FYI for new EMTs: In my area we use CAT tourniquets which have a spot to make the time of application. It is not said in this video, but your proctor might expect you to verbalize marking the time on the tourniquet.
The intro and outro are a little too loud compared to the audio, no big deal though. Overall the editing, pacing, and level of professionalism in this video is excellent! 9/10!
I am very grateful for this video...It was straight forward..it is also a mandatory skill I have to do for my exam and did not know how to do it ..Thanks to you guys I can now learn this and pass my skill
You’d also want to mark the date and time that you put the tourniquet on, so that the hospital staff know how to proceed. You don’t want to leave the tourniquet on for too long.
In NY we were instructed to use tourniquets as a last resort pretty much, for us it goes, direct pressure, pressure dressing, and then if that doesn't work then we apply a tourniquet proximal to the injury site. idk if that's how it is for everybody or just NY
+CptCujo2 Same in Jersey too, although they have started to change it. Basically when I took my refresher they told us pressure dressing if that fails Tourny it up.
I love your videos. They are very informative but I do have one suggestion. To be more realistic consdier using a commercial tourniquet instead of a phlebotomy consticting band. Just my thoughs.
I fully get it. I'm a rusty OFA 3 from Canada. We also have to abide by course guideline in order to pass but perhaps differently in the field. But we can be held liable if we stray especially if things don't work out. it seems policies are slow to change even in the face of overwhelming evidence.
I'm taking my EMT course this year and so excited and nervous at the same time... The 7 skills that I will be performing, from what I saw in the videos is the proctor always going to change the scene as u are working on the patient or is it the same from the EMTNRSE... What I'm getting at is the proctor from the vids is it different then the actually skill exam or do they say different things while u are assessing the patient
+EMTprep yea sorry lol The proctor that is giving the scene do they ever say okay they have no pulse and there going into cardiac arrest ? Or do they just let u finish the assessment ? For the exam
+alyxandria mean Hey Alex, thanks for the clarification. While we can't guarantee what your proctor will do, usually they are going to help guide you through the skill with verbal cues when appropriate. Hope that helps!
tip: with the oxygen tank, always have TWO hands on it or lie it on the ground. If it were to fall or anything, the pressurized canister would essentially become a propelled rocket. it could go through concrete
thanks for such videos sorry could u please tell me, is it allow to use the torniquets in such trauma or not? in 2023 because i studied that we should never use torniquets in trauma instead we must use military anti shock trouser (MAST) OR pnumaric anti shock trouser. thank u
MASt /PAST garments are no longer used just about anywhere, as they cause more harm than good. The CAT style tourniquets are the way to go. It is interesting the patterns of how research changes how we do various things in EMS! For instance, 10 years ago, Tourniquets went out of fashion, and then out of protocol. Then a few years later they came back with good evidence of efficacy - and killing some old wives tales in the bargain (Like no more than 2 hours and loosing them every so often). Now, if direct pressure doesn't work on an extremity wound, go straight to a tourniquet. The lives saved in Afghanistan and Iraq kind of proved the point. (The same is true for the use of Hemostatic Gauze on wounds that you cannot put a tourniquet on),
Why don't they determine (or attempt to) if it is arterial or venus bleeding? I didn't think you used tourniquets for venus bleeding. Matbe that is updated protocol in the 9 years since this video was made?
Just curious... Why position the tourniquet so high? Yes, it needs to be proximal, but you're also cutting circulation to her entire arm when the wound is on her mid-forearm. Is this normally how it's done?
Alex Hylton Hey Alex, great question, in all truthfulness, the EMT in the video could have placed the tourniquet a bit closer to the wound. You're correct in the placement needing to be proximal to the wound.
+Andréa Craft We hear you Andrea. It is a point that has been raised a lot in the comments. Filming the videos AND showing what the EMT was doing meant that we sometimes had to place things in different positions to show the viewer what was going on. This is the best example of that kind of a choice. We agree that the oxygen bottle should be flat on the ground, but also recognize that this type of oxygen bottle has a cage around the top to absorb a ground level fall impact. Not ideal, but it was considered. Thanks for the feedback!
Absolutely Jim, we were mainly trying to hit home a step for the NREMT exam. A lot of people reported to us that their exam had IV tourniquets for this skill station, so when we shot these it seemed appropriate.
James is correct. The IV tourniquet is not an appropriate device for arterial bleeding control as it does not have the ability to slow/stop arterial flow. In fact, as it can stop venous return, in effect it will increase the pressure at the injury site, resulting in increased difficulty controlling the bleeding. I strongly recommend editing this video. CAT tourniquets are inexpensive (
Should be have followed up on the bleeding after he had treated for shock? And elevating the legs would've been an option for shock management, correct?
skillet2331 Hey Skillet, it is assumed that he would follow up on the patients injuries en route to the hospital when he discusses the transport option and vital signs he would take.
+Jeremy Gassert I'd imagine if you were a patient for an emt practical you wouldn't want a real tourniquet on you for however many people are going to use you as the patient.
+T you are correct and that would suck, however what would suck even more is if an EMT truly believes that the featured equipment is a tourniquet and applies one to their patient with uncontrollable hemorrhage. I appreciate what they are trying to do with this demonstration, but as an educator I take issue with any testing location that would provide this as a tourniquet for the exam.
Actually u should try wound packing before tourniquet if direct pressure doesn’t work. Tourniquet should always be last resort bc patient will likely lose the limb.
Me being a medic in the Army, we are required to take an EMT course. As I read the book, it always says that you want to check to make sure that the distal pulse is gone to assure the tourniquet is on tight enough. But as I look through my all skills handbook, I don't see it. Is it not mandatory that you do it during a skills exam or what?
+Bennie Faze Hey Bennie, these videos go directly off the NREMT skill videos to help people prepare for their practical exams. What you're describing is an excellent step in the process, it just isn't specifically covered in the skill sheets.
I know some emt testing sites will ask you how do you know how tight to make the tourniquet, and responding with until the bleeding stops always seems to make any examiner happy, but it usually applies to the tourniquet that you can slowly tighten, and not the rubber band.
NREMT is not as detailed as TC3. EMT-B's are training to go through the steps of elevation and direct pressure before a tourniquet in the presence of "major bleeding". As recognizing arterial bleeding early is a skill of the Combat Medic, use of tourniquet is the 'first' choice in these instances, not the last resort. There is still a lot of myth and stigma surrounding the use of tourniquets in the civilian world. This is strange since military casualties often take much longer than 1 hour to reach higher level medical care, while civilian patients usually take far less. Not only that, but dressing a wound with a pressure bandage and/or hemostatic agent and then releasing the tourniquet is also a simple skill. If you ever see some rig time in an area with a lot of gun violence or an austere environment, you can expect to see that your local medics aren't as frightened about tourniquet use.
+Eva Post Hey Eva, good question. Direct pressure with an appropriate bandage would probably be your first go to technique. As with everything in EMS, it really depends on your patient's presentation.
It would be during your initial patient contact after a quick head-to-toe assessment. The main thing you need to worry about is to stop the life threatening bleeds, start with applying pressure but if that fails then a tourniquet is the next best step.
This is 3 yrs old, would you not use Combat Gauze or some hemotatic agent and an Israeli bandage before a tourniquet?Also continue a primary then secondary survey followed up with a set of vitals written down and sent off with casualty??
Great questions Roger. The short answer is yes and no. This video is meant to help people study for the EMT practical skill check-off they need to perform correctly to get certified. In the field, we would absolutely try some of the new tools in the toolbox to stop the bleeding before moving to a tourniquet. Remember, all of this stuff is dependent on local protocols, which you should always follow!
Striker51z Hey Striker, those are no longer utilized. I would recommend you take a look at the new skill sheets provided by the NREMT on their website, here is the Bleeding, Wounds and Shock one: www.nremt.org/nremt/downloads/E213%20Bleeding%20Control%20Shock%20Management.pdf
That's very weird because I got my EMT-B in April and we were taught about the use of elevation and pressure points but like you said, it isn't in the skill sheet
Striker51z Hmm. Might have had a change in your state at that point. Not sure. Sometimes states teach to older guidelines until their offices accept the new changes.
Wouldn't a pressure dressing be appropriate to apply directly to the wound sight after the tourniquite is applied as assistance for hemorrhage control?
I think all skill sheets are different of course, but would he have to dress the wound by wrapping roll of gauze so that the patient wint really have to hold it?? In our skills sheet, we were taught to use piece of cloth and pencil as a tourniquet XD hahaha be nice to have those rubber bands :3
![🔴 ฟุตบอลแชมป์กีฬา 7HD แชมเปียน คัพ 2024 [รอบรองชนะเลิศ]](http://i.ytimg.com/vi/zPm8ClLVhoE/mqdefault.jpg)
FYI for new EMTs: In my area we use CAT tourniquets which have a spot to make the time of application. It is not said in this video, but your proctor might expect you to verbalize marking the time on the tourniquet.
The intro and outro are a little too loud compared to the audio, no big deal though. Overall the editing, pacing, and level of professionalism in this video is excellent! 9/10!
Bea
my boi quagsire
Q no 1q1
Thank you for that wonderful evaluation??
@@kennedy4257 lmao
EMTprep You guys have the best videos on TH-cam! Thanks so much!
DadLovesAlex You bet! Glad you're finding these useful.
"is there anything else you'd like to do?" THE HORROR
I am very grateful for this video...It was straight forward..it is also a mandatory skill I have to do for my exam and did not know how to do it ..Thanks to you guys I can now learn this and pass my skill
Tomorrow is my practical. Omg 😲 😱
Same ! Same
You’d also want to mark the date and time that you put the tourniquet on, so that the hospital staff know how to proceed. You don’t want to leave the tourniquet on for too long.
Also elevate the legs.
In NY we were instructed to use tourniquets as a last resort pretty much, for us it goes, direct pressure, pressure dressing, and then if that doesn't work then we apply a tourniquet proximal to the injury site. idk if that's how it is for everybody or just NY
+CptCujo2 Same in Jersey too, although they have started to change it. Basically when I took my refresher they told us pressure dressing if that fails Tourny it up.
Same here, in Calgary. direct pressure, pressure dressing, pressure points, last resort tourniquet.
Same protocols for California also
In California its, Direct Pressure, Pressure Dressing, Pressure points, then tourniquets proximal to the injury.
ALWAYS apply tourniquet first when there is major hemorrhage
I love your videos. They are very informative but I do have one suggestion. To be more realistic consdier using a commercial tourniquet instead of a phlebotomy consticting band. Just my thoughs.
I fully get it. I'm a rusty OFA 3 from Canada.
We also have to abide by course guideline in order to pass but perhaps differently in the field.
But we can be held liable if we stray especially if things don't work out.
it seems policies are slow to change even in the face of overwhelming evidence.
I'm taking my EMT course this year and so excited and nervous at the same time... The 7 skills that I will be performing, from what I saw in the videos is the proctor always going to change the scene as u are working on the patient or is it the same from the EMTNRSE... What I'm getting at is the proctor from the vids is it different then the actually skill exam or do they say different things while u are assessing the patient
+alyxandria mean Hey Alyx, I am having a hard time understanding your question. Can you rephrase?
+EMTprep yea sorry lol
The proctor that is giving the scene do they ever say okay they have no pulse and there going into cardiac arrest ? Or do they just let u finish the assessment ? For the exam
+alyxandria mean Hey Alex, thanks for the clarification. While we can't guarantee what your proctor will do, usually they are going to help guide you through the skill with verbal cues when appropriate. Hope that helps!
They are looking for you to perform a specific skill, they're not going to throw you curve balls.
tip: with the oxygen tank, always have TWO hands on it or lie it on the ground. If it were to fall or anything, the pressurized canister would essentially become a propelled rocket. it could go through concrete
thanks for such videos
sorry could u please tell me, is it allow to use the torniquets in such trauma or not? in 2023
because i studied that we should never use torniquets in trauma instead we must use military anti shock trouser (MAST) OR pnumaric anti shock trouser.
thank u
MASt /PAST garments are no longer used just about anywhere, as they cause more harm than good. The CAT style tourniquets are the way to go.
It is interesting the patterns of how research changes how we do various things in EMS! For instance, 10 years ago, Tourniquets went out of fashion, and then out of protocol. Then a few years later they came back with good evidence of efficacy - and killing some old wives tales in the bargain (Like no more than 2 hours and loosing them every so often). Now, if direct pressure doesn't work on an extremity wound, go straight to a tourniquet. The lives saved in Afghanistan and Iraq kind of proved the point.
(The same is true for the use of Hemostatic Gauze on wounds that you cannot put a tourniquet on),
Why don't they determine (or attempt to) if it is arterial or venus bleeding? I didn't think you used tourniquets for venus bleeding. Matbe that is updated protocol in the 9 years since this video was made?
Just curious... Why position the tourniquet so high? Yes, it needs to be proximal, but you're also cutting circulation to her entire arm when the wound is on her mid-forearm. Is this normally how it's done?
Alex Hylton Hey Alex, great question, in all truthfulness, the EMT in the video could have placed the tourniquet a bit closer to the wound. You're correct in the placement needing to be proximal to the wound.
It always drives me nuts that this guy leaves his tanks standing up and unattended in like every video
+Andréa Craft We hear you Andrea. It is a point that has been raised a lot in the comments. Filming the videos AND showing what the EMT was doing meant that we sometimes had to place things in different positions to show the viewer what was going on. This is the best example of that kind of a choice. We agree that the oxygen bottle should be flat on the ground, but also recognize that this type of oxygen bottle has a cage around the top to absorb a ground level fall impact. Not ideal, but it was considered. Thanks for the feedback!
Dan is the man
What about pressure point and elevating the arm if it's still bleeding through the gauze?
Tabia Rolle Great idea Tabia! If you get that feedback during your test be sure to let the proctor know how you would handle it.
Just a treasure to have! Thank You!!
Is that a venous tourniquet. If so, wouldn't that be a bad idea? Better idea is a pressure dressing followed by an arterial tourniquet, right?
Absolutely Jim, we were mainly trying to hit home a step for the NREMT exam. A lot of people reported to us that their exam had IV tourniquets for this skill station, so when we shot these it seemed appropriate.
James is correct. The IV tourniquet is not an appropriate device for arterial bleeding control as it does not have the ability to slow/stop arterial flow. In fact, as it can stop venous return, in effect it will increase the pressure at the injury site, resulting in increased difficulty controlling the bleeding. I strongly recommend editing this video. CAT tourniquets are inexpensive (
Wish me luck I Take the skills on Monday.
How'd you do?!
@@mckaylabryant6242 great
Should be have followed up on the bleeding after he had treated for shock? And elevating the legs would've been an option for shock management, correct?
skillet2331 Hey Skillet, it is assumed that he would follow up on the patients injuries en route to the hospital when he discusses the transport option and vital signs he would take.
Oh! That makes sense now aha thank you very much for your reply! Cheers.
skillet2331 Also note that trendelenberg is contraindicated in hemorrhagic shock management.
That is not a tourniquet. That is a constricting band. The best that will do is slow bleeding but should never be used for hemorrhage control.
+Jeremy Gassert Very true Jeremy. Sometimes you will have to do what you can with the materials you're provided in the test.
+Jeremy Gassert I'd imagine if you were a patient for an emt practical you wouldn't want a real tourniquet on you for however many people are going to use you as the patient.
+T you are correct and that would suck, however what would suck even more is if an EMT truly believes that the featured equipment is a tourniquet and applies one to their patient with uncontrollable hemorrhage.
I appreciate what they are trying to do with this demonstration, but as an educator I take issue with any testing location that would provide this as a tourniquet for the exam.
Agreed. Maybe instruct the emt's not to tighten a real tourniquet all the way or demonstrate proficiency on a training aid.
I don't think any reputable EMT having taken a reputable EMT course would ever mistake that for a tourniquet....common sense etc etc.
Actually u should try wound packing before tourniquet if direct pressure doesn’t work. Tourniquet should always be last resort bc patient will likely lose the limb.
Me being a medic in the Army, we are required to take an EMT course. As I read the book, it always says that you want to check to make sure that the distal pulse is gone to assure the tourniquet is on tight enough. But as I look through my all skills handbook, I don't see it. Is it not mandatory that you do it during a skills exam or what?
+Bennie Faze Hey Bennie, these videos go directly off the NREMT skill videos to help people prepare for their practical exams. What you're describing is an excellent step in the process, it just isn't specifically covered in the skill sheets.
I know some emt testing sites will ask you how do you know how tight to make the tourniquet, and responding with until the bleeding stops always seems to make any examiner happy, but it usually applies to the tourniquet that you can slowly tighten, and not the rubber band.
NREMT is not as detailed as TC3. EMT-B's are training to go through the steps of elevation and direct pressure before a tourniquet in the presence of "major bleeding". As recognizing arterial bleeding early is a skill of the Combat Medic, use of tourniquet is the 'first' choice in these instances, not the last resort. There is still a lot of myth and stigma surrounding the use of tourniquets in the civilian world. This is strange since military casualties often take much longer than 1 hour to reach higher level medical care, while civilian patients usually take far less. Not only that, but dressing a wound with a pressure bandage and/or hemostatic agent and then releasing the tourniquet is also a simple skill. If you ever see some rig time in an area with a lot of gun violence or an austere environment, you can expect to see that your local medics aren't as frightened about tourniquet use.
The tourniquet would be used only as last resort correct? If that is so, what would you do instead?
+Eva Post Hey Eva, good question. Direct pressure with an appropriate bandage would probably be your first go to technique. As with everything in EMS, it really depends on your patient's presentation.
What part of our assessment would we apply direct pressure and the application of the tourniquet?
It would be during your initial patient contact after a quick head-to-toe assessment. The main thing you need to worry about is to stop the life threatening bleeds, start with applying pressure but if that fails then a tourniquet is the next best step.
This is 3 yrs old, would you not use Combat Gauze or some hemotatic agent and an Israeli bandage before a tourniquet?Also continue a primary then secondary survey followed up with a set of vitals written down and sent off with casualty??
Great questions Roger. The short answer is yes and no. This video is meant to help people study for the EMT practical skill check-off they need to perform correctly to get certified. In the field, we would absolutely try some of the new tools in the toolbox to stop the bleeding before moving to a tourniquet. Remember, all of this stuff is dependent on local protocols, which you should always follow!
In my PADI Diving progression, we are going to learn Emergency Oxygen Administration. Is this similar/ will help me for EMT School?
Our videos will definitely help you with EMT school. I can't speak to the specific class you're referencing but it sounds like it would help also!
elevate feet too. that's a requirement in oregon.
EMTprep is actually based in Oregon! Remember, Oregon goes off the NREMT skill sheets like other states, so be sure to follow those!
So... What about elevation of the extremity and use of pressure points?
Striker51z Hey Striker, those are no longer utilized. I would recommend you take a look at the new skill sheets provided by the NREMT on their website, here is the Bleeding, Wounds and Shock one: www.nremt.org/nremt/downloads/E213%20Bleeding%20Control%20Shock%20Management.pdf
That's very weird because I got my EMT-B in April and we were taught about the use of elevation and pressure points but like you said, it isn't in the skill sheet
Striker51z Hmm. Might have had a change in your state at that point. Not sure. Sometimes states teach to older guidelines until their offices accept the new changes.
Should you also mention to take note what time they applied the tourniquet?
Absolutely Mariel!
Wouldn't a pressure dressing be appropriate to apply directly to the wound sight after the tourniquite is applied as assistance for hemorrhage control?
+Robert Claar absolutely Robert! Remember this is for the test and doing something like what you're describing in the field is very appropriate.
+EMTprep Alright, awesome! Thanks!
Why is the tourniquet so high up wouldn't you want it under the elbow joint so she would have more movement when she was fitted with her prosthetic
Good thinking Cerise, it could be a bit lower.
why would we not put the tourniquet above the forearm but below the joint.
***in the forearm above the ijury and below the joint
Hey Diana, he definitely could have placed the tourniquet lower down the arm.
+EMTprep thanks!
That standing up oxygen tank makes me nervous, bout to send a rocket flying
What about checking for PMS after applying a tourniquet?
Hey Arika, not a bad idea, what would you be looking for after applying the tourniquet?
No pulse
I think all skill sheets are different of course, but would he have to dress the wound by wrapping roll of gauze so that the patient wint really have to hold it??
In our skills sheet, we were taught to use piece of cloth and pencil as a tourniquet XD hahaha be nice to have those rubber bands :3
danimidnight1 That is definitely a possibility. When you're short handed sometimes the patient has to get in on the action as well :)