So does it work or not?

[Gutshot John]

I know it's not going to be the answer you want to hear, but ultimately they are both correct. The question is WHICH is your standard of training.

You completed a curriculum that only gradually increases in aggressiveness towards hemorrhage control. It subscribes to an ANTIQUATED doctrine that still exists that tourniquets destroy a limb by cutting off all blood flow.

More recent studies discredit this information and has shown little long-term adverse affects either nerve or vascular due to tourniquet application even for hours. This however is new. The old "bad" information hasn't been fully processed out of the curriculum.

The issue for you as first responder is whether you can apply that information without some risk. If you deviate from the standards of our training, you open yourself up to significant liability. This may not be a problem if it's YOU that's got the hemorrhage, but if you have to treat someone who might end up suing you, they might make an argument that you deviated from your standards and therefore not covered by good samaritan protections. My suggestion is to be very quickly moving through the different levels (you can probably ignore the pressure point method) until you get to the tourniquet. You talked about 30 minutes of trying to stop bleeding, that's not realistic to my way of thinking...you should have moved through the steps within 2 minutes. You also have to consider that you're probably going to have to move/transport someone.

If you go through those steps, albeit quickly/perfunctorily, you limit your liability as its still consistent with your training standard. You're a lawyer and you know how it works.

CPR has almost 0% success, I've never seen it work but I almost always got there several minutes after the person went down. If applied rapidly (within seconds) it might have greater effect. Mostly paramedics do CPR to show the family that we're trying to save the person pumping blood until we can get to a hospital where the Doc can call it. If you're having to apply CPR to a guy for massive hemorrhage he's pretty much dead.

PS. I don't care what class you take, you're not going to be doing a chest tube. No First Responder is going to have the wherewithal to put in a tube. Your buddy has an exceptional amount of training, but I'd be skeptical that he gets to apply it that often.

Just got my First Responder/CPR/AED/O2 certification. OK, yea me.

Spoke with a very good friend who, as part of a full-time tac team, received quite a bit of advanced emergency trauma training. We talked about the stuff I'd learned in class and his opinion was that most of it was wishful thinking. He doesn't claim to be an expert by any means, but it raised a lot of questions that I thought the experts here might be able to explain.

Examples:

Tourniquets: Official DOT/ARC word-of-God is that you never put a tourniquet on unless you've decided, in effect, to amputate the limb. Official procedure is bandage, if bleeding continues more bandage, if bleeding continues pressure point, if bleeding continues then tourniquet if and only if medical help is > 30 minutes out.

I'm not a doctor, but I have a hard time believing someone with a sliced open femoral artery is going to last 30 minutes. When I raised this point in class, the instructor basically said, "this is what DOT/ARC teaches ... use your judgment."

My friend's take: if you know you have a serious arterial bleed, it's time for the tourniquet. By the time you've gone through all the other steps, the victim might not have enough blood left to be worth worrying about. Also, contrary to the DOT/ARC view -- "once you put a tourniquet on you've poisoned the limb and it's probably going to be lost" -- apparently there is quite a bit of evidence that limbs have survived hours after a tourniquet.

So which is it?

Open chest wound: We were taught occlusive dressing, taped down on three sides, and "burp" the air/blood from a pneumothorax or hemothorax.

Friend's take: you need to get something inserted into the chest to drain the pressure actively. This is obviously well beyond the scope of what we were taught in EFR.

CPR: Based on what my friend relayed and what I read here in the "when your patient dies" thread, it sounds like CPR has an almost 0% success rate. WTFO? Is that a matter of timing -- professional rescuers arrive too late for it to matter, but someone on the scene at the moment of arrest might be able to make a difference -- or is it really just a feel-good thing that people learn to say they've learned it?