Tourniquet advice from a combat medic

[GrandadInTheWoods]

Ok looking for advice, only have said from combat medic because I'm making the assumptions they would be the people with the most experience in sector.

Originally I thought a tourniquet could be left on for around 2 hours before damage Iv recently been told that it's not the case and it's a matter of sacrificing the limb to save the life, a few articles I have read have had mixed info so just wondering if anyone that has had the training and experience to clarify for me the actually time scale ECT

 

[Chris]

Tourniquets can be left on for hours if required, but only under medical supervision (or if essential for saving life) without tissue death. A tourniquet going in is by no means an immediate write-off for the limb involved.

Tourniquets are applied every day at hospitals for routine surgeries which last hours.

In the field if you are applying a tourniquet it is to prevent catastrophic bleeds, and therefore you do it because a dead person won’t thank you for saving their leg.

 

[Van-Wild]

From actual experience: once its on its on.

 

[Decacraft]

A TQ is applied to stop a catastrophic bleed, and if applied correctly due to the lack of blood flow to the limb there is chance of damage being caused. Left on for too long and it could cause compartment syndrome. I would 100% prefer one be applied if needed rather than the alternative being loss of life.

 

[Decacraft]

Ok looking for advice, only have said from combat medic because I'm making the assumptions they would be the people with the most experience in sector.

Originally I thought a tourniquet could be left on for around 2 hours before damage Iv recently been told that it's not the case and it's a matter of sacrificing the limb to save the life, a few articles I have read have had mixed info so just wondering if anyone that has had the training and experience to clarify for me the actually time scale

In a combat situation the ability to extract the casualty to give further care may not be within a timescale to save a limb.

 

[Bishop]

Was on the receiving end of tourniquet for ankle surgery (removal of k-wire fixation), five minute job, local anesthetic, sit up you can watch.. Grab with pair pliers and pull, easy job.

However surgeon who put them in clipped two off flush with the bone so getting them all out took a while and was an hour into it when the doctor said "sod this, hand me a bone chisel". Senior nurse was dropping hints about time & stitching my foot back up, the doc was not having any of it. As for me after 90 minutes was sweating heavily, labored breathing, leg on fire with pins+needles, it was painful and I wanted out. My brain's going gnaw your leg off, beat the doc to death with it and crawl for the door. Valium premed definitely helped as did the large nurse with an iron grip on my shoulders.

 

[Pattree]

Now, well back I used to play the part of casualties in first aid competitions.
Whenever I had a “trapped limb” the first aider was expected to ask how long I had been trapped. If it was longer than - (tries to remember) I think after 20 minutes or more they were not to release me in case of anaphylactic shock. Sometimes I was not to remember how long.

I am well aware that protocols change.
My last update is out of date. I am trained to give mouth to mouth resuscitation after two verses of Nelly the elephant doing chest compressions but I understand that m2m is no longer done at all.

 

[Wildgoose]

The policy, rules and myths of first aid are debated as much as the best bushcraft knife.

Traditional first aid books list a lot of do’s and don’ts and rules. Modern first aid is much more based on what is appropriate in the circumstances.

Mouth to mouth is still part of CPR, but if you don’t want to do it compressions are better than nothing.

 

[Broch]

Ok looking for advice, only have said from combat medic because I'm making the assumptions they would be the people with the most experience in sector.

Originally I thought a tourniquet could be left on for around 2 hours before damage Iv recently been told that it's not the case and it's a matter of sacrificing the limb to save the life, a few articles I have read have had mixed info so just wondering if anyone that has had the training and experience to clarify for me the actually time scale ECT

If you imagine ever having to use a tourniquet, go on a FA course that covers their use such as the FAW +F (forestry extension). You will then also learn how to apply such things as Celox and Israeli bandages as well.

CPR is currently two breaths for 30 compressions but, as said, the compressions are the most important if you're not comfortable with giving breaths.

Now, well back I used to play the part of casualties in first aid competitions.
Whenever I had a “trapped limb” the casualty was expected to ask how long I had been trapped. If it was longer than - (tries to remember) I think after 20 minutes or more they were not to release me in case of anaphylactic shock. Sometimes I was not to remember how long.

I am well aware that protocols change.
My last update is out of date. I am trained to give mouth to mouth resuscitation after two verses of Nelly the elephant but I understand that m2m is no longer done at all.

It's not 'anaphylactic shock' it's called rhabdomyolysis. Good info on it here:

Crush Injury — REAL First Aid

Crush Injury and Crush Syndrome: Rhabdomyolysis, Compartment Syndrome and pre-hospital recognition and treatment.

www.realfirstaid.co.uk

 

[billycoen]

Rescue breaths went out years ago,except in children.Most important thing is to do chest compressions,so that it builds up a blood pressure,therefore circulates the blood.The volume of oxygen required is low enough that the air flow created by chest compressions is enough.

 

[Broch]

Rescue breaths went out years ago,except in children.Most important thing is to do chest compressions,so that it builds up a blood pressure,therefore circulates the blood.The volume of oxygen required is low enough that the air flow created by chest compressions is enough.

Sorry but that just isn't true. All professional first aid courses include 2 breaths for every 30 compressions 'if you are trained and are comfortable to do them'.

However, I agree that compressions are the most important and are better than doing nothing.

 

[TeeDee]

Seems the general theme is that protocols change.

I hope the human body can keep up with the various updates.

 

[forrestdweller]

last year i had to do a first aid course (done by a really great paramedic) which involved applying a tourniquet. we were told that it's important to note exactly when it's put on but no mentioning was made in regards to the Op's question... .
in a recent video on YouTube there was a mentioning of soldiers in Vietnam (during the last Vietnam war) loosing limbs when surgical tubing was used as tourniquet -- if i understood correctly the risk of tissue damage is lower with a wider piece of material used. i'm however no expert on the subject (and hope i won't have to apply on or need one myself)...

 

[Wildgoose]

Seems the general theme is that protocols change.

I hope the human body can keep up with the various updates.

Does feel that way sometimes.

In all seriousness, with a few exceptions first aid taught during WW2 will still save lives today, it’s just the new techniques are more effective.

 

[billycoen]

Sorry but that just isn't true. All professional first aid courses include 2 breaths for every 30 compressions 'if you are trained and are comfortable to do them'.

However, I agree that compressions are the most important and are better than doing nothing.

I'm sorry that you think i'm wrong,but the information is from a front line medical professional,who had been doing the job for twenty years.Before Covid hit,the British Heart Foundation inline with the Resusitation Council put out a video starring Vinnie Jones,that stated the new guidelines of chest compressions only.You should still be able to find this on youtube if you so wish.If you are on your own,then you do compressions only,if you are a trained clinician and you have access to an O.P.A,or an iGel,and you are trained to use them,then you could start thinking about the airway,but an iGel needs two people,as you don't sacrifice chest compressions to work on the airway.Sorry about the long winded reply,but i thought the O.P. should get the best info i could give,without getting too in depth.

 

[Jared]

Chest compressions only for untrained people.
If trained can do 30:2.

Don't believe the advice has changed since 2021? The process for rewritting (EU) CPR guidelines has started and expected in 2025.

 

[Broch]

Yep, I did say 'if you are trained and comfortable doing them'. The reason they dropped them is because people weren't doing CPR because they thought they had to give breaths. Giving breaths improves the chance of recovery.

Not that this has got anything to do with using a tourniquet

 

[Pattree]

…… a tourniquet on the airway is not recommended.

 

[TeeDee]

I'm late to the party - not entirely sure what a "tourniquet" is??

Is it a medieval knights competing festival set in Spain?

 

[Mesquite]

@Dave Budd lost a first place in a blacksmiths forging competition because he failed to make a certain type type of tourniquet out of stainless steel.