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March 15, 2010

NC adds tourniquets to EMS treatment protocols

By Jeff Hampton
The Virginian-Pilot

PASQUOTANK COUNTY, N.C — Pasquotank County paramedic Jack Boyce slipped a manufactured tourniquet on his arm, pulled the strap tight and twisted the plastic crank until blood vessels bulged from his wrist.

The demonstration was done in seconds.

Shunned in the past, the mechanical tourniquets proved to be life savers with few side effects after the Sept. 11 attacks and in the Iraq war.

On April 1, Pasquotank and Camden counties will stock ambulances for the first time with the manufactured tourniquets.

Tourniquets will remain a last resort, but life-threatening arterial bleeding from vehicle and aircraft crashes and accidents with farm equipment or chain saws are always possible, said Jerry Newell, director of the Pasquotank-Camden Emergency Medical Service.

"We've got the potential around here," he said. "If you're putting this on somebody, it's life or death. They're bleeding out."

Tourniquets are part of 58 new training and treatment protocols required by North Carolina's Office of Emergency Medical Services to be in place by April 1.

Tourniquet Tips to Remember

By Art Hsieh, EMS1 Editorial Advisor

Civilian EMS often evolves based on research carried out in the military. In this case, experience in Iraq and Afghanistan clearly shows that rapid control of bleeding saves lives, and that the application of tourniquets does not automatically require the amputation of the extremity.

In this article, the EMS systems are putting these two concepts into practice, using equipment designed specifically for the task. In other parts of the country, EMS systems are using a variety of substances to promote rapid clotting in an open wound, such as Quikclot, HemCon and Celox bandages.

Remember the following tips: Direct pressure on the wound will control the vast majority of bleeding. The key is to apply the pressure right on top of the bleeding source, not around it. Pressure points and elevation to stop bleeding have not been shown to be helpful, and may be harmful as the patient continues to bleed profusely while the rescuers struggle to gain control.

These are some of the reasons why the National Registry stopped evaluating these techniques in testing candidates.

In addition, advances in microsurgery and rehabilitation have significantly improved the ability to save the limb, allowing tourniquets to return to practice.

Art Hsieh, MA, NREMT-P, is Chief Executive Officer & Education Director of the San Francisco Paramedic Association, a published author of EMS textbooks and a national presenter on clinical and education subjects.

"We wanted to standardize treatment statewide," said Drexdal Pratt, chief of the agency.

Statewide protocols were put in place in 2000 and have been updated regularly. This is the first time tourniquets were included, Pratt said.

Few complications
New manufactured tourniquets, quick to use and easily controlled, can save lives with few or no complications — such as loss of the limb — especially with typically quick transports to the hospital, Dr. Greg Mears, North Carolina EMS medical director, said in an e-mail.

"There has been better evidence that appropriate tourniquet use is less detrimental to distal tissue than previously thought," Mears said, "especially when used in a more controlled setting with better equipment and better tourniquet pressure control."

Successful treatment of blast injuries after Sept. 11 and in Iraq have promoted the use of tourniquets, he said.

"It is now being taught in these preparedness courses," Mears said.

New tourniquets purchased for local ambulances have a padded U-shaped band that fits over the appendage while a strap cinches around the other side through a clasp. A plastic half-circle can be cranked, tightening the strap until blood flow is stopped. A quick-release button eases tension immediately when needed.

"It takes about 15 seconds," Newell said.

Currituck, Pasquotank and Camden will use also use other treatment upgrades in the protocols, including a continuous positive airway pressure machine, a device that pushes air into the lungs if the patient has quit breathing.

Another new device is the adult intraosseous, or IO, which injects an IV directly into bone marrow and is used only when a blood vessel is inaccessible.

Currituck also plans to use a protocol for aquatic bites, such as putting vinegar on jellyfish stings, typical for counties that border the ocean.

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