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Mon Dec 11 21:18:12 GMT 2006

I think those that comment on the importance of direct pressure over
tourniquets are missing a crucial element: mobility. Under battlefield
conditions (which has been the primary reference point for tourneiquet use),
the name of the game is to get out of harm's way. Stopping to delvier
effective direct pressure impedes that directive.  Extended to the civilian
world, direct pressure is to be commended if one has enough help and hands.
I don't think their use is as "last resort" as some commenters paint.

Jeffrey Hammond MD, MPH
Chief, Trauma/Surgical Critical Care
Robert Wood Johnson Medical School
New Brunswick, NJ
ph: 732-235-7920
e-mail: hammond at umdnj.edu

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of jkaymdc at aim.com
Sent: Sunday, December 10, 2006 6:47 PM
To: trauma-list at trauma.org
Subject: Re: The case against tourniquets

-----Original Message-----
From: vdkleyn at hotmail.com
   PHTLS manuel sixth edition (normal version): page 97 :

  the prehospital care provider can control hemorrhage in the following
ways:
>>>>Tourniquets are very effective in controlling severe hemorrhage and
should be used if direct pressure or a pressure dressing falis to 
>>>control hemorrage from an extremety.
>>>>COMENTS???

I believe this is still stating it would be considered as a final resort,
following direct pressure and/or a pressure dressing failure, "in an
extremity".

  Pressure points lost some favor mostly from a lack of actually finding the
appropriate pressure point and exerting enough pressure on it to control
hemorrhage.

I would view this recommendation in the same light as Quik Clot (or a
similar product)....it works in "extreme" cases when exsanguination  is
possible and other methods of hemorrhage control are not working.

In other words..it's still basically a last resort measure, IMO.

Jules

  --------

From: "oded private" <tangentcarrot at hotmail.com>
Reply-To: "Trauma &amp; Critical Care mailing list" 
<trauma-list at trauma.org>
To: trauma-list at trauma.org
Subject: RE: The case against tourniquets
Date: Sun, 10 Dec 2006 21:22:43 +0200
>the military edition or the regular?
>
>
>>From: "James Richardson" <jimmnn at comcast.net>
>>Reply-To: "Trauma &amp; Critical Care mailing list"
>><trauma-list at trauma.org>
>>To: "'Trauma &amp; Critical Care mailing list'"
>><trauma-list at trauma.org>
>>Subject: RE: The case against tourniquets
>>Date: Sun, 10 Dec 2006 09:01:40 -0700
>>
>>They have been reemphasized in the new PHTLS edition.
>>
>> Jim<
>>
>>-----Original Message-----
>>From: trauma-list-bounces at trauma.org
>>[mailto:trauma-list-bounces at trauma.org]
>>On Behalf Of Karim Brohi
>>Sent: Sunday, December 10, 2006 6:55 AM
>>To: trauma-list at trauma.org
>>Subject: The case against tourniquets
>>
>>Recently, the US and UK military have "rediscovered" tourniquets.
>>Their use
>>has been published in meetings around the world and is now spreading 
>>to civilian practice. ATLS and other groups have spent years 
>>campaigning to remove tourniquets from civilian practice, for good 
>>reasons, and now they are back - with not a shred of evidence to 
>>support this reversion.
>>
>>
>>
>>
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The case against tourniquets