I recall a past FAC Conference where Prof. Keith Porter (trauma specialist) talked about tourniquets. He said If I recall) that they often keep them on for more than an hour.

I believe that, as Dave has suggested, its to do with the toxin release.  In the far reaches of my mind i can remember somewhere that the toxin release can lead to hypotensive crisis which may in turn lead to cardiac arrest.  Even a simple saline IV line can give some circulatory support.  Haartmans solution is better for this as i believe that it can neutrelise some acidosis, though iam prepared to stand corrected.  Maybe a First Aider could use the Capilary Refil test to determine the extent of lack circulation to the extremity, however, how many would have the confidence and experience to make such a call. 

suspension trauma protocol - you should keep sitting not flat.

From the missing part of the forum:



PHECTA
 
    Posted: 21 Aug 2008 at 5:58pm
Well here is a good one for debate

Why is there such a short time period on when first aiders should or should not release a person crushed by a heavy weight??

This is one for the pre-hospital practitioners to ponder over, as often, there is very little difference in the first aid and ambulance aid treatment the victim will receive, and often ambulance staff will seek rapid extraction of the casualty where life threatening injuries are presenting.

Although the treatment may differ in a hospital environment, rarely does the treatment differ from a person trapped and crushed for 30 minutes as oppose to 5 minutes.

so learned friends lets open  this debate and see if we can either support current practice or challenge current practice

i leave this open for rational sound debate

David



DontForget2Pull
 Posted: 21 Aug 2008 at 6:11pm
I would say after the time period given; between lifting the weight and advanced care arriving the casualty may be poisoned due to his/her injuries. First aider are not equiped and trained to deal with the situation.



DontForget2Pull
 Posted: 21 Aug 2008 at 6:27pm
David what 's the treatment for the potential poisoning due to an RTC, lets say victims legs crushed. Paramedics on site.

Thanks

DontForget2Pull
 
 Posted: 21 Aug 2008 at 6:55pm
A little research on the internet, I ve found out Sepsis(Bloodpoisoning) treated with antibiotics.



chris.rigby.69
 Posted: 21 Aug 2008 at 7:05pm
As I understand it, if the crush injury occludes blood vessels, toxins are built up in the trapped blood (presumably a mixture of waste products from the cells and byproducts from anaerobic respiration). If these are returned to circulation too quickly, they can kill. First Aiders (of which I am one) don't have the knowledge of this, or how to avoid it, so are taught to let the professionals deal with it




PHECTA
 Posted: 21 Aug 2008 at 9:04pm
Gentlemen thats why ive posed this conundrum

As we do not use tourniquets in the ambulance service (This was the old method for preventing toxins moving through the cardiovascular system and throughout the body in olden days) i was wondering what magical tools the boffins conclude that us mere paramedics may use as opose to the first aider to prevent toxin saturation?

We seem to be letting patients suffer under weights so that when an ambulance crew arrive (and the crew may not have a paramedic on board) to simply release the weight??

so again i ask  should we not challenge current practice??

i leave this open again for discussion

David




resq
 Posted: 21 Aug 2008 at 9:59pm


I think the issue lies with the devastating effect a large amount of lactate and potassium would have when the pressure was realeased into the circulation.

Suddenly you are faced with a situation where the electrolyte imbalance and sudden influx of potassium will cause a cardiac arrest.

I have no idea what the answer is other than a medical team on scene for prolonged entrapments/severe crush injuries.


Having never been in this situation for prolonged entrapments I am only guessing but I supose you could buffer them with bicarb and calcium prior to release but I suspect that would be very hit and miss. Peritoneal exchange with a buffered solution may support the kidneys. Not routinely carried out pre hospital.

I wonder if the removal of tourniquets from the ambulance arsenal is to ensure the call of a mobile medical team with specialist expertise and kit. 

When I get back to work I will pose the question to the trauma gods I work with and ask their opinion. I will report back.




mediaid
 Posted: 21 Aug 2008 at 11:17pm
I believe that first aiders are recommed not to remove if trapped for longer than 15 minutes is down to Shock (Hypovoleamic) which may suddenly accur following sudden release of crushing object and bllod rushing into the tissues. Parmedic's are normally recommended to insert two large canuler's before removal but if prolonger (30 minute plus) should consider Medical Team who pay satart drugs to combat the toxin (Moist-Gangrene) build up.
 
Different countries have different time scales. I believe the condition was first indentified/recorded during the First World war (Murphy 1914 (fasciotomy) ) but had been seen ealier but not understood clearly.
 
 
z
 
 


Edited by mediaid - 21 Aug 2008 at 11:19pm
Richard
Mediaid Training Services Ltd
www.mediaid.co.uk



chris.rigby.69
 Posted: Yesterday at 1:19am
I attended a talk on suspension trauma, which talked about the same thing. The effect of suspension trauma as far as I'm concerned fr this example is that of having both legs crushed at the top of the legs. The guy who gave the lecture said to in no circumstances lie them down. Whilst he recommended calling the pros, he did say that the best treatment would normally be to get them into a sitting position, allowing the toxins to gradually leave the affected tissue rather than all leaving in one rush.
 
He was also only an FA IIRC, but kind of makes sense to me

Thanks all for the input