The Firing Line Forums - View Single Post - Shooter puts a Round Through His Foot... What do you do NEXT?

insomni · July 12, 2012, 08:30 PM

hehehe, I love the arguments on this site, great brain candy.

cedar, you are correct, the tourniquet in combat is still the army standard for massive hemorrhage, arterial bleed, or amputation (2012 TC3 and CLS). You are also correct, if it's at least 1", it can be in place for a matter of hours before the chance of limb loss or dysfunction significantly increases (though there's still a chance). That considers that a combat casualty will get to a CASH where they treat almost nothing but combat trauma, and are VERY well versed at tourniquet conversion and removal, and they've been getting returns from tourniquets that 10 years ago were pretty much guaranteed to be amputations.

here's my BUT:
According to AAOS Orange Book 10th Ed. (2011) though, NREMT standards still recommend Pressure dressing, then tourniquet for the civilian side (considering there isn't any massive arterial bleed or amputation). Combat medicine allows and expects you to take more risky, drastic measures, and do them quickly because you are providing life saving care for high energy penetrating wounds, but you are also either under fire, or there is a very real possibility of a follow-on attack (There is ALWAYS a very real possibility of a follow on attack), and you need to dee-dee-mao. EMT is immediate, lifesaving care that must be done rapidly, but is done in an environment without the risk of a follow on attack, or treating under fire. You have more time to try to stop the bleeding before getting drastic. You also don't know what kind of emergency room this guy is going to. It's not going to be a CASH. How many gunshots do they see? is it an Emergency room that deals with a hunter here and there in the fall and winter, or is it a Stage I trauma center in a major city? How many tourniquets do they deal with? Yes, trauma is trauma, and surgeons are very capable people, it's just some are more practiced at certain aspects than others, and you always want to try to create as few additional issues for them as possible.

To get back onto where this topic has migrated to: Orange Book also says don't speed because it increases the risk of a wreck, and ambulance studies show it doesn't help when going through anyway.... I still don't think I believe that..... Where I will back their argument is that a pickup truck doing 90 is way more likely to be pulled over by a cop than an ambulance doing 90 with the lights on, and then you have to explain to the cop why there's a gunshot victim in your truck, where you're going etc etc, and that wastes precious time.

again, this is one of the more stimulating threads I've found on here, thanks for the debate guys. Definitely got me thinking about some things I've admittedly ventured into a mental safe zone on.

July 12, 2012, 08:30 PM	#51
insomni Senior Member Join Date: September 28, 2011 Posts: 342	hehehe, I love the arguments on this site, great brain candy. cedar, you are correct, the tourniquet in combat is still the army standard for massive hemorrhage, arterial bleed, or amputation (2012 TC3 and CLS). You are also correct, if it's at least 1", it can be in place for a matter of hours before the chance of limb loss or dysfunction significantly increases (though there's still a chance). That considers that a combat casualty will get to a CASH where they treat almost nothing but combat trauma, and are VERY well versed at tourniquet conversion and removal, and they've been getting returns from tourniquets that 10 years ago were pretty much guaranteed to be amputations. here's my BUT: According to AAOS Orange Book 10th Ed. (2011) though, NREMT standards still recommend Pressure dressing, then tourniquet for the civilian side (considering there isn't any massive arterial bleed or amputation). Combat medicine allows and expects you to take more risky, drastic measures, and do them quickly because you are providing life saving care for high energy penetrating wounds, but you are also either under fire, or there is a very real possibility of a follow-on attack (There is ALWAYS a very real possibility of a follow on attack), and you need to dee-dee-mao. EMT is immediate, lifesaving care that must be done rapidly, but is done in an environment without the risk of a follow on attack, or treating under fire. You have more time to try to stop the bleeding before getting drastic. You also don't know what kind of emergency room this guy is going to. It's not going to be a CASH. How many gunshots do they see? is it an Emergency room that deals with a hunter here and there in the fall and winter, or is it a Stage I trauma center in a major city? How many tourniquets do they deal with? Yes, trauma is trauma, and surgeons are very capable people, it's just some are more practiced at certain aspects than others, and you always want to try to create as few additional issues for them as possible. To get back onto where this topic has migrated to: Orange Book also says don't speed because it increases the risk of a wreck, and ambulance studies show it doesn't help when going through anyway.... I still don't think I believe that..... Where I will back their argument is that a pickup truck doing 90 is way more likely to be pulled over by a cop than an ambulance doing 90 with the lights on, and then you have to explain to the cop why there's a gunshot victim in your truck, where you're going etc etc, and that wastes precious time. again, this is one of the more stimulating threads I've found on here, thanks for the debate guys. Definitely got me thinking about some things I've admittedly ventured into a mental safe zone on.