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Sun Dec 17 21:35:56 GMT 2006

Sorry Mathias, but looks like you are spinning that table!
 Tourniquets are used every day in theatre, with complete limb ischaemia in ASA1-4 patients without significant detrimental effect.......I would say that the pressure is on you to demonstrate good clinical evidence that in the prescence of exsanguinating haemorrhage which cannot be controlled (for any of the reasons discussed before) the use of a tourniquet for a short period to defintive care is not life or limb threatening.
karim quoted an interesting yet anecdotal case and his mine workers are in a specific situation and were even using wire tourniquets in a manner that is not equivalent to most of our civilian or even military practice.
Not a single advocate of the tourniquet on the list has recommending routine use at the first sign of a bleed nor for prolonged transports.
Regards
Mark F

----- Original Message ----
From: Mathias Kalkum <listen at doc-kalkum.de>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Sunday, 17 December, 2006 11:30:39 AM
Subject: Re: The case against tourniquets

Maybe someone can enlighten me:

this discussion started with Karim drawing our attention to the fact 
that tourniquets are becoming more and more on vogue (or, perhaps, might 
never have been abandoned in some niches, for that matter) and, in the 
following, somehow found their way into current guidelines such as PHTLS.

He made some alarming remarks which really should raise our attention, 
as there is the doubled rate of limb loss compared to other wars. Also, 
other than just pinpointing this, he gave us an example of a young (and 
I assume otherwise healthy) patient who suffered severe side effects 
from having a tourniquet applied and he supported us with data from the 
anti mine coalition supporting the ban on tourniquets.

Right so far?

But all I hear is: "the military is different" - "we have to save lives 
- live before limb" - "in some civilian settings there is no big 
difference to war zones, thus tourniquets might as well be appropriate" 
- "you know, soldiers are young an healthy, but the civilian often sick; 
  thus soldiers tolerate tourniquets better" - "one just has to 
administer them properly".

Forgive my ignorance, but this below the level of this list. I would 
really encourage the supporters of tourniquets to provide us with 
*data*, proving that the lives safed are due to tourniquets (and thus 
justifying the enormous amputation rate in young people) and not to 
improved body armor, new rapid response strategies, permissive 
hypotension, new clotting agents etc. etc. Hearsay, guestimation and 
good will are not enough to reintroduce a device that otherwise has been 
proven to be detrimental.

Eager to learn more...

Mathias
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The case against tourniquets