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davtruss t1_j9e6fjp wrote

I'm so impressed with the comments so far from surgeons and folks who know what they are talking about, I would like to extend the inquiry. When an average citizen or family member comes upon somebody with a profound limb injury, say a teenage girl with a major shark bite below the knee, or a gunshot wound to the lower arm, would it be correct (after calling for help etcetera) to immediately apply a tourniquet of some sort as a life saving measure? As opposed to attempting to apply pressure for instance? I'm just wondering what average people should consider in the absence of immediate first responder care.

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911derbread t1_j9ehn7b wrote

This is a great question! The short, unhelpful answer is do whatever you have to to stop the bleeding. It really depends on the injury as to whether pressure would be a good start. If it's bleeding a lot, put a tourniquet on it, we'll figure it out in the ED. And check out the Stop the Bleed campaign, ask your boss to host a class!

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pauvre10m t1_j9jivxm wrote

As I was instructed when I had received first aid courses, you should first try to use pressure. If it's not enough to stop the bleading you should consider using a tourniquet.

Please note also the time where the tourniquet where put in place, it's importent for doctors. also please note that she tourniquet should only be removed by a doctor ;).

In any case, the tourniquet should be the last attempt

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smellygooch18 t1_j9hftsk wrote

Would a Good Samaritan law apply in this situation if you try to help someone and they end up dying?

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911derbread t1_j9htfdo wrote

Generally, yes! There's really not a lot you can do to someone even as a layman that's really going to hurt them if you're trying to help, with maybe the exception of moving someone with a broken neck. It gets fuzzier for us doctors who might try to save someone with a procedure in the field that goes wrong, like a cricothyrotomy or c-section.

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pauvre10m t1_j9nupzo wrote

Hum, I don't know the US law, but in my country the same kind of law is applyable.

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BeneficialWarrant t1_j9e6uto wrote

Its debatable whether an untrained person could help more than harm by applying a tourniquet. Some sources say yes, some say no. If you are familiar with how it works and there is uncontrollable bleeding from an appendage, then yes, wind that sucker down tight.

Edit is to reflect more up-to-date instruction. You can see discussion in below comments for context.

Tourniquet use is appropriate for a bleed from a limb which cannot be controlled by direct pressure alone. Without training or instruction, an improvised tourniquet applied by a layperson isn't likely to be effective. Fortunately, proper tourniquet use can be learned in only a few minutes and an emergency services dispatcher can instruct you on tourniquet use if you find yourself in a situation where it is necessary and you don't know how to do it. If in doubt and the patient is conscious, it may be a good idea to first attempt to control bleeding with direct pressure alone. Note that direct pressure is not appropriate if there are significant amounts of sharp, foreign bodies within the wound which may make the injury worse than it already is. In that case, elevation, manual arterial compression, and tourniquet use as needed will be the appropriate first-aid.

Tourniquet or not, you can help by finding a clean and dry cloth, garment, towel, applying firm pressure, and don't remove the cloth. If it bleeds through, put another cloth on top and keep the pressure on! You can also apply pressure to the artery above the bleed. Groin for the leg and under the biceps for the arm.

Don't remove any foreign object that may be sticking out of the person, don't put yourself in danger that might cause a second casualty, and don't move a patient who may have suffered a spinal trauma unless absolutely necessary.

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RuhrowSpaghettio t1_j9gg01s wrote

It’s really not debatable. If someone is hemorrhaging, they will die of blood loss. Anyone who can do anything to help stem that blood loss is saving their life, no debate.

Plus, tbh, the risks of tourniquets are greatly over-stated in both popular culture and even in the medical world. All of the time limits people discuss for tourniquets are essentially made up theoretical limits without much data to back them up.

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I_am_Jo_Pitt t1_j9gzapz wrote

Stopping blood loss is so critical that even the military changed from the ABC's of first aid (airway, breathing, circulation) to MARCH (Major hemmorage, airway, respiration, circulation, hypothermia). No one survives massive blood loss.

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LogicJunkie2000 t1_j9hlrue wrote

I vaguely remember the aid training shifting in the late oughts from a kinda checklist/hierarchy of things to do before applying a tourniquet into something close to "when in doubt if they might need a tourniquet, put a tourniquet on it."

Aside from the reasons you gave, I think it probably came down to the fact that there was an expectation that you would be getting treated by an expert in a hospital or purpose-fitted vehicle within an hour (whenever life/limb/eyesight was in jeopardy)

I have a lot of mixed feelings about my country and my service, but am still very impressed/proud of the extreme lengths the medical corps and supporting units went through to make MEDEVACs and treatment such a priority.

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BeneficialWarrant t1_j9uwe3q wrote

OK, prior caveat: This will be a long post and will not directly cite publications for every claim

So first off, I'll say that my advice on the topic is informed by (but not infringing on any intellectual property) my time working as a 911 dispatcher using data-informed protocols for prehospital treatment by laypeople (created by a Salt Lake City-based organization that is generally recognized as the standard for these protocols, and which sells them to most public-safety emergency answering centers.) [Bohm and Kurland, 2018] While this raises doubts about its accuracy, it establishes its uniquity] I understand that instructions for tourniquet use by non-healthcare personnel is changing as newer data shows that, as you said, improperly applied tourniquets are not as harmful as once believed and that laypeople can apply tourniquets effectively and quickly with proper instruction. [Scott, et. al. 2020] I believe that the previously mentioned company may have altered their product to reflect this, but I've been out of that gig for a few years now.

That said, the reason why (at the time) laypeople were generally not advised to apply tourniquets in the absence of unambiguously lethal, uncontrollable hemorrhage was not that a poorly applied tourniquet could worsen the outcome for a person with an otherwise lethal hemorrhage. Instead, it was to discourage the use of tourniquets when not necessary, as it was believed that a layperson may not be able to make this distinction and thus use them excessively. The vast majority of prehospital appendicular bleeds probably do not require tourniquet use (anecdotal, but it was probably close to 1 in 100 during my time answering phones). This is probably due to the low threshold some people have for requesting emergency medical transport. For a layperson who may have trouble telling the difference, attempting to control bleeding by direct pressure first is often a good idea in the absence of unquestionably uncontrollable, arterial (or massive venous/tissue capillary bed) hemorrhage.

TLDR: Until recently, tourniquet use by untrained laypeople was generally discouraged, but things have changed within the past few years.

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RuhrowSpaghettio t1_j9ve58w wrote

This is true, but the amount of damage done by tourniquets is overstated, whereas the damage done by uncontrolled hemorrhage is…death.

Let’s say that, as you posited, only one of every hundred wounds needs a tourniquet to prevent death. If the perception is that tourniquets cause minor injury every time they’re used and permanent damage one time in 10, then you’ve hurt 99 people and caused permanent damage to 10 for every life saved with a torniquet.

Now let’s do the math if, say, you see minor injury one time in 10 and permanent damage once in 1000 applications. All of a sudden, you’re only causing 10 people minor harm for each life saved. Completely different math.

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Mneurosci t1_j9ewq3c wrote

If direct pressure is working, continue that. If it is still bleeding, then Tourniquet.

Also, for reference, any arm injury below the elbow should be able to be controlled with direct pressure.

  • source general surgery resident
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RuhrowSpaghettio t1_j9gznco wrote

Controlled, sure, but at some point you’ve got to be able to take your hands off and MOVE the person. Tourniquets are great for that, as are some pressure bandages but making a good one of those is a more advanced skill for the lay person

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_mizzar t1_j9ivhbc wrote

Isn’t a tourniquet more likely to cause a need for amputation? Maybe the idea is to avoid that if pressure is working?

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RuhrowSpaghettio t1_j9ivstu wrote

That’s the…presumed risk of tourniquets, but again, the data just isn’t there to show that much of a risk.

If you are just sitting there waiting for EMS, by all means continue holding pressure.

But if you need your hands for something else (like calling EMS) or you need to move, or you have multiple people you’re trying to help, or any other reason why sitting there with your hands ON the wound applying pressure isn’t sustainable…sure, apply the tourniquet.

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EnchantedCatto OP t1_j9e6k3e wrote

unless you are first aid trained i reckon follow the advice of the medical professionals that guide you through it after you call 111

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Urutengangana t1_j9elxcl wrote

If you don't stop arterial bleeding until after you've gotten through to the emergency service, then the person will bleed out 10-20 times.

Ps: You can realistically only bleed out 1 time....

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