bullit,
I have been working as a Professional Paramedic as long as you have been a Dr and a Tactical Medic for five years, and just like you, Ive seen many treatments come and go. In my entire career Ive only seen tourniquets used a couple of times.
I cant recall ever having trouble using direct pressure to successfully control severe bleeding. But I have a couple of advantages that helped me. I have an entire ambulance full of equipment, a "generally" secure scene and the help of at least one other Medic along with several EMTs.
End up by yourself, in a hostile environment with severe bleeding from an extremity and a TK may be what saves your life.
I teach a Tactical Medicine course and I tell the students that direct pressure should be attempted first to control severe bleeding from an extremity, unless you are by yourself or under fire or have an expectation that you may be fired upon again. In those cases put on the TK. It would be nearly impossible for a person to apply enough pressure to their own limb to be truly effective.
There are a number of scenarios that would put EMS too far out to be of immediate help. One of the victims of the Von Mauer shooting died from a single gunshot to the lower leg. If that victim had even a basic knowledge of how a TK worked and the proper mindset they could have saved themselves because nobody stepped up to even attempt direct pressure.
In all the literature and research I have read the generally accepted time for removal of a TK, without severe damage, is three hours. Limbs have been saved with TKs applied as long as eight hours but with some lasting injury.
Our PHTLS protocols have changed to include the use of TKs prehospital. We are allowed to apply a BP cuff and use it as a TK if we are unable to control bleeding with direct pressure. Pressure points and elevation are out and have been deemed as ineffective.
Your right that they have been used extensively in the middle east. One of the complaints is that they have been used too frequently on injuries that didn't require them. But, as I'm sure you know, lying in the dirt and bleeding to death from an extremity has been the number one preventable cause of death on the battlefield for hundreds of years. The use of TKs has and will continue to save lives on the battlefield. And, to a lesser degree, they will find a place in pre hospital and law enforcement.
Limited use? Absolutely. But I would rather have one and not need it...as the saying goes.
- Shawn