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Mon Dec 18 13:29:29 GMT 2006

Perfectly said, Claudia!
Happy Holidays,
Ron

>>> claudia <glamourcv at gmail.com> 12/16/06 4:15 PM >>>
There is something with Evidence Based medicine that never is enough said.
When you apply the data obtained from one study done among a selected or
specific population, to the case you are evaluating, you need to check if
the patient you are treating fits the population of the study, and the
scenario of the study. Limitations are clear.
Military people are a very well selected population. Less diabetes,
atherosclerosis, prothrombotic conditions, etc. War scenario is also a very
specific one,
severe traumatic amputations and overt bleeding is more common than in the
usual prehospital civilian care.
Also, the first aid material needed to stop bleeding in such severe injuries
are not always available at the time casualties occur. Many times,
improvisation has to be done by the victim himself.
I believe, like karim said, that we must be very careful when extrapolating
these data to the civilian population, when first care is given by the
prehospital care team,  basic material to stop  bleeding from limb wounds is
usually available, and the population is not that well selected.
In the first scenario (war) a tourniquet may be worth the possible side
effects, considering that in many cases  there is nothing else that can be
done in time  to stop a perhaps lethal bleeding and the victims are healthy.
In the second scenario, remember that the patient may not be so healthy and
atherosclerosis, thrombosis, diabetes, might be important concomitant
factors to worsen  unacceptable side effects from TQ.

Entirely different populations, remember that.

Claudia

On 12/16/06, Frank Østergaard Hansen <foh at hco.kollegienet.dk> wrote:
>
>
> karim Brohi
>
> first off the military is not "rediscovered" tourniquets(TQ) in the
> manner you say, TQ are to be use in the car under fire phase as self aid
> /boddy aid. TQ is then chance in tactical field care phase to a normal
> bandage. it all in the PHTLS book in part on military medicine where
> tactical combat casualty care(TCCC) is pint out.
>
> on the "no shred of evidence" i think you shut read Butlers et al. paper
> on TCCC, i dont say EBM, but military medicine like trauma care is some
> times "best guess" care. on The Tromsoe Mine Victim Resource Centre ban
> on TQ you right, but if you talk to them about the way militay use TQ,
> thay tell it is not the same. the military is "short time" use and the
> the Tromsoe Mine Victim Resource Centre is banning the long time use and
> as a first resort to use to stopping bleeding.
>
> also TQ is no longer only a stick and belt, there is a lot out there.
> see : http://tacmed.dk/new_page_12.htm, what tromso have see is thing
> like small wires ect.
>
> and then your case, yes it the reason for ATLS and other groups try to
> remove tourniquets from civilian practice, but there is also case out
> there where some in combat and civil life have bee safe by a TQ - but
> that is no way to do EBM case by case.
>
> TQ has a place in military medicine and civilian some times first some
> times last resort, but go against them just because, some dont use them
> as thay  have learn in the military, for last resort!, dont make good EBM.
>
> Frank Hansen
> denmark
>
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The case against tourniquets