Effectiveness of Tourniquet Use in Managing Mass Hemorrhage Injuries

Description: The presentation titled "Effectiveness of Tourniquet Use in Managing Mass Hemorrhage Injuries" focuses on the use of tourniquets in the management of mass hemorrhage injuries of the extremities. This presentation will cover the pathophysiology of such injuries and the interventional outcomes using various types of commercial vs. improvised tourniquets. The presentation will also critically analyze and discuss current evidence-based studies involving positive clinical outcomes in using various types of tourniquets in modern military trauma. The types and limitations of various commercially available tourniquets utilized in both tactical and civilian pre-hospital trauma situations will be distinguished. Additionally, the presentation will analyze and discuss evidence-based decision-making criteria in the application of tourniquets for various limb trauma situations. Lastly, the presentation will use and apply knowledge of tourniquets to various pre-hospital trauma situations encountered by athletic trainers. BOC Domains of Athletic Training: Domain II - Clinical Evaluation and Diagnosis Domain Ill - Immediate and Emergency Care Upon completion of this course, participants will be able to: Recognize the pathophysiology of mass hemorrhage injuries of the extremities, with a focus on interventional outcomes using various types of commercial vs. improvised tourniquets. Critically analyze and discuss current evidence-based studies involving positive clinical outcomes in using various types of tourniquets in modern military trauma. Distinguish the types and limitations of various commercially available tourniquets utilized in both tactical and civilian pre-hospital trauma situations. Critically analyze and discuss evidence-based decision-making criteria in the application of tourniquets for various limb trauma situations. Use and apply knowledge of tourniquets to various pre-hospital trauma situations encountered by athletic trainers. Practice Gap: Despite the effectiveness of tourniquets in managing mass hemorrhage injuries of the extremities, there is a gap in the knowledge and skills of healthcare providers, including athletic trainers, in their use and application. This gap is particularly notable in the recognition of the pathophysiology of mass hemorrhage injuries and the critical analysis and discussion of current evidence-based studies involving positive clinical outcomes in using various types of tourniquets. There is also a gap in understanding the types and limitations of various commercially available tourniquets utilized in both tactical and civilian pre-hospital trauma situations. This knowledge gap leads to a delay in the application of tourniquets, which could result in increased mortality and morbidity rates. Therefore, there is a need to bridge this gap in knowledge and skills among healthcare providers, particularly athletic trainers, in the effective use and application of tourniquets in managing mass hemorrhage injuries of the extremities. Clinical Bottom Line: Commercial tourniquets (e.g. Combat Application Tourniquet, or CAT; pneumatic tourniquets; et.) have consistently been demonstrated to be highly effective in the rapid early control of major bleeding. These devices are preferred over improvisational techniques in their demonstrated ability to provide arterial and venous ocCLusion, as well as minimal risk of palsy development at the tourniquet site. Commercial tourniquets (such as the Combat Application Tourniquet) are relatively inexpensive (less than $25) and can be easily carried in medical kits or in a person's pocket for easy accessibility. Additionally, and of practical importance, is the simplicity of use and greatly reduced learning curve to effectively and correctly apply the tourniquet. Commercial tourniquets are designed for a "one-size fits all". Of special note is that one limitation of tourniquets is the inability to stop bleeding above the upper thigh or upper arm. Summary Conclusions: The management of pre-hospital trauma patient care skill sets should include the use of commercial tourniquets. The early use of tourniquets to stop bleeding in major limb trauma results in high survival rates in both military and civilian settings where blunt-force or penetrating trauma to the extremities has occurred. There is strong supporting evidence of a low morbidity risk of palsies at the site of tourniquet application. Not using or hesitating to apply a tourniquet to an extremity with major bleeding will result in an increased likelihood of mortality. Non-tourniquet methods (e.g., hemostatic agents, direct pressure, etc.) to stop major bleeding in extremity trauma are not effective interventions alone; however should be considered and utilized as part of the interventions in addition to tourniquet use.

  Ray Castle, PhD, LAT, ATC, NREMT BIOGRAPHY Dr. Castle has an extensive background in education, clinical practice, and professional service spanning over 31 years. Dr. Castle's clinical practice background has included experiences at the high school, college, and international (1996 Atlanta Olympic Games; USOC Sports Medicine Staff for 2003 Pan American Games; and 2004 US Women's Bobsled) levels, large scale medical coverage and coordination, as well as extensive experience in emergency medicine. Dr. Castle is a highly active member of the athletic training profession, having made more than 150 presentations at the local, state, national and international levels, numerous publications, as well as serving on various organization committees at state, district, and national levels. At the national level, he has served as chair of the NATA Educational Multimedia Committee (2004-08), a member of the NATA's Education Council Executive Committee (2004-08), board member of NATA Research and Education Foundation (2010-12), and board member on Commission on Accreditation for Athletic Training Education (2011-2017). Dr. Castle has been recognized for his service efforts in the athletic training profession, and has been the recipient of a number of honors included:  Louisiana Athletic Trainers’ Association (LATA) – Hall of Fame (2019); Commission on Accreditation for Athletic Training Education (CAATE) Bob and Lynn Caruthers Service Award (2018); National Athletic Trainers’ Association (NATA) Most Distinguished Athletic Trainer Award (2017) and Athletic Trainer Service Award (2007), Southeast Athletic Trainers’ Association (SEATA) Hall of Fame (2014), Chuck Kimmel Award of Merit (2011), and District Award (2005); and Athletic Trainers’ Association of Florida (ATAF) College/University Athletic Trainer of the Year Award (2001). Dr. Castle is Owner and Chief Medical Officer of Action Medicine Consultants, LLC. His company provides: sports medicine event coordination; emergency medicine and response training; EAP development and audits for organizations and events; and continuing education courses. He currently serves as medical coordinator for over 20 large-scale events in Louisiana, Mississippi, Alabama, and Florida.    

Action Medicine Consultants, LLC (BOC AP#: P12095) is approved by the Board of Certification, Inc. to provide continuing education to Athletic Trainers (ATs). This program is eligible for a maximum of 0.75 Category A hours/CEUs. ATs should claim only those hours actually spent in the educational program. GENERAL DISCLAIMER: It is the responsibility of the participant, relying on the independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient. Participants must use discretion when using the information contained within this presentation.  The presenter has provided the following regarding disclaimers: The information and content provided in this course are for informational purposes only. The presenter nor Action Medicine Consultants, LLC bears no liability for your use of this information and content. The views expressed in this course are those of the presenter(s). CONFLICTS OF INTEREST: In compliance with continuing education requirements, all presenters must disclose any financial or other associations with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters as well as any use of unlabeled product(s) or product(s) under investigational use.  This presentation does not involve the unlabeled use of a product or product under investigational use.  During the presentation, the presenter provides disclosure of any relevant financial relationships or other associations.  Refund Policy:  Live (virtual or in-person) Courses - Full refunds (Minus 10% for handling fees) are given after completion of the course if cancellation request is received 14 days prior to the course date. No refunds will be given after this deadline, but fees may be applied to another current or a future course. This also applies to virtual courses if a technical issue occurred on the presenter side that prevented a full presentation from being performed. On-Demand Courses - No refunds will be given, but fees may be applied to another current or a future course if there is a technical issue in Action Medicine Consultant's delivery of the course and in which no certificate of completion was issued.