Wednesday, April 16, 2014

Tourniquets: The Class Every CERT Wants to Take (But No CERT Wants to Use)

Based on the near-instant sellout for Fairfax County CERT's first-ever "tourniquet class," (officially known as "First Aid for Hostile Mass Casualty Incidents and Improved Splinting Skills") you might get the mistaken impression that huge numbers of people in the US are dying due to the lack of tourniquet training.

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A selection of commercially available tourniquets demonstrated during the class. Image by Flickr user joelogon. All images used under Creative Commons.
Fortunately, the truth is not quite so dire, and the need for tourniquets in the US is still pretty rare. (For example, a 5.5-year-study of Houston trauma centers found that, out of over 75,000 eligible cases, only 8 might have benefited from the use of a tourniquet.)

However, CERTs thrive on being prepared for low-probability, high-impact events of all kinds. And, with active shooter incidents and the one-year anniversary of the Boston Marathon bombing fresh in our minds, Fairfax County CERT instructors Rich Hall and Brian Talbot taught CERT students about the use of tourniquets, pressure dressings, occlusive dressings, and improved splinting techniques for both hostile and non-hostile environments.
 
A Hostile Environment Forces a Change in Treatment
A critical thing for CERTs to remember is that a hostile mass casualty incident (MCI) requires a very different response than non-hostile ones.

If there's a present threat, like an active shooter on the move or a bombing scene where secondary devices may be suspected, the goal of CERTs should be to keep themselves safe, while using the resources on hand to do two things for themselves and others:
  1. Stop major blood loss
  2. Treat open chest wounds
That's it. Unlike other scenarios CERTs train for, there is no triage, tagging, or treatment.

Applying Tourniquets
In a hostile environment (think "pinned down by an active shooter"), when faced with an obvious, actively spurting arterial wound to a limb, instructors Rich and Brian recommended immediately applying a tourniquet, instead of trying to first use a pressure dressing.

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Instructors Rich Hall and Brian Talbot demonstrate the use of a MAT tourniquet. Image by Flickr user joelogon.
They demonstrated the use of commercially available tourniquets, as well as improvised tourniquets made from materials likely to be on hand: belts, t-shirts, long sleeves torn off of shirts, etc.

When improvising a tourniquet, they advised that using wider materials is better, though if the alternative is letting someone bleed out to death, a shoelace is better than nothing.

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CERTs check for pulse after an improvised duct tape tourniquet is applied. Note that current EMT protocols usually call for tourniquets placed close to the wound site, while military practice is to apply tourniquets as high on the limb as possible. Image by Flickr user joelogon.
Students learned how to apply a tourniquet, and how to check that the pulse was stopped in the affected limb (to ensure that the tourniquet has stopped both arterial and venous blood flows, preventing a complication known as compartment syndrome).

CERTs were also taught how to apply a second tourniquet if blood flow wasn't completely halted, to mark a patient with the time the tourniquet was applied, and to never take off a tourniquet once applied.

Pressure Dressings
Instructors also demonstrated the use of pressure dressings to control less serious bleeding, using both a trauma bandage (popularly known as an "Israeli bandage"), as well as one improvised using gauze pads and rolls.

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Chris Thiel, Fairfax County CERT Class 74, acts as victim while Randy Weidman, Class 80, applies an Israeli-style trauma bandage, under the guidance of Instructor Brian Talbot. Image by Flickr user joelogon.

Occlusive Dressings
Penetrating chest injuries (like from gunshots, shrapnel, or stab wounds) can allow air into the cavity that surrounds the lungs, causing life-threatening breathing impairment.

To prevent this, Rich demonstrated how to cover a chest wound with a piece of plastic wrap (or similar impermeable material), sealing with tape on three sides to create a one-way valve. (He also reminded CERTs to check the back for an exit wound, which should be sealed on all four sides.)

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Rich demonstrates an occlusive dressing on a CPR dummy. Image by Flickr user joelogon.

Improving Your Splinting Technique
CERTs also learned improved techniques for a skill they'll be far more likely to use: Applying splints. CERTs learned how to use a second rescuer to stabilize the limb while applying the splint, and were reminded on best practices including:
  • Securing the splint by wrapping the limb above and below the point of injury
  • Immobilizing the joints above and below the injury using slings and swathes
  • Checking the limb before and after the splint is applied for PMS: Pulse, Movement, Sensation
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Instructor Rich Hall checks the secureness of the splint and sling on CERT James Weikert, as CERT Volunteer Lead Missy Tuttle-Ferrio assists. Image by Flickr user joelogon.

Summary
Hopefully, CERTs will never be in a position where they'll need to apply a tourniquet, though should the need arise, they'll be much more prepared.
The class is very hands-on and covers much more information not included in this blog post -- I highly recommend taking it.

Also, remember that tourniquets are not recommended for general civilian use, and please don't attempt to apply a tourniquet without proper training.

The next sessions for First Aid for Hostile Mass Casualty Incidents and Improved Splinting Skills (CERT-MCI-1) are scheduled for May 5 (class full) and June 9 (register now at FairfaxCERT.com).

Keep reading the weekly Fairfax County CERT emails for announcements for upcoming classes, for this class and other great offerings.



Did you attend the class and have any impressions to share? Or are you planning on taking this course in the future? Please leave a comment below.

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