TRAINING BULLETIN #147

Transcription

1 TRAINING BULLETIN #147 COMBAT APPLICATION TOURNIQUET (C-A-T) I. Introduction The Combat Application Tourniquet (C-A-T) is a small, lightweight one-handed tourniquet that completely occludes arterial blood flow in an extremity. The C-A-T is an approved device that may be used by LAFD members in situations where a tourniquet is indicated. The C-A-T is currently being used by soldiers in the U.S. Army with documented effective results. Other agencies that carry this tourniquet include LAPD Metro, LACoFD, and the FBI. II. Features The C-A-T uses a Self-Adhering Band and a Friction Adaptor Buckle to fit a wide range of extremities combined with a one-handed windlass system. The windlass uses a free moving internal band to provide circumferential pressure to an extremity. Using only one hand, the windlass is locked in place with the Windlass Clip. In addition, the Hook-and-Loop Windlass Strap is used to further

2 secure the windlass. The C-A-T comes in three colors: Orange - EMS I Fire Black- Law Enforcement I Military Blue- For Training Purposes Only

3 III. Indications for Use According to the Los Angeles County EMS Agency, tourniquets are approved for use by EMTs and Paramedics when direct pressure with elevation has failed to control external hemorrhage from an extremity. Tourniquets may be used early on if the rescuer determines that the bleeding cannot be controlled with other measures. If bleeding is uncontrolled with one tourniquet, then a second tourniquet may be applied proximal to the first tourniquet. In this scenario, do not remove the first tourniquet. IV. Application

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10 Application- Key Concepts: Apply tourniquet proximal to bleeding site as close as possible to injury. DO NOT apply tourniquet over a joint. Ensure bleeding has stopped and distal pulses are absent after the application of a tourniquet. A tourniquet should be secured tightly and should not cut into the skin or underlying tissue. Caution must be taken to prevent potential damage to nerves, muscles, blood vessels, and soft tissue which may result in further injury and loss of the extremity. Once a tourniquet is applied it should not be loosened or removed without physician approval. Reassess patient at least every 5 minutes. Application of tourniquets typically results in severe pain. Always consider administration of morphine after tourniquet application and fluid administration, in the absence of any contraindications. Note While tourniquets have been shown to be safe and effective in stopping lifethreatening hemorrhage from extremity wounds, direct pressure should always be

11 attempted first prior to the application of a tourniquet. V. Documentation Using an ink pen document on the tourniquet's Windlass Strap the time the tourniquet was applied. Document using the Electronic Patient Care Report (epcr) in the flow chart TREATMENT section as follows: 1. Select "TOURNIQUET" (a secondary flex field will appear). 2. Enter the location of the tourniquet and the time of application. 3. Document all patient reassessments using manual free text in the NARRATIVE section. 4. Document using manual free text in the NARRATIVE section any directed removal of a tourniquet by a physician or base station. The name of the physician and time the order was received and completed shall be included in this narrative. VI. Distribution/Ordering Initial distribution will be one CAT to each Fire company, BLS and ALS rescues only. The CAT can be re-ordered using the Supply Requisition System (SRS). VII. Conclusion The C-A-T is an effective tool to help control severe external hemorrhage from extremity wounds or amputations. This device has a proven track record of saving the.lives of U.S. soldiers during combat and is easy to apply. Although use ofthis tourniquet may occur less frequently in the civilian setting the C-A-T is an approved device that may be employed in life-threatening situations where a tourniquet is indicated.