⚠️Can you spot the critical errors in this tourniquet application?

⚠️for educational purposes, fake wound and blood. Can you spot the critical error in this TQ application? To be honest, I missed it too because I was filming with one hand and pressing the syringe with the other. I only caught it when I reviewed the video before posting about teaching our youth. So shame on me for missing this as an instructor. The learning point here is that we get so focused on stopping the bleeding with the TQ and forget about the last final details of correct TQ application. Can you spot the mistake? Let’s save lives together and I will personally learn from this💪 #traumapak #bethedifference #tourniquet #savelives

[Traumapak]

Thank you to all of you for being vulnerable and commenting on what you see as the mistake. All your comments are truly appreciated A So there is a difference between the following: Critical…important...
recommended…preference...and situation dependent. There are always a few variations on how to treat the same injury or respond to the same incident but there are also times where things are black and white and there is a standard of care. Those would be what I consider "Critical" (as in if they are not done, someone will die or get seriously hurt). With that, the critical error in this video is that the strap was accidentally routed the wrong direction and any second the Velcro would give causing rapid and immediate failure of the tourniquet.
The other things mentioned in the comments fall under all the other categories like Important(gloves, too many turns on the rod or even trying a pressure bandage first depending on other circumstances like other patients or multiple injuries to this patient). As far as the gloves they don't fall under critical error in my opinion because failure to apply them has no impact on the success or failure of the tourniquet. However if you're taking an EMT test you would fail if you didn't wear them. Under the recommended category and again not critical would be the example of where to apply a tourniquet. It's recommended 2-3" above the wound and not on a joint or high and tight when under a threat. In this case the joint is 2-3" above the wound and everyone perceives a threat differently depending on their training and experience.

[bigrod]

he is putting it on a limb, gone from the body

[astrovical]

back in my day the comments had the answers 💀💀

[km]

For starters he forgot to put on gloves. Then you only need to tighten as needed to stop the bleeding. This student stopped the bleeding and wound that sucker even more. Too much dude. Depending on what course this is, he might have to do more talking to the imaginary patient and start the MARCH process, ask some basic questions to assess alertness and orientation. It's also sometimes protocol to apply pressure first and if that doesn't work you then you move to the tourniquet. It's very important for students to follow the outline protocol to learn everything first. If they want to go straight to a tourniquet let them do so when they have more experience as a first responder.

[aaronr]

This would be good enough, but ideally you get the velcro strap to finish the same direction as you start. (He doubled back.) Also, better to be too tight than to continue to lose blood. But too tight can also cause nerve and tissue damage, especially as time goes on (>120 minutes). He could have stopped cranking 1/2 turn after the blood stops. If applied properly, it can always be cranked tighter later if bleed resumes. No reason to torture somebody beyond necessity.

[spacemonkey]

To creator: you need to have the answer somewhere, people have no clue what the "critical mistake" is. There is no point in this video if people won't learn from whatever this mistake is.

[ChrisC]

The true critical error is telling the trainee it's FINE when there are a few errors. They won't learn if you don't tell them what they're doing wrong. Time on applying your tourniquet is the biggest error.

[kgrssrc]

Dang is he trying to kill the arm??? Too tight

[whatdoinamethischannel]

Shouldn’t the strap be over the other side to secure it properly to prevent it from giving out?

[christincoulter]

1. No gloves, 2. Need to apply direct and firm pressure

[btappe]

Looped the velcro the wrong way, its gunna loosen. Also talk to your who youre helping and keep them coherent. Keep them stimulated or they'll go into shock.

[benni]

The initial pull on the strap is what matters most, you mist have the red tip towards you when applying to maximize the firt pull, if you do not pull hard enough in the beginning you can tun the handle 20 times and will still not be affective.

[teofilocarrasco]

I only tighten to the point the bleed stops. There were extra turns made. Also, document when the tourniquet was placed. It could also have been placed nearer to the elbow and not mid bicep.

[esthertownsley]

No PPE, but probably most importantly, he didn't apply direct pressure.

[loganacuff]

he velcroed the strap the same way it was put on at the end, causing the tourniquet to come off/loosen if the strap were to be pulled any

[maplelass]

Old former trauma nurse here. First, grab a dressing and apply pressure over the artery spurting. Then, if you must apply a tourniquet, time of application is essential for ER to know. Any tourniquet must be secured firmly whether velcro or in a barn with a belt and a stick. Yes, patients have come in with all kinds of makeshift tourniquets. Again, "how long has it been on?" was the question asked first.

[ExperimentalKana]

paramedic here, idk what he meant by wrongly routed i couldn't see properly in the video,

he didnt have gloves, and in this situation you wouldn't use torniquet, instead a medical pad (its called wundauflage in german) and create a pressure point with pressure bandage and fixate it with a gauze roll (mullbinde) or trianular bandage then if it doesn't stop then use the torniquet because it cuts the bloodflow to the whole limb so there is risk of necrosis after a while

[goodinsrt]

The biggest error is trying to stop the bleeding on a severed limb.

[SPACKLEBOX]

I was going to say that the trainee did not write (or verbalize that he/she would write) the time of TQ application on the white velcro - which would count as a fail for this skill. But having read the answer, it definitely makes more sense that the white velcro strip should've been moved to expose more of the windlass clip's male-velcro surface to allow a better securing of the loose strap.

Excellent demonstration of an easily overlooked misstep. This is why we must train continually.

[TheWraithone]

If you don't have a fancy one like this, you can use a stick or something ridged to twist whatever you can find to wrap around the injured area, always above the injury site. A good hands length above should suffice. Second, always write the time of application somewhere close to the tourniquet. Once on, do not remove unless you're the dr taking it off. In the event you can not make one, a properly applied pressure dressing can buy you the time needed in an injury of this nature. If it's a Severed appendage, only a tourniquet will work. Unless you can find something to clamp or tie off the artery. Fyi any length of fabric can be used to make one. Most of us have shoe laces, and that will work well. Rule of thumb: Once the patient starts complaining, the tourniquet is hurting more than the injury. You're on the right track of stopping the flow of blood. When applied right, it's going to hurt like hell.