinging on his lungs, and he was one of the most cyanotic patients I've ever seen. His body had no problem keeping up with the blood loss though.

He was losing so much blood into his abdomen that he ballooned up like he was pregnant and his body was keeping up with that? What am I missing?

 

[yfarm]

Had the good fortune to learn from a hematologist who at one time was the leading authority on iron metabolism, developed a bleeding gastric ulcer, was advised to have a transfusion, elected to go home and take iron to rebuild his red cell mass, died from a myocardial infarction at home secondary to hypoxia from inadequate oxygen carrying capacity of his remaining red blood cells. O2 carrying capacity is the basic issue with blood loss when volume is replaced without blood.

 

[RockAndSage]

He was losing so much blood into his abdomen that he ballooned up like he was pregnant and his body was keeping up with that? What am I missing?

Time. It wasn't battlefield conditions. Happened over the course of 1-2 weeks, after the artery was nicked in some type of abdominal surgery. Apologies if that wasn't clear. "In the moment" wasn't at the time of the injury, it was EMS and E-room. My point in sharing the story was that not all arterial bleeds are insta-death.

 

[yfarm]

He was losing so much blood into his abdomen that he ballooned up like he was pregnant and his body was keeping up with that? What am I missing?

Look at that CT of the abdomen, there is a huge retroperitoneal hematoma on the left, more than half his blood volume is sitting there unused for carrying oxygen, he survived after having half or more of his blood volume gone because his pO2 was kept at normal levels with volume replacement and supplemental oxygen.

 

[fwafwow]

Posting for general consideration, especially for those who may find themselves in remote places beyond the 2-

And seriously - if you carry a TQ, have actual TQ training, or especially if you provide emergency medical training, please read thoroughly and consider before commenting.

Thanks for this post. More info is always helpful. I agree on the training.

I worked for a very busy, big city fire department for 35 years. Ran 1000s of trauma calls with 100s of GSWs in the mix. Saw less than 10 tourniquets applied. This current emphasis on them is laughable.

I get the point. For me, however, my calculus is comparable to other EDC items. I’m unlikely to need lots of things I tend to carry (a flashlight during the day, a gun at the local grocer, a knife, etc.), but I carry them. The low chance of needing a TQ isn’t much different for me. And the downside of needing a TQ and not having one is much worse than the inconvenience of not having a knife or flashlight. (What I carry always varies by location and activity.)

They instead want to carry their TQ like a merit badge for everyone to see, so that they are perceived as that person, when in most cases, they are not that person. Or in the case of this article, its combat with limited leadership, poor training, and prolonged access to higher medical care.

I also understand the tacticool/look at me consideration, which I could see applying to people who carry openly in low risk situations. I do admit, however, that I tell my friends that I sometimes carry a TQ or other less intense methods of bleed control. Most are completely oblivious to how to control bleeding and don’t even know about pressure, much less other steps. I’d like more of my friends to know the basics, and mentioning a TW often gets the conversation started.

 

[Silver Wings]

I get the point. For me, however, my calculus is comparable to other EDC items. I’m unlikely to need lots of things I tend to carry (a flashlight during the day, a gun at the local grocer, a knife, etc.), but I carry them. The low chance of needing a TQ isn’t much different for me. And the downside of needing a TQ and not having one is much worse than the inconvenience of not having a knife or flashlight. (What I carry always varies by location and activity.)

I’m not against carrying a TQ. My kid gave me a nice one of these ready made TQs they make now and I threw it in my pack. Even though they are incredibly easy to improvise in just about any situation, the weight penalty for the one I was given is next to nothing.
I was referring to the completely unnecessary application of TQs we see in video after video.