Added tourniquet to my thigh pocket

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The tourniquet was abandoned as a first aid tool several decades ago around here. If you need to stop a serious bleed, a pressure bandage is much, much better than a torniquet which will cut off circulation. A torniquet should be a last effort, when all other measures have proved to be ineffective. Like, when someone has lost a limb.

This is no longer the current thinking on tourniquets. Improvement in microvasuclar surgery have completely changed the thinking on tourniquets. We teach tourniquet use in all of our DAN first aid classes now. Take a few minutes to watch this TED talk for more information -
We have added tourniquets to all of our first aid kits and have added these marine grade ones to our field kits - Marine Tourniquets

I have to admit that I didn't think to add one to my thigh pocket while diving, but I am going to now.

Thanks Rooster59!

Jackie,
 
This is no longer the current thinking on tourniquets. Improvement in microvasuclar surgery have completely changed the thinking on tourniquets. We teach tourniquet use in all of our DAN first aid classes now. Take a few minutes to watch this TED talk for more information -
We have added tourniquets to all of our first aid kits and have added these marine grade ones to our field kits - Marine Tourniquets

I have to admit that I didn't think to add one to my thigh pocket while diving, but I am going to now.

Thanks Rooster59!

Jackie,
very good article there are a lot of first aid courses that have abandoned tourniquets in the past ans still have not returned to teaching .years ago a fellow i worked with in a meat plant accidentally cut his arm off just below his elbow .my dad applied a tourniquet with a sleeve from a smock and used a sharpening steel to twist tight .that man still has his arm and function of his hands decades later
 
I'm the OP. My thinking came from previous stories and finally this one-

Man Killed by Shark in Maui ID’d as Recently Retired Optometrist From NorCal

He was missing one leg from the knee down. I'm not a trained medic, so bear with me. Maybe these times are about right to bleed out-

"Femoral Artery: 5-60 minutes. The doctors also noted: “Pretty unusual to see these without compression by EMS)

Popliteal Artery: Located behind the knee, would be similar (but slightly less) to cutting the femoral artery."

So victim gets bit, long does it take to get them on deck or on shore? Are they going to bleed to death in the mean time? Can we get them up in say 10 minutes? My guess is maybe or no. Step one has always been stop the bleeding, Thus my thinking as to using a tourniquet.

Then a question is which tourniquet? I have no idea what is best. I thought an Israeli wrap might work as the long silicone strap wouldn't be bothered by salt water and repeated immersion. Maybe not such a good idea.

https://www.ratchetingbuckles.com/wp-content/uploads/2015/07/EVAL-2012-12-Phase_I-m2-.pdf

Thoughts?
 
Thoughts?
If it's a missing limb, I'd use whatever is available to make a makeshift tourniquet. I'm pretty certain I'd find something suitable. Worst case, I have some 2m of webbing on my backplate.

Anything less, I'd follow my first aid training. And I don't believe that a torniquet would be necessary to handle any of the scenarios I've been trained on; a pressure bandage would probably be sufficient in 99+ % of those scenarios.
 
I don't think divers need to take trauma kits underwater, but if others disagree, I am happy to become rich at their expense. So I now announce a new product, which if there is enough demand I will supply (this is just the idea). Blood pressure cuffs do a great job of occluding blood flow distally. My idea is to make a dry suit with four blood pressure cuffs built in, powered by an inflator hose running from the first stage regulator, and made safe by one way valves and also conservative overpressure exhaust valves, with the whole thing operated by buttons to push to inflate the cuff for a particular extremity. This will be the base model. The deluxe model will have oximeters on a finger or toe for each extremity, tied to a controller that will automatically inflate the proper extremity's cuff when an extremity is bitten off. One plus of this invention is that it gives you a little buoyancy to move you to the surface easily.
 
So the thing is, everyone is right. Sort of. Tourniquets were taught decades ago. Then they did fall out of favor. That was because doing something like garroting a leg or an arm with a shoestring tended to do a lot of damage to the vessels and nerves under the tourniquet, and also when they were left on for a long time the limb would likely be lost. Direct pressure, and to some degree pressure points, because the recommendation. More recently, tourniquets have come back in the context of military combat care. However, that is because it's combat care, and the idea is to keep people in the fight by letting them quickly apply a tourniquet one handed, and then fight on. That's spelled out quite clearly in TCCC guidelines. But those tourniquets are wide enough that they shouldn't do much immediate damage, except for pain. Then, it's usually possible to evac quickly to a medical person who can take the tourniquet off in a reasonable period of time, while maintaining control of bleeding. (Also, all this is being done in conjunction with dressings that have a blood clotting agent.) So, if you're in combat and get a limb blown off, put on a tourniquet. That concept has been spreading to civilian practice, probably quicker that it should, since in most cases direct pressure is still best. And that can mean fingertips pushing hard on a specific spot, rather than just a palm. Most places in the US, a store bought tourniquet probably wouldn't do too much damage before someone in a definitive care setting would be able to get it off. This is sort of akin to how backboards used to be the thing for possible spinal injuries, and now there's serious rethinking about whether that's actually good and necessary; thoughts change on medical care, and TKs are coming back.

I don't know whether this should be necessary diving equipment. Tourniquets have become something of a fad lately, with people buying them up for police officers to wear on their belts, and whatnot. They might occasionally have a use, but won't do much good without practice. Don't use them for every bleed, since most bleeds aren't all that bad, but if it's horrendous, go to it.

Although I don't know much about dealing with shark attacks, as I'm more of a hiker, I do know about avoiding bear attacks. For that purpose, I just carry a jar of bacon grease, find someone camping a ways off, and smear it on their tent. Keeps the bears away from mine. Maybe something similar would work with a dive buddy.

REMEMBER: All bleeding stops eventually.
Interesting that ideas and protocols on tourniquets seem to have changed somewhat over the years (from what I read here). Something like the changes/tweeks you find in CPR courses over a couple of years. I wonder if the Tourniquet people go through 5 year periods of gathering info. from actual cases (done by professionals and amateurs) like the CPR folks do?
 
II wonder if the Tourniquet people go through 5 year periods of gathering info. from actual cases (done by professionals and amateurs) like the CPR folks do?
I don't think so, because the guidelines for CPR are formally published every few years, and the medical industry knows who does that, and it's accompanied by lengthy explanations of the changes, and so forth; it's pretty much as official as anything in medicine gets. But there isn't the same sort of thing for tourniquets. What there is, are US military guidelines that say that for military purposes, slap on a tourniquet and keep fighting, or slap one on someone else and keep fighting. And that's useful because what with body armor and all, extremity injuries have become a leading cause of death in combat. Some people think those guidelines directly translate to civilian use of tourniquets for any kind of scary bleeding, but in my view it doesn't. There are some enthusiastic people who fantasize about being heroes and still want to play army, will only buy equipment that has molle straps, and endlessly dream of glory, and think that the military's TCCC guidelines are the bible for first aid everywhere--next, they'll be wanting underwater chest decompression needles. But I digress, sorry. What has been going on in recent years are civilian Stop the Bleed programs based on military practice, that emphasize tourniquets as something that can be used after all despite their previously having fallen out of favor, but only after direct pressure fails. One thing perhaps making that less of a concern now is the availability of decent commercial tourniquets, as opposed to electrical cords or trouser belts. However, since it's easily possible to go a lifetime in the US without ever seeing a situation where a tourniquet is necessary, but it isn't possible to do that without having lots of opportunities to stop bleeding by direct pressure, I'm not entirely enamored with the idea that people could be misunderstanding the hype and jumping to tourniquets as a first intervention, instead of being used only if direct pressure doesn't work. But perhaps the emphasis on tourniquets in Stop the Bleed programs is like CPR training in a way: what gets taught now for bystander CPR isn't actually techniques for doing the most effective resuscitation. They are simplified techniques designed to get closer to being idiot proof, on the assumption that something is better than nothing, and medical perfection is too much to expect of the average bystander. Hence, the current simplification of CPR. Similarly, what with cell phones everywhere, a tourniquet in a trauma kit on the wall next to an AED probably won't do too much damage before someone can be taken to real care. Hopefully people will grab it for massive bleeding, and not for normal bleeding. What's really a shame is that it seems like the perceived need for Stop the Bleed comes in the wake of 9/11, and various mass shootings, and the need to be prepared for more of the same. Not so fun a world to live in. Of course, having seen boat prop injury, we have our own icky possibilities to deal with anyway. If you're curious about new things in first aid, look at hemostatic dressings.
 
I don't think so, because the guidelines for CPR are formally published every few years, and the medical industry knows who does that, and it's accompanied by lengthy explanations of the changes, and so forth; it's pretty much as official as anything in medicine gets. But there isn't the same sort of thing for tourniquets. What there is, are US military guidelines that say that for military purposes, slap on a tourniquet and keep fighting, or slap one on someone else and keep fighting. And that's useful because what with body armor and all, extremity injuries have become a leading cause of death in combat. Some people think those guidelines directly translate to civilian use of tourniquets for any kind of scary bleeding, but in my view it doesn't. There are some enthusiastic people who fantasize about being heroes and still want to play army, will only buy equipment that has molle straps, and endlessly dream of glory, and think that the military's TCCC guidelines are the bible for first aid everywhere--next, they'll be wanting underwater chest decompression needles. But I digress, sorry. What has been going on in recent years are civilian Stop the Bleed programs based on military practice, that emphasize tourniquets as something that can be used after all despite their previously having fallen out of favor, but only after direct pressure fails. One thing perhaps making that less of a concern now is the availability of decent commercial tourniquets, as opposed to electrical cords or trouser belts. However, since it's easily possible to go a lifetime in the US without ever seeing a situation where a tourniquet is necessary, but it isn't possible to do that without having lots of opportunities to stop bleeding by direct pressure, I'm not entirely enamored with the idea that people could be misunderstanding the hype and jumping to tourniquets as a first intervention, instead of being used only if direct pressure doesn't work. But perhaps the emphasis on tourniquets in Stop the Bleed programs is like CPR training in a way: what gets taught now for bystander CPR isn't actually techniques for doing the most effective resuscitation. They are simplified techniques designed to get closer to being idiot proof, on the assumption that something is better than nothing, and medical perfection is too much to expect of the average bystander. Hence, the current simplification of CPR. Similarly, what with cell phones everywhere, a tourniquet in a trauma kit on the wall next to an AED probably won't do too much damage before someone can be taken to real care. Hopefully people will grab it for massive bleeding, and not for normal bleeding. What's really a shame is that it seems like the perceived need for Stop the Bleed comes in the wake of 9/11, and various mass shootings, and the need to be prepared for more of the same. Not so fun a world to live in. Of course, having seen boat prop injury, we have our own icky possibilities to deal with anyway. If you're curious about new things in first aid, look at hemostatic dressings.
All of that makes sense to me, the CPR lay person. I have surmised in the past that making CPR more "idiot proof" is because many (most) people take CPR (even every 2 years) and don't review any of it in between. But that's just a theory. There used to be something like 15 compressions to 2 rescue breaths except 30:2 for children (or vice versa). But it was changed to the same ratio for both to make it easier to remember (2009?). I thought that if 2 different ways was best it was something even I could remember---with a little review now and again. I doubt that change had much to do with extensive testing and data, but may well be wrong.
 
There is a lot of research on resuscitation, but of course protocols differ between the street and the ER.
 
My workplace has these Stop the Bleed kits on the wall next to the AEDs. They all have tourniquets.

Bleeding Control Station
 
https://www.shearwater.com/products/perdix-ai/

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