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Emergency First Response Updates

Emergency First Response® Tourniquet Use in Emergencies

Since the release of the 2020 ILCOR Guidelines, tourniquet use may be considered as a means of controlling life-threatening bleeding when direct pressure and hemostatic dressings can’t control the bleeding.  

In your EFR®Primary and Secondary Care Instructor Guide, under the heading of Primary Care Skill 6, Serious Bleeding Management, under Critical Steps, after Pressure Bandage, please add two new subheadings:

Commercial Tourniquet 

For life-threatening bleeding that can’t be controlled by direct pressure and dressings, and in a location where you can use a tourniquet (i.e. arm or leg wounds, amputations), apply a commercial (manufactured) tourniquet as soon as possible.
Place the tourniquet around the wounded limb, ideally 5-7 centimetres/2-2.5 inches above the wound but not over a joint.
Tighten the tourniquet until the bleeding slows and stops, though some minor oozing is acceptable. This tightening will be painful, so it may help to warn the patient and explain why you have to do it.
Maintain the tourniquet pressure.
Note the time that the tourniquet was applied by writing it on the tourniquet or the patient.
Once applied, do not remove the tourniquet – the tourniquet must only be removed by a healthcare professional.
Monitor for shock and continue to use the Cycle of Care to monitor the patient’s medical status.
Some cases may require two tourniquets in parallel to slow or stop the bleeding. If necessary, apply the second tourniquet directly above the first. 

Improvised Tourniquet 

If a commercial tourniquet is not immediately available or it doesn’t control bleeding alone, reapply direct manual pressure with a gloved hand and a sterile dressing. If sterile dressing is not available, use standard gauze, a t-shirt or other fabric as available.
Use of an improvised tourniquet only for life-threatening bleeding that isn’t controlled by direct pressure and in situations where a manufactured tourniquet is not available. 
To apply an improvised tourniquet, take a triangular bandage and roll to a width of 7-10 centimetres/3-4 inches. If no triangular bandage is available, a piece of clothing such as a necktie, bandana or other similar cloth item can be tied around the limb. It must be strong enough to be wound tightly. Note: Use of a belt is not suitable.
Wrap the triangular bandage (or other item) around the limb, about 5 centimetres/2-2.5 inches above the wound site and tie a square knot over the top of the limb.
Locate a suitable and sturdy windlass – hard wood stick, a pen flash light, carabiner, spoon, a pair of shears, a wrench or similar – and place on top of the knot. Beware of objects like pencils and pens because they can snap. 
Tie another square knot on top of the windlass to secure it in place.
Turn windlass so a large knot forms directly under it on the limb.
Tighten until bleeding is controlled, then secure by tying the loose knot tails over windlass.

For more information on the use of tourniquets, please refer to the Pros’ Blog article Techniques for Controlling Catastrophic Bleeding.

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