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Incidents
Re: [platypii] Ammon McNeely
By no means am I trying to be rude, I'm just confused how replacing brake lines would have factored into the equation... I can see if you're changing the length, but on gear that you have used with "precision and confidence" in the past why would you do that? Again, simply trying to learn from this.
Re: [xnewmanx] Ammon McNeely
He said they were fraying. If I consistently use the same setting I've had to replace them after 100 jumps. An old friend spun into the ground after the brake line broke on the setting so I use caution if I notice any wear and change them. Larger people experience more wear than smaller.
Re: [base698] Ammon McNeely
base698 wrote:
He said they were fraying. If I consistently use the same setting I've had to replace them after 100 jumps. An old friend spun into the ground after the brake line broke on the setting so I use caution if I notice any wear and change them. Larger people experience more wear than smaller.
Right. But he said that he had just replaced them... they were new. Wouldn't they be replaced with the same length?
In reply to:
I adapted and learned to jump this older gear with precision and confidence. But, I started to notice that one of my brake settings was getting a bit frayed and needed replaced. This is where I should have been a lot more cautious about something new, but with 1000+ jumps, felt quite confident. Just like in climbing, it's best to experiment with singular differences rather than a handful, or even a couple of new variations. In this case, new brake lines and an exit that I had never experienced before.
Re: [xnewmanx] Ammon McNeely
He could have had a customized deep setting that wasn't there when the line was replaced.
Re: [base698] Ammon McNeely
base698 wrote:
He could have had a customized deep setting that wasn't there when the line was replaced.
That's the only thing I can think of as well... It just seems impractical to do it to gear you've perfected.
Oh well. I hope he gets better soon. The pictures are gnarly...
Re: [xnewmanx] Ammon McNeely
xnewmanx wrote:
base698 wrote:
He could have had a customized deep setting that wasn't there when the line was replaced.
That's the only thing I can think of as well... It just seems impractical to do it to gear you've perfected.
Oh well. I hope he gets better soon. The pictures are gnarly...
ANY time you change a critical path, it's a good idea to test it in a non-critical environment -- like he said, a bridge or somewhere else "safe."
On the other hand, 180s happen whether you change anything or not, so we'll never know if it was a "real" factor or just a possible factor.
In any event, he followed the old standby: Never ever give up (and always say hi to Mom).
Glad he made it through alive and still in one piece. Hope he gets to keep the OEM foot and not need an after-market model. He earned a second chance for that unit.
44
Re: [platypii] Ammon McNeely
Mad props to Ammon for possessing the mental & physical toughness, as well as the ingenuity and presence of mind to rapidly assess and treat his life-threatening injury. A different jumper in the same situation could have very possibly found him or herself on this forum as fatality. Also, thank you to Ammon for making the details of this incident available for the other jumpers to learn and hopefully benefit from. This incident highlights the importance of being prepared for any possible outcome of a jump. I would argue this applies to mental preparation and first aid training as well as being properly equipped. Since shortly after I started jumping I've kept a combat tourniquet < http://combattourniquet.com/> and other goodies for life-saving hemorrhage control in one of my saddle bags for just such a situation happening to myself or buddy.
Fortunately, Ammon's quick thinking and knowledge of first aid enabled him to improvise a suitable tourniquet to stop his arterial bleeding and save his life. Ammon, fortunately also had buddies with him on the jump capable of expediting his rescue, which is another important point to consider as well, but even they did not reach him right away. It was up to him save his own life.
The incident serves as an opportunity to other jumpers to reflect on whether they are adequately prepared both in being properly trained and properly equipped to respond to a similar situation. How many of us for example keep the essentials of life-saving hemorrhage control with us on every jump? How many of us know how to apply a tourniquet or pressure bandage to stop bleeding?
The gear discussion that’s taking place is important as well, but we may never know if his brake lines were the cause here; after all, lots of folks have had 180s and wall strikes for all kinds of reasons. I think what’s more important to shine a light on in this case is the jumper’s actions after the jump that almost certainly saved his life.
Thanks again to Ammon for sharing his story, and best wishes for a speedy and full recovery!
Re: [1064] Ammon McNeely
Looking at the pictures I was having trouble understanding what I was seeing. Was it a compound tib/fib or an open dislocation of the ankle? I'm very glad you were able to keep it. Again out of my gruesome curiosity, How long was the tunicate on the leg? Was there any sign of circulation to the foot? Were you able to straiten it to restore any form of circulation? And did you try to loosen the tunicate at any time to try to circulate any of the blood? How long was the wound open over all before you reached the hospital? Lee
Re: [Treejumps] Ammon McNeely
I thought the South Africans, Aussies and Russians were the toughest.... Turns out Ammon one up'ed us all. Well done on a well handled situation and heal up well buddy
Re: [xnewmanx] Ammon McNeely
xnewmanx wrote:
base698 wrote:
He could have had a customized deep setting that wasn't there when the line was replaced.
That's the only thing I can think of as well... It just seems impractical to do it to gear you've perfected.
Oh well. I hope he gets better soon. The pictures are gnarly...
I am having a hard time grasping this because it seems painfully clear to not change brake settings and jump a slider down cliff...my brain is telling me I MUST be missing something because nobody would do that.
Heal well Ammon...I've always admired you on super taco.
Re: [RiggerLee] Ammon McNeely
I'm in the army and during CLS training they tell us a tourniquet can stay on for up to 24 hours and you can still save the limb. That seems like a long time, but the human body is more resilient than some might expect. At risk of sounding like a Monday morning quarterback, the tourniquet probably should have gone above the knee because there's some space in between the tib and fib that won't get cut off. Above your knee, you just have one bone, the femur, so you can cut off all the circulation. However, he's going to keep the foot, so it's hard to argue with success.
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
Should be released and retightened every 15 mins.
That is not true.
Do not loosen or release a tourniquet after it has been applied and the bleeding has stopped.
Re: [hookitt] Ammon McNeely
Yeah wait until gangrene sets in. Cut all blood supply to a limb for more than 15mins and see what happens.
Re: [Holdfast] Ammon McNeely
I believe common practice is if the wound significant that patient can go into shock or can bleed out. Leave tourniquet on. This is basic boy scout stuff.... Watch who you jump with IT MAY KILL YOU.
5. Don’t release in the field if the patient is in shock, has an an amputated limb, or has a wound site that cannot be monitored for re-bleeding.
6. For a long evacuation, wait an hour before trying to release it. If bleeding starts again, re-secure. Note the time and leave it in place until definitive care is reached or arrives.
7. Under dangerous circumstances, one may be applied before a thorough evaluation is possible. These should be applied to the proximal thigh or arm if there is any question about the location and/or number of wounds. Carefully check the wound when it is safe and feasible. As indicated, leave, reposition, or release it or add a second one proximally.
Re: [Huck] Ammon McNeely
From very real experience; tourniquets are difficult and potentially dangerous to use. Their application is often questionable and may in some cases be more damaging than life saving. Restrict all blood supply/circulation from a limb and see what happens. Get real Hookit. The Military recommend applying pressure to the wound with a FFD to try and stop bleeding and only using a tourniquet if its pressure is released every 15/20 mins.
Re: [Holdfast] Ammon McNeely
OK. IF THAT IS TRUE... then I'll stand corrected. The documentation I have read states otherwise in cases like Ammons. I'll be reviewing, relearning, and modifying as needed... if it's needed. Do you have a reliable website link I can look at in the mean time? Not being lazy, just not able to use anything more than my phone for a day or 2.
Don't worry, I will continue to update my first aid training.
Pointing people in a good direction is helpful and appreciated.
Re: [hookitt] Ammon McNeely
This is kind of why I asked. I've actually heard both statements over the years. That the blood quickly becomes stale, acidic, and that loosening a tunicate can allow that blood to reenter the body putting it into shock. They say that if you're going to resort to a tunicate that you must make it tight and just write off the limb. That it's application garenties an amputation.
I've also heard that if the patent is stable enough to survive the increase in blood lose that you should try to loosen the tunicate, the number I've most often heard is 15 min intervals, and let some of the blood try to circulate if possible.
I've also heard that they are getting better at dealing with the shock issues of removing the tunicate under hospital conditions and that there is now a higher probability of saving the limb even if the tunicate has been left tight for an extended period of time.
I was kind of hoping some one might pipe up with the current recommendations.
Lee
Re: [hookitt] Ammon McNeely
The Military would seem to be a good place to start, they seem to have some current experience with limb loss in the field. Crash medics are also very hands on and I am sure would be willing to give solid advice. Boy Scouts; less so.
Re: [RiggerLee] Ammon McNeely
Yep, me too Lee. Holdfast, many of us have been at this a long time, and some even longer. Educating is a lot more helpful than telling me to get real
Correcting us or verifying how we think goes a long way.
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
The Military would seem to be a good place to start, they seem to have some current experience with limb loss in the field. Crash medics are also very hands on and I am sure would be willing to give solid advice. Boy Scouts; less so.
I'm not joining the military so perhaps the (sort of) local pararescue folks would be available to help.
Re: [hookitt] Ammon McNeely
Better just keep a photo of McNeely in your wallet and take a look before you jump, maybe that way you'll never need to learn.
Re: [Holdfast] Ammon McNeely
[… tourniquets are difficult and potentially dangerous to use. Their application is often questionable and may in some cases be more damaging than life saving.] In my experience manufactured tourniquets, such as the Combat Action Tourniquet (CAT), are fairly easy to use. In fact, they are designed to be capable of being applied one handed in the event an individual must self-apply to an amputated upper extremity. Improvised tourniquets are another story and depend on the individual applying them and the materials available.
You are correct though that tourniquets should be used only when the patient is experiencing otherwise uncontrollable and potentially life-threatening arterial bleeding (i.e. bright red blood spurting from the wound). Ideally tourniquets should only be applied by properly trained personnel. However, once a tourniquet is applied it should not be removed except by medical personnel at the trauma center to which the patient is taken. See below an excerpt from the Army field manual for first aid, FM 4-25.11.
“Once applied, [a tourniquet] must stay in place, and the casualty must be taken to the nearest [medical treatment facility] as soon as possible. DO NOT loosen or release a tourniquet after it has been applied as release could precipitate bleeding and potentially lead to shock."
To reiterate, Holdfast is correct that a tourniquet can cause undue harm if it is misused or used unnecessarily. Tourniquets shouldn't be used unless needed to control life-threatening blood loss (like the kind described by Ammon in his account of the incident), but once applied should not be loosened or removed except by medical personnel. Like a previous poster in this thread I have also been trained that tourniquets may be left on for up to 24 hours while still retaining the possibility to “save” the limb. The same can’t be said if the person has died of blood loss or shock.
Re: [Holdfast] Ammon McNeely
The military has trained me to never loosen or remove a tourniquet once it's applied. It's also a good idea to mark "T" on the forehead of the person with the tourniquet on. However, I'm not some bad ass SF guy.
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
The Military would seem to be a good place to start,
Yeah, I just checked with them (as did 1064 above). They say you're wrong.
A tourniquet is a last resort, but once applied it should not be released. In that situation saving the patient's blood is more important than saving their limb.
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
Should be released and retightened every 15 mins.
NO!
Edited to add that documenting when it was applied is a good idea in case you pass out, that way the medics know there is one, and how long it has been on.
SAVE BLOOD, ITS MORE IMPORTANT THAN FIGHTING INFECTION IN THAT ENVIRONMENT!
Re: [RiggerLee] Ammon McNeely
[I was kind of hoping some one might pipe up with the current recommendations. ] Prior to the present conflicts the prevailing miltary doctrine regarding controlling traumatic bleeding of an extremity was a three step "escalation of force" type response of attempting progressively more invasive hemorrhage control measures in the form of the following.
Step 1. Field Bandage
Step 2. Pressure Dressing
Step 3. Tourniquet.
Soldiers were trained to use the least invasive means likely to control the bleeding and move to the next only if the less invasive means failed. This came about because during the Vietnam conflict medical evacuation following becoming wounded generally took a long time and battlefield medicine wasn't as advanced as it is today. So if you got a tourniquet you were probably going to lose the limb. Therefore a lot of emphasis was placed on not using them unnecessarily.
Fast forward to post-911 conflicts: Soldiers had been trained the same way since Vietnam to stop bleeding, going through an exercise where they would sequentially apply the field dressing, the pressure dressing, and then finally a tourniquet. In battle, we do not rise to the occasion; we fall to our level of training and preparation. So, when Soldiers in Iraq and Afghanistan started getting serious wounds to the extremities their battle buddies often times instinctively followed their training and sequentially applied field dressings, then pressure dressings, and sometimes finally tourniquets for wounds that just flat out just needed tourniquets from the get go. They hadn't been as well trained to assess when a tourniquet was needed immediately. This is obvious in an amputation, but less obvious for applicable puncture wounds or lacerations
Unfortunately some troops were dying of their blood loss that could have been saved if they had had tourniquets applied from blast. So the doctrine eventually shifted to training troops to (1) better recognize when bleeding presents significant risk of loss of life and (2) made applying tourniquets to life threatening bleeding of the extremities the primary course of action rather than going through other less invasive steps first. When coupled with much quicker medical evacuation and more advanced 21st century trauma care at role-3 medical centers the result was more lives saved and also the eventual knowledge gained that limbs can "live" longer than previously expected with a tourniquet applied - up to 24 hours.
Re: [1064] Ammon McNeely
In reply to:
Step 1. Field Bandage
Step 2. Pressure Dressing
Step 3. Tourniquet.
4. Elevation, above the heart?
From the video it seems like he elevated it. Good work
Re: [MBA-FRANK] Ammon McNeely
Right on... elevation of the legs, intended to help keep more blood in the torso where vital organs hang out, doesn't hurt and is considered one of the standard measures for preventing/treating shock. Severe pain however can also contribute to the onset of shock. In this case he probably got himself in to whatever position was most comfortable and/or least painful. It might have been exceedingly painful for him to try and elevate his leg up above his heart or he might not have been in a position to recline. He did appear to have his leg sort of propped up in front of him though.
Re: [MBA-FRANK] Ammon McNeely
The purpose of a tourniquet is not to save the limb. It's to save the patient's life. If you get to the hospital and they can also save the limb, that's bonus. It's true that the military has changed their policy since 9/11. Now the default treatment for massive blood loss from a limb is to go straight to a tourniquet above the elbow or knee. Google "combat lifesaver" and look at the study guide. This is the most up-to-date medical training that average soldiers (non-medics) get.
Re: [jws3] Ammon McNeely
Then apply a tourniquet on yourself, leave it there for a while and see what happens. The idea of loosening and retightening a tourniquet is to allow blood to flow into the limb or what remains of it following trauma, this is to try and save whatever is below and prevent gangrene. Imagine severing the femoral artery, having a tourniquet placed near the groin for an extended period of time and then loosing the entire leg to gangrene because it was not released occasionally. Think people.
Re: [Holdfast] Ammon McNeely
I would defer to Doc Peabody for his specific experience, but I was always trained to put a tourniquet on and leave it. BUT never apply one unless you have made the conscious decision to sacrifice all tissue below the wound in order to save the life. I've only been around full amputations though, so it was an easy decision.
P.S. Ammon, you're a fucking beast yo. Mad ups my man. Heal up.
Re: [Holdfast] Ammon McNeely
I dont agree with releasing it. If I have a tourniquet on it is because I am at risk of dieing from blood loss. If you have a short time to get professional care, maybe, but everytime you release the tourniquet you are loosing your juice. Keep it tight. The right choice needs to be made between direct pressure vs. tourni. Its all situational. Another option is the quick-clot type compound, might be useful for an emergency kit. I have some in my med pouch.
http://www.z-medica.com/
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
Should be released and retightened every 15 mins.
You are wrong. Very very wrong. Once the tourniquet is applied you do not touch it until the hospital. The medics I fly with (you know the ones who actually flew Ammon) say you leave it in place.
Do as you please on yourself but I'm going to listen to the guys who do this for a living
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
Then apply a tourniquet on yourself, leave it there for a while and see what happens. The idea of loosening and retightening a tourniquet is to allow blood to flow into the limb or what remains of it following trauma, this is to try and save whatever is below and prevent gangrene. Imagine severing the femoral artery, having a tourniquet placed near the groin for an extended period of time and then loosing the entire leg to gangrene because it was not released occasionally. Think people.
You don't seem to comprehend that having such a serious wound in the first place is a really fucking shitty situation and you don't get to have everything your own way. You must prioritise and the limb is not the top priority. Imagine severing the femoral artery and bleeding to death because some tool loosened your tourniquet.
You need to think about what you are saying. Your plan of action is to let a patient die in order to attempt to save a limb. Well guess what, if the patient runs out of blood the limb dies too.
(And that comes from the US military too - the field manual is available on line.)
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
Should be released and retightened every 15 mins.
How long does it take for gangrene to set in? 15min? 16min? 13min?
If you try this method you may release gangrene back into your system where you dont want it to be. apply the tournequit, mark t in blood like a real man, and the time you applied it. sit back, drink a beer.
Re: [JBag] Ammon McNeely
Being that it took hours to get Ammon off the talus, He might have bled to death if the tourniquet was released every 15 minutes. But what do I know, I'm not a Dr. or a paramedic. It would be helpful if the comments to release every 15 minutes, or keep it on were backed up by a source such as a reputable link, manual, paramedic training etc. Otherwise, an erroneous comment may kill someone. Here's what I found from what looks like a legit website from hopefully real Dr's.
http://www.ncbi.nlm.nih.gov/...articles/PMC2660095/
The article states, "A policy of periodic loosening of a tourniquet in an attempt to reduce limb ischaemia has often led to incremental exsanguination and death."
ischaemia: an inadequate supply of blood to an organ or part, as from an obstructed blood flow.
exsanguination: the action or process of draining or losing blood.
Re: [Holdfast] Ammon McNeely
I appreciate all the kind words. I've had a little time to gather some info. I'm going to continue with my thoughts on the subject. If there are exceptions, there sure didn't appear to be one when it came to Ammon. He wrote his foot off, not only survived, he still might be keeping it.
Good luck Ammon.
Re: [1064] Ammon McNeely
Sorry, that is the only link I have, it was on the book so i just copied it. The video shows Ammon's injuries and he absolutely cool, calm and collected while facing a potentially limb losing situation.
I have a ton of respect to him for that.
I'd like to add that boots might have helped to keep it all together and lessen the potential for amputation. Dress for the worse, hope for the best.
Re: [FrankieB] Ammon McNeely
In my humble opinion, tourniquetes should only be used in a life threatening situation where exactly as people stated, you will bleed to death if you dont. You should always assume you will lose the limb when you apply a tourniquet, because you should be in a situation where that is the best case scenario. That being said, it is still plenty possible to salvage a limb in this situation. Many surgeries, especially orthopedic type procedures use tourniquetes for serveral hours or more during operations to reduce bleeding in the surgical field, and these do fine. Moral of the story is use them if you need them, and youll know when you need them.
Re: [FrankieB] Ammon McNeely
It would be helpful if the comments to release every 15 minutes, or keep it on were backed up by a source such as a reputable link, manual, paramedic training etc. You are wrong. Very very wrong. Once the tourniquet is applied you do not touch it until the hospital. The medics I fly with (you know the ones who actually flew Ammon) say you leave it in place.
is that not good enough?
Re: [Dadsy] Ammon McNeely
This comes from very real hands on experience; most recently from Central Africa. (Common typical injuries from AP mine, blast, fragmentation and laceration/amputation from machete). WE do apply tourniquets as IA to stem extensive bleeding but release their pressure every 15/20 mins in coordination with applied pressure. An effort is made, where possible to locate the source of the bleed and stem it with an artery clamp or similar instrument. The reason that we release the pressure is to try and conserve the limb, however the situation will dictate the measure. eg Immediate risk, How far, position, nature of primary and secondary injuries, expected aid/type etc. Infection being the secondary most probable cause of death. Current American field training is designed around a designated battle zone with extensive support and cassevac. Not all situations will be under such direct influence. If you are untrained, get trained, your buddy will not thank you for being the reason he lost his leg when it could have been saved, or worse.
Re: [Holdfast] Ammon McNeely
It needs to be said here as well, these are very different injuries. Blast injuries with partial amputations and continued bleeding, sure, why not. Complete amputations with arterial spurting or an injury like ammons which is very close to an amputation with arterial bleeding and already a large volume of blood loss, keep that shit on. Also, if the patient is receiving blood/fluids already, then the protocol is much different than if they are just bleeding to death in the middle of no where. For most people on this board for very basic and general knowledge, if there is bleeding and its bad, try holding pressure first. Youll know quickly if this is a scenario where this isnt going to work. Limb ripped off, blood spurting everywhere... tourniquete. If you are going to do one, do it like you mean it, and just assume whatever is downstream of the tourniquete might die. These really should only be used in a life or death situation.
Re: [hjumper33] Ammon McNeely
In my opinion, McNeely should never have expected to have an amputation, except of course if he did not receive medical attention within reasonable time, or the foot being in unsuitable state to save due to infection/gangrene. This is proven by the operation and excellent after care. He was in civilized zone (not war zone or without assistance) with cassevac to hand. In most cases that you are likely to witness the situation will be similar and the person has a right to expect to save his limb. I would not want to be his "friend" that failed to carry out a simple procedure that compromised that chance and destroyed the limb below the tourniquet. However IA: stop the bleed.
Re: Ammon McNeely
Only have experience talking to an SF medic in the UK and his experience dealing with multiple amputations from blast wounds and the odd civi issue like motorcycle accident amputations etc, he said once he applies the tourniquet he will not release it, leave that to the hospital. I was advised to stop any catastrophic bleeding first then deal with anything else. Most serious/life threatening to least serious. p.s. Ammon took that like a champ.
Re: [Holdfast] Ammon McNeely
you seem to have very strong opinions on this, do you have a background in this area?
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
where possible to locate the source of the bleed and stem it with an artery clamp or similar instrument.
Well then obviously Ammon is a complete idiot for not waiting to see if any of his buddies happened to be carrying some spare artery clamps. Or better yet, digging around in his own traumatically amputated leg to pinch off the artery with his fingers
Ammon, you definitely earned yourself a spot on the list of "Hard Cunts".
Re: [Fledgling] Ammon McNeely
Seems like he did "wait around." Shame 1064 wasn't there with his CAT. All credit to McNeely, he roughed that one out. Maybe now that "Chopper" has passed away he can replace him.
Re: [Holdfast] Ammon McNeely
[..Shame 1064 wasn't there with his CAT.] Hate on me if you must Holdfast, but please, leave the poor defenseless CAT out of it.
Re: [1064] Ammon McNeely
No hate on you my friend; this is a forum to discuss and hopefully learn, or maybe I got that wrong?
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
In my opinion, McNeely should never have expected to have an amputation, except of course if he did not receive medical attention within reasonable time, or the foot being in unsuitable state to save due to infection/gangrene. This is proven by the operation and excellent after care. He was in civilized zone (not war zone or without assistance) with cassevac to hand. In most cases that you are likely to witness the situation will be similar and the person has a right to expect to save his limb. I would not want to be his "friend" that failed to carry out a simple procedure that compromised that chance and destroyed the limb below the tourniquet. However IA: stop the bleed.
Just to clear this up, Moab is highly rugged terrain. There is no "simple procedure" rescue most of the time. Even if someone is only 400 feet vertical above you, the talas is often complicated to ascend. You can see and have verbal communication with someone but to reach them can take hours.
The spot he was in fully justified Ammon's thinking. It was obviously a gnarly injury and one that even in a "civilized" zone can still be life threatening. This is not a flat ground Kansas rescue. Even helis will have a hard time navigating right next to cliffs to operate any personnel plucking (hopefully Cutter can chime in on this because of his knowledge on this subject). So, yes we are here to learn but you are making some pretty ridiculous assumptions.
Also, I am going to order a new canopy and possibly container for Ammon. Please PM me if you would like to help contribute. We have to get the pirate back in action! Yarrrr!
Re: [Holdfast] Ammon McNeely
I was in the Norwegian army for three years up until 2011 and have extensive training as a medic. At one point I was patrol medic in my unit so I have my fair share of training and knowledge on this field. Thought I drop my 2 cent here since this is important and can be the difference between life and death. Why do you apply a tourniquet? It is not to save the limb beneath it, it is to stop the patient from bleeding out and dying - that is the ONLY purpose of it. Holdfast you are right in some things but releasing/tightening the tourniquet every 15/20 minutes is outdated and not the way to do it with severe arterial/venous bleedings. However, there are exceptions and I will explain them further down*
Yes - "blood becomes stale, acidic, and that loosening a tunicate can allow that blood to reenter the body putting it into shock"
This is correct and it will occur with the blood in the limb that is cut of beneath the tourniquet. But you DO NOT release the tourniquet to prevent this on someone who is bleeding out. That happens on the surgery table in the hospital.
If you stumble upon someone with a severe bleeding (like an arterial) you do 4 things:
1) STOP THE BLEEDING
2) STOP THE BLEEDING
3) STOP THE BLEEDING
4) CALL FOR HELP
The same goes for yourself. Stopping the bleeding is priority number one, and you are not doing it to save the leg/arm, you're doing it to save the life. A tourniquet will do this and you tighten it till it wont tighten anymore...
* Here is the exception - it all comes down to how severe the trauma is and what you have at hand. If you have a deep cut (for example, a wrist cut) and arterial bleeding you stop it, any means possible. Get your hand on it, apply pressure, dig your knee into the armpit, put a tourniquet on. Now you have stopped the bleeding. If you have a bandage, pack in the wound tight and with pressure. Now, if the bandage is good you can SUPERSLOWLY release the tourniquet and check if the wound is still bleeding. If not, good, keep an eye on it! If bleeding, crank the tourniquet tight again and let it stay...
When your foot is ripped half of like Ammons, you do not release the tourniquet. Yes the foot will eventually rot and you might lose it, but in that case it is a risk you run! The only thing that matters is saving life.
It all comes down to how severe the trauma and bleeding is. And while not ideal, an hour usually goes ok with it on, maybe as much as up to two if you get under the surgeons knife. But remember, STOP THE BLEEDING
Everyone here owes it to themselves and their jumping buddies to be on top of life saving first aid - and beware, medicine is an ever changing field so what you learned 10 years ago might not be right or the best way.
Good topic and extremely important discussion!
Re: [Heat] Ammon McNeely
Someone mentioned here that tourniquets below the knee are ineffective due to the space between the tibia and fibula being shielded from the pressure. Is that true? If applying a tourniquet runs an unfortunate but necessary risk of losing the limb, it would be cool to do it below the knee if possible.
Re: [shveddy] Ammon McNeely
The best place to put it is in the crotch high on the thigh (you'll be able to find you pulse in the front there). The circulatory system with the arteries are the least shielded here. The same goes for the inside front of your armpit. This offers a nice option for immediate action - use your knee and shove it in the crotch/armpit of the patient to stop the circulation. Train with a buddy on this so you learn exactly where to put pressure. And before anyone asks - No, you are not supposed to knee him in the balls.
While maintaining pressure (and use your whole bodyweight because it is needed) apply a tourniquet... And if it works below the knee, great. But usually that won't be enough. Crotch/inner top of thigh and as high in the armpit is best
Re: [Heat] Ammon McNeely
I am not a medical professional, so these comments are my opinion, rather than any established/approved/recommended methodology. I believe 'Heat' is referring to applying pressure to 'pressure points' on the body, which can be used to reduce/stop the blood flow to areas of the body fed by that supply line. These are sometimes hard to find and often hard to apply sufficient pressure to, to stop the blood flow. They also require a dedicated person to continue to apply the pressure. Tourniquets can be applied much closer to the point of injury and can be left unattended. However, First Aid is not straight forward - your intention of saving someone, may make his condition worse, or in the case of using a tourniquet may result in a permanent disability. Blood freaks people out, but a lot of the time people do not realize that seeing a lot of blood does not necessarily indicate a life threatening injury. Lets take a nice clean cut to the eyebrow - this will bleed extensively and will make bandages soak up pretty quickly - does it need a tourniquet - of course not. In the case of a sever open fracture, which looks stomach turning, we may have a lot of initial blood, but due to the trauma, veins may contract and there may not be any additional arterial bleeding - a simple first field dressing may be sufficient and help with clotting.
I am not trying to provide a solution here, but if people have an interest in this they should sign up for a certified Wilderness First Aid course, rather than trying to get their 1st Aid Training of a forum on the internet - 1st Aid Safes Lives, but incorrectly applied, it can also destroy them. If there are no courses near you, get a few of your friends together and it is not that difficult to arrange your own course.
One more thing, which I learned the hard way - way cool if you have all the navigation, scouting, climbing, first aid and rescue skills, plus all the emergency gear - not so cool if you are the only one in the group and you get into trouble ;-) (oh, by the way I am not suggesting I have any of those skills, I am generalizing.)
Of course if people are bored, they can also take this thread to the legal issues - 'Good Samaritans Law', patients consent, etc.
Re: [MMK] Ammon McNeely
Some good points, and turniquets are used on massive bleedings or life threatning bleedings, of course. A lesser bleeding that can't be stopped can also turn critical if rescue is delayed - and don't forget: training training training. Stay current. And dont use a tourniquet around the neck if some has a massive bleeding there
Re: [hookitt] Ammon McNeely
hookitt wrote:
Holdfast wrote:
Should be released and retightened every 15 mins.
That is not true.
Do not loosen or release a tourniquet after it has been applied and the bleeding has stopped.
thank you tim. we train 3 times a year in basic CPR/first aid/responder. and one thing you do NOT do is remove a tourniquate after youve applied it.
Re: [TransientCW] Ammon McNeely
ok after reading this post, im still standing by the fact that as active duty, we are trained to leave the tournequet be. if elevation and direct pressure, followed by major pressure points fail, and you are still at risk for bleeding out, then apply a tournaquit, mark a T and the actual time on your forehead, and dont touch it. let medical personnel deal with it, even if its hours away. i am going to ask my "doc" onboard the ship i work on about the specifics about this. i dont know exactly why you wouldnt want to remove it to let some blood flow, but i am very interested as to why. ill report back what we have in black and white on paper, and whatever medical folks have to say subjectively as well.
Re: [TransientCW] Ammon McNeely
and for the record, ive only jumped with ammon for one weekend, but i had a fuckin blast with him and hes a fuckin super trooper. good job saving your own ass dood. i would love to hear DAVE858 chime in on this conversation and give some medical advice........
Re: [TransientCW] Ammon McNeely
Im no expert, ask Doctor Charlie. From what I do know If you cant stop the bleeding then apply tourniquet & record time. This information is very important & is useful to the surgeons in determining if a re-attachment is possible. If too much time elapses & the tissue distal to the site of the injury becomes necrotic, then re-attachment is not an option. Ammon did a very good job saving his own life. I wish him the best.
Re: [Heat] Ammon McNeely
Every situation will have differing solutions and frequently many could work. Fundamentally we agree; the IA is stop the bleed. Most First aid training will not take people further than the application of the tourniquet simply because they expect rescue within reasonable time and trained personnel will take over. Opinions will vary, for sure, it is to be expected, techniques improve, however in a discussion and with hands on experience with a traumatic Surgeon within the last 12 months, in a major European Hospital, he agreed; release, they cant save dead flesh.
Re: [Holdfast] Ammon McNeely
For the record, if any of you have to apply a tourniquet to me some day (I'm looking at you Mr. Holdfast Sir ), please do not release my tourniquet every 15 minutes in hopes of saving my leg in the field. Feel free to initially try applying the tq to the most distal possible site on my leg, including below the knee. If that achieves hemostasis, you needn't put anything above the knee or in my groin. If a tq over my tib-fib does not work, I would kindly ask you to advance the location proximally until I stop exsanguinating. Do not worry about my leg; I have a spare in case I lose this one.
If I happen to be in the African bush accompanied by any Europeans of a different opinion on tq management, with no hope of rescue or surgical intervention for several days, we will certainly have discussed in advance, any possible (but unlikely) exceptions to my above personal request.
Thanks in advance!!
Re: [Holdfast] Ammon McNeely
RE: [No hate on you my friend; this is a forum to discuss and hopefully learn, or maybe I got that wrong?] Just teasin' big fella... Different ideas and points of view that facilitate intelligent discussion are always appreciated!
Re: [Heat] Ammon McNeely
"1) STOP THE BLEEDING 2) STOP THE BLEEDING
3) STOP THE BLEEDING
4) CALL FOR HELP "
Well said, and probably plenty for 99.9% of what people around here will ever need. Ill let down tourniquetes on request so people can observe your well perfused limb in your casket after you bleed to death.
Im no military man, but I paid 200k to have some fancy letters after my name, teach ATLS on the side, and once beat a man to death with his own shoes.
Re: [hjumper33] Ammon McNeely
hjumper33 wrote:
"1) STOP THE BLEEDING
2) STOP THE BLEEDING
3) STOP THE BLEEDING
4) CALL FOR HELP "
Well said, and probably plenty for 99.9% of what people around here will ever need. Ill let down tourniquetes on request so people can observe your well perfused limb in your casket after you bleed to death.
Im no military man, but I paid 200k to have some fancy letters after my name, teach ATLS on the side, and once beat a man to death with his own shoes.
This thread is Exhibit A for the affirmative that the artificial intelligence community adage is correct:
"Intelligence emerges from the interaction of conflicting elements."
I am certain that because of this thread a severely injured jumper will live because he or his friends learned what to do about blood loss from this thread.
I am almost as certain that this is is the best incident thread there's ever been on this site (I certainly can't remember a better one), so thanks to all of you who contributed so much good stuff here.
Speaking personally, I'm above average in my basic first-aid knowledge, both from my military experience and from self-educating because bleeding is a byproduct of the things I've so long done for fun. I knew basic tourniquet etiquette but I would say I know ten times more now than I did before I waded through this conversation. More importantly, I feel confident that if I ever have to deal with a tourniquet situation for myself or someone else, I'll be way more capable of making the right decisions and doing the right thing than I was before I read this thread.
There are two things I'd like to add to the conversation that I didn't see discussed so far (sorry if I just missed them):
1. The 3Bs - breath, blood, bone. This is a basic first aid mantra to remind us (as we fall to our level of training and preparation) of what's most important and what to do first.
Breath means be sure the injured party can breathe. That is the first priority because except in rare cases, you asphyxiate faster than you bleed out. Sometimes there are airway obstructions, sometimes the position of the injured party restricts or cuts off the ability to get air. Solve that first.
Blood means, as Heat said so delicately: STOP THE BLEEDING. STOP THE BLEEDING. STOP THE BLEEDING.
Bones means deal with whatever fractures there may be in whatever manner is most appropriate for the situation, with the goal being to reduce pain and minimize further damage.
(NOTE: There is another basic first aid mantra related to the 3Bs: "ABC," which stands for Airway, Breathing and Circulation. It is a sort of cross between the first two Bs: Make sure they can breathe; do "rescue breathing" if they aren't; make sure their heart is pumping, do CPR if it isn't.
Here is one site and here is another with very basic info about all of this and, as at least one previous poster has said, if you have never taken a basic first aid course, take one as soon as you can -- and if you have the time and $$ to upgrade that training to a first responder course, then do that.
2. The speed of the bleed. As most of the soldiers on this thread unfortunately know from direct observation, you can bleed out very fast, so knowing exactly how to tourniquet yourself or another person can literally mean the difference between life and death. That is why this thread is so important -- if you commit to mind-muscle memory (3M?) all the key information contained in this thread, you will be able to act faster and more accurately.
Finally, I had a personal experience exactly like Ammon's except completely different. I had a tib-fib pylon fracture that was also limb-threatening. I don't know if it looked as bad as Ammon's because I also broke my neck and was half-paralyzed so I couldn't move around much. The people who attended to me did say it was pretty gnarly, though.
Unlike Ammon, I landed at the bottom of the object and help was there before the dust had settled -- and because it was an "event," that help included A-list paramedics with full first-responder kit.
Like Ammon, the people who attended to me on a very steep, rocky, hard-to-walk-on hillside did in fact rise to the occasion and did a splendid job of taking care of me.
Unlike Ammon, I was off the rocks in 15 minutes and into an ambulance in 25 -- just as it started to hurt (I hit so hard it didn't hurt initially).
Unlike Ammon, I didn't think about losing my leg because I didn't know what it looked like; I was more interested in trying to move my fingers. (That happened two hours later.)
Long story short, when I woke up from the first surgery (for sterilization and general cleanup/alignment, not a "fix"), the doc said he didn't think he could save my leg.
"There's so much tissue damage," he said, "that I don't think the tissue will recover fast enough to tolerate the surgery before it's too late to fix the bones."
And I said to him: "No problem, doc. I'm alive and not paralyzed any more. If I get out of this with just an after-market foot, I will still be a very happy guy."
As it turned out, I healed faster than he expected so everything worked out fine and I still have two OEM feet.
The point of all this is to address a key conflict element in this thread: The importance of saving a life versus saving a limb and that is where my experience and Ammon's are exactly alike even though they were completely different: Keeping or losing a limb is absolutely unimportant when a life hangs in the balance. Period.
Look at Ammon's video. He was sure he would lose his foot and he showed a touch of regret at losing such an old friend with whom he'd been through so much, but he had no problem putting a tourniquet on it. Staying alive was so much more important that he didn't give a thought to trying to save his leg. Live first; deal with how and what you will walk on later.
I felt the same way; there was zero mental trauma at the thought of losing my foot - I was alive and not paralyzed! WooHOO!
All this is a long-way-around to say: Losing a limb seems really horrifying and a really big deal when you're uninjured and sitting safely at your keyboard, but when you're at risk of death, that prospect does indeed fade in importance to the point that you tend to go Monty Python about it and consider it to be "a scratch" or "just a flesh wound."
Bottom line: Save the life first; worry about the limb later.
And thanks again, Ammon. In saving your own life, you've probably saved several others down the road.
44
Re: [robinheid] Ammon McNeely
Having drills like the ABC or 3Bs are an excellent tool to guide you trough a stressful situation where seconds may count. Glad you brought it up! From my background in combat medics my focus is on massive trauma - thats what happens when bullets fly or an IED goes of. The mechanics of the injury is often far worse than most situations you'll encounter in civilian life. But car accidents happen everyday and Ammons injury is a wake-up call. High energy accidents (like a bullet or car accident) or stabbings are the most common scenarios where a massive bleeding will occur...
There is one thing I would like to point out though, and I'll use the military drill MARCH to explain
M - Massive hemorrhage
A - Airways
R - Respiration
C - Circulation
H - Head trauma
Patient is unconscious, not breathing,:
Normally, securing free airways and getting the respiration going is the first steps. However, doing CPR on someone who is bleeding out equals pumping them empty. So in this case, you check for massive bleeding and, if there is one, you stop it. Unless the person is using Gore-Tex clothing (or similar) you will see a massive ongoing bleeding. It is unmistakable. If the person is is wearing Goretex, unzip the jacket and pants and do a sweep-down of the whole body. This only takes a few seconds and ones done you move on to Airways.
If you guys ever have a chance to chat with a combat medic or similar, do it, and learn from them. They are trained and experienced in dealing with serious traumas in war - that makes it way easier the next time someone chokes on their pretzel and you are there to save the day
Re: [robinheid] Ammon McNeely
robinheid wrote:
hjumper33 wrote:
"1) STOP THE BLEEDING
2) STOP THE BLEEDING
3) STOP THE BLEEDING
4) CALL FOR HELP "
Well said, and probably plenty for 99.9% of what people around here will ever need. Ill let down tourniquetes on request so people can observe your well perfused limb in your casket after you bleed to death.
Im no military man, but I paid 200k to have some fancy letters after my name, teach ATLS on the side, and once beat a man to death with his own shoes.
This thread is Exhibit A for the affirmative that the artificial intelligence community adage is correct:
"Intelligence emerges from the interaction of conflicting elements."
I am certain that because of this thread a severely injured jumper will live because he or his friends learned what to do about blood loss from this thread.
I am almost as certain that this is is the best incident thread there's ever been on this site (I certainly can't remember a better one), so thanks to all of you who contributed so much good stuff here.
Speaking personally, I'm above average in my basic first-aid knowledge, both from my military experience and from self-educating because bleeding is a byproduct of the things I've so long done for fun. I knew basic tourniquet etiquette but I would say I know ten times more now than I did before I waded through this conversation. More importantly, I feel confident that if I ever have to deal with a tourniquet situation for myself or someone else, I'll be way more capable of making the right decisions and doing the right thing than I was before I read this thread.
There are two things I'd like to add to the conversation that I didn't see discussed so far (sorry if I just missed them):
1. The 3Bs - breath, blood, bone. This is a basic first aid mantra to remind us (as we fall to our level of training and preparation) of what's most important and what to do first.
Breath means be sure the injured party can breathe. That is the first priority because except in rare cases, you asphyxiate faster than you bleed out. Sometimes there are airway obstructions, sometimes the position of the injured party restricts or cuts off the ability to get air. Solve that first.
Blood means, as Heat said so delicately: STOP THE BLEEDING. STOP THE BLEEDING. STOP THE BLEEDING.
Bones means deal with whatever fractures there may be in whatever manner is most appropriate for the situation, with the goal being to reduce pain and minimize further damage.
(NOTE: There is another basic first aid mantra related to the 3Bs: "ABC," which stands for Airway, Breathing and Circulation. It is a sort of cross between the first two Bs: Make sure they can breathe; do "rescue breathing" if they aren't; make sure their heart is pumping, do CPR if it isn't.
Here is one site and here is another with very basic info about all of this and, as at least one previous poster has said, if you have never taken a basic first aid course, take one as soon as you can -- and if you have the time and $$ to upgrade that training to a first responder course, then do that.
2. The speed of the bleed. As most of the soldiers on this thread unfortunately know from direct observation, you can bleed out very fast, so knowing exactly how to tourniquet yourself or another person can literally mean the difference between life and death. That is why this thread is so important -- if you commit to mind-muscle memory (3M?) all the key information contained in this thread, you will be able to act faster and more accurately.
Finally, I had a personal experience exactly like Ammon's except completely different. I had a tib-fib pylon fracture that was also limb-threatening. I don't know if it looked as bad as Ammon's because I also broke my neck and was half-paralyzed so I couldn't move around much. The people who attended to me did say it was pretty gnarly, though.
Unlike Ammon, I landed at the bottom of the object and help was there before the dust had settled -- and because it was an "event," that help included A-list paramedics with full first-responder kit.
Like Ammon, the people who attended to me on a very steep, rocky, hard-to-walk-on hillside did in fact rise to the occasion and did a splendid job of taking care of me.
Unlike Ammon, I was off the rocks in 15 minutes and into an ambulance in 25 -- just as it started to hurt (I hit so hard it didn't hurt initially).
Unlike Ammon, I didn't think about losing my leg because I didn't know what it looked like; I was more interested in trying to move my fingers. (That happened two hours later.)
Long story short, when I woke up from the first surgery (for sterilization and general cleanup/alignment, not a "fix"), the doc said he didn't think he could save my leg.
"There's so much tissue damage," he said, "that I don't think the tissue will recover fast enough to tolerate the surgery before it's too late to fix the bones."
And I said to him: "No problem, doc. I'm alive and not paralyzed any more. If I get out of this with just an after-market foot, I will still be a very happy guy."
As it turned out, I healed faster than he expected so everything worked out fine and I still have two OEM feet.
The point of all this is to address a key conflict element in this thread: The importance of saving a life versus saving a limb and that is where my experience and Ammon's are exactly alike even though they were completely different: Keeping or losing a limb is absolutely unimportant when a life hangs in the balance. Period.
Look at Ammon's video. He was sure he would lose his foot and he showed a touch of regret at losing such an old friend with whom he'd been through so much, but he had no problem putting a tourniquet on it. Staying alive was so much more important that he didn't give a thought to trying to save his leg. Live first; deal with how and what you will walk on later.
I felt the same way; there was zero mental trauma at the thought of losing my foot - I was alive and not paralyzed! WooHOO!
All this is a long-way-around to say: Losing a limb seems really horrifying and a really big deal when you're uninjured and sitting safely at your keyboard, but when you're at risk of death, that prospect does indeed fade in importance to the point that you tend to go Monty Python about it and consider it to be "a scratch" or "just a flesh wound."
Bottom line: Save the life first; worry about the limb later.
And thanks again, Ammon. In saving your own life, you've probably saved several others down the road.
44
Re: [Heat] Ammon McNeely
Heat wrote:
Having drills like the ABC or 3Bs are an excellent tool to guide you trough a stressful situation where seconds may count. Glad you brought it up!
From my background in combat medics my focus is on massive trauma - thats what happens when bullets fly or an IED goes of. The mechanics of the injury is often far worse than most situations you'll encounter in civilian life. But car accidents happen everyday and Ammons injury is a wake-up call. High energy accidents (like a bullet or car accident) or stabbings are the most common scenarios where a massive bleeding will occur...
There is one thing I would like to point out though, and I'll use the military drill MARCH to explain
M - Massive hemorrhage
A - Airways
R - Respiration
C - Circulation
H - Head trauma
Patient is unconscious, not breathing,:
Normally, securing free airways and getting the respiration going is the first steps. However, doing CPR on someone who is bleeding out equals pumping them empty. So in this case, you check for massive bleeding and, if there is one, you stop it. Unless the person is using Gore-Tex clothing (or similar) you will see a massive ongoing bleeding. It is unmistakable. If the person is is wearing Goretex, unzip the jacket and pants and do a sweep-down of the whole body. This only takes a few seconds and ones done you move on to Airways.
If you guys ever have a chance to chat with a combat medic or similar, do it, and learn from them. They are trained and experienced in dealing with serious traumas in war - that makes it way easier the next time someone chokes on their pretzel and you are there to save the day
Love the MARCH... first time I've heard that one.
And the M handles my point #2: "the speed of the bleed." Because, yes, you can bleed out before you need another breath in some cases and MARCH covers that.
The bottom line is: the more you know, the easier it is to be flexible and adapt to do the right thing no matter what variation you may encounter. The thread information generally and these acronyms in particular can help all of us during times of stress to remember how to sort out the most critical of the several critical paths, then act appropriately and accurately.
Thanks again, Heat. Wonderful info.
44
Re: [Holdfast] Ammon McNeely
Releasing and then retightening the tourniquet in the field to allow reperfusion of the limb is poor advice. As others have correctly pointed out, the reason a tourniquet should be applied in the first instance is to control a life threatening haemorrhage that is not able to be controlled by direct pressure. The limb's perfusion is no longer a priority. If the wound is so that releasing the tourniquet every 15 minutes does not result in life threatening haemorrhage then it should not be there in the first place. Releasing and retightening the tourniquet and causing further hypovolaemia will also lead to metabolic acidosis, coagulopathy and hypothermia - otherwise known as the triad of death.
Releasing and retightening the tourniquet in the field can also lead to mortality, independent of blood loss. There is the risk of pulmonary embolism, and, of course, the effects of compartment syndrome and hyperkalaemia which can cause dysrhythmias and cardiac arrest.
Removing a tourniquet is actually a big deal. Once a tourniquet is in place the patient should ideally have a large 'T' and the time the tourniquet was applied written on their forehead and it should only be removed by the trauma team in a trauma centre.
Re: [JesseP] Ammon McNeely
I'm glad this thread has developed because you wouldn't believe some of the things that I've heard put forward over the years as information. I do have one complaint. For those of us who studied math instead of biology could you please define any multi syllable terms that you want to use. I swear you people love your Latin. The last post is a good example. I think I caught most of it or can guess it from the context. But throwing out undefined terms does not constitute the transfer of information. And I also have to comment,
And I said to him: "No problem, doc. I'm alive and not paralyzed any more. If I get out of this with just an after-market foot, I will still be a very happy guy."
Those must have been some pretty good drugs. This guy took it relatively well, but even then you can hear the fear and despair in his voice at the thought that he had just given up his leg. I wouldn't trivialize that. That type of fear and panic can really affect some one physically. I don't understand the mechanisms but I've seen people practically drive them selves into shock. Some times it seems like keeping them calm is almost as important as keeping them warm. It sounds stupid but I've seen a guy go into shock at the thought that he had lost a finger. Not exactly a life threatening injury, but the... psychological trauma of it and the pain put him in to an absolutely classic case of shock.
Lee
Re: [JesseP] Ammon McNeely
JesseP wrote:
Releasing and then retightening the tourniquet in the field to allow the return of blood of the limb is poor advice.
As others have correctly pointed out, then reason a tourniquet should be applied in the first instance is to control a life threatening extreme loss of blood that is not able to be controlled by direct pressure. The limb's blood flow is no longer a priority. If the wound is so that releasing the tourniquet every 15 minutes does not result in life threatening extreme loss of blood then it should not be there in the first place. Releasing and retightening the tourniquet and causing further low blood level in the body will also lead to to much acid build up in body fluids, inability of the blood to clot and dangerously lowered body temperature - otherwise known as the triad of death.
Releasing and retightening the tourniquet in the field can also lead to death, independent of blood loss. There is the risk of blockage of artery in the lungs by clot, and, of course, the effects of pressure from uncotrolled bleeding in the muscle compartments and build up of potassium in the blood which can cause irregular heartbeat and stoppage of the heart.
Removing a tourniquet is actually a big deal. Once a tourniquet is in place the patient should ideally have a large 'T' and the time the tourniquet was applied written on their forehead and it should only be removed by the trauma team in a trauma centre.
Latin translated
Re: [nickfrey] Ammon McNeely
Someone with more medical knowledge then I might be able to refute or comfirm this but I have a theory. I read somewhere, may not have been here that a total of three tourniquets were applied, one by Ammon, one by friends or S&R and one by the life-flight crew. This leads me to believe that the bleeding was not completely controlled by the tourniquets (at least the first 2). Possibly because they were applied below the knee (I don't know the location of #2 and #3). This still allowed some blood flow to the foot via undamaged blood vessels that the technically improperly applied tourniquet did not cut off. Sounds to me like the bleeding was controlled enough to stave of death but not enough to prevent blood flow completely. A happy accident perhaps, in the end everything was done right for this situation, had it been done by the book we might be talking about a peg legged pirate
. Ammon, you definitely take the Hardman award, we'll have to go hit your mast as soon as your able!
Re: [nickfrey] Ammon McNeely
Hey guys, Ammon here from the hospital bed. You are correct Nick three tourniquets were applied. Every injury is going to take different actions but I'm not a professional in the medical field. It was brutally obvious what I must do to save my life. I was losing tons of blood FAST and I knew that if I didn't apply a tourniquet that I was going to bleed out within minutes. At first I was going to use my lines but quickly thought the bridle would be way better and not cut into my skin as much.
I was 100% prepared to become an amputee. Blood was squirting five feet in all directions. The video was recorded after I stopped most of the bleeding. I pulled up my bridal wrapped it around my leg just above the opening exit wound and tied a truckers hitch. Before I tied the hitch I slid a nearby stick under the top piece of webbing. After the knot was tied I propelled the stick until I couldn't stand the pain anymore. Then I tried to straighten the ankle and elevated my leg above my heart.
I yelled down to my buddies to let them know I just lost my foot and could possibly bleed out and needed a helicopter ASAP. I knew it was going to be a while before they were going to reach me a few hundred feet above the road. The cliff is very rugged and I knew it was going to take some time to get to me.
There was an EMT and an highly competent climber on the load and a paramedic and another climber/EMT joins the rescue efforts. It took about 40 minutes for them to reach me and they drilled bolts and had lines fixed before the local SAR arrived on the scene. They helped place another tourniquet on my thigh because I was still dripping blood. The helicopter had to to land down the street because there is power lines directly below the exit, hence the name of the jump "Electric Chair".
SAR arrived and with the ropes in place they just had to ascend the ropes with a litter cage and their rescue kit. They dumped drugs into me, just enough to not kill me, haha. Applied a 3rd tourniquet just above the one I had placed and got me in the litter. The descent was treacherous with loose flakes and falling rocks. It took just over an hour to get me to the road. They got me in an ambulance, got me to the helicopter and flew me to St. Mary's in grand Junction. The entire time period was just over 4 hours from accident to ER.
The docs told me that the tourniquet time was somewhere around 4 hours before you were going to lose the limb. I lost nearly 3 pints of blood and came super close to bleeding out and and losing my life. So, obviously the 15 minute release of the tourniquet would have killed me. But, like I said, in its case it was completely obvious that we just kept it on and sacrificed the foot/leg. Those that have seen the video can see it in my face, I absolutely was prepared for the sacrifice to save my life.
In the morning, I woke up and was very surprised to see my foot still attached. A huge smile spread across my face as I wiggled my toes. I still have to fight off infection but it's looking very good that I will recover and climb and jump again, soon enough.
The docs say that my calm reaction and quick thinking with the tourniquet was the the main factor for surviving, at all. If I would have freaked out my heart rate would have sky rocketed and would have lost more blood. I didn't have much left to lose before the end was near, as it was.
Also, if the lines weren't fixed saving hours I might not have made it either. I will be forever grateful for my fast acting friends, SAR and the flight crew.
It's amazing how fast shit hit the fan and hope my tale can save someone else in the future.
Lots of love, Ammon
Yaaaaaaaar!!!
PS: I thought I was recording when I exited but alas, I actually turned it off while it was on in the first place. So, no gnarly bouncing POV.
TO: Ammon McNeely RE: BMF
The docs say that my calm reaction and quick thinking with the tourniquet was the the main factor for surviving, at all.
If I would have freaked out then my heart rate would have
sky rocketed and I would have lost a lot more blood.
Kudos for being smart and saving your life, keeping
the foot is of course one hell of a nice added bonus!
Great point about staying calm and keeping your
heart rate as low as possible to minimize blood loss.
I agree with the loquacious BASE 44 that your story
will likely help save someone else's life one day…
Re: [Ammon] Ammon McNeely
Wow! Good on you, man! This is a good reminder for people that who you jump with matters, too. A little shared knowledge between a small group of jumpers can go a long way!
Re: [Ammon] Ammon McNeely
Way to handle it brotha ! ...you will be back..betta..fasta...stronga... What were the wind conditions at exit ? the electric chair has seen more than it's share of off headings , as it sits up on the corner of two valleys
Also wondering what size and kind of canopy you were jumping ( vents or not ) and what you're loading it at ?
Stay strong...positively positivity
Re: [Dadsy] Ammon McNeely
Dadsy wrote:
It would be helpful if the comments to release every 15 minutes, or keep it on were backed up by a source such as a reputable link, manual, paramedic training etc.
Hjumper (post above yours) is an MD who is board certified in Emergency Medicine. I suspect he's the most knowledgeable contributor to this thread on this topic.
Re: [Ammon] Ammon McNeely
Well done Ammon. It's good that this happened in a not so remote part of a remote part of a first world country. Food for thought before hucking nasty little cliffs in truly remote and/or developing parts of the world. Pretty sure an amputation would have been the best case scenario in one of those places.
Re: [stinkydragon] Ammon McNeely
stinkydragon wrote:
Well done Ammon.
It's good that this happened in a not so remote part of a remote part of a first world country. Food for thought before hucking nasty little cliffs in truly remote and/or developing parts of the world. Pretty sure an amputation would have been the best case scenario in one of those places.
what would have been worst case? anal rape by savage local tribes? mauling/maiming by prehistoric beasts with a craving for human flesh? getting scooped up in the talons of a massive, 75-foot-wingspanned flying lizard creature? being poisoned then cocooned by a monstrous serpent-spider from an alienistic planet outside our immediate solar system?
perhaps being impaled by the horn of an aggressive and deadly winged unicorn with a thirst for blood?
even worse: an attack by a 90-foot tall robot with a CPU thats gone AWOL thus making the metal monstrosity completely self aware?
youre really scaring me my friend, i dont like where youve gone with whatever point you were trying to make, and i fear now that i wont sleep tonight.
Re: [TransientCW] Ammon McNeely
TransientCW wrote:
stinkydragon wrote:
Well done Ammon.
It's good that this happened in a not so remote part of a remote part of a first world country. Food for thought before hucking nasty little cliffs in truly remote and/or developing parts of the world. Pretty sure an amputation would have been the best case scenario in one of those places.
what would have been worst case? ...
Being dead.
Re: [shortleash] Ammon McNeely
I'm also interested to know more about the details of the jump like what exactly caused the off-heading. He said it may have had something to do with new brake lines. Also, what type of gear, how old was the gear, wingloading, wind conditions, etc. If anyone knows or if Ammon can chime in again, I think it would be helpful.
Re: [jws3] Ammon McNeely
All the info is in the ST thread. Iirc, old velcro rig with a Fox. New brake lines too short or brake setting too deep made it open in a stall.
Re: [Dano302] Ammon McNeely
Hey guys, Want to help Ammon out? Let me rephrase, help our goddamn friend get a pirate logoed canopy so he can return to jumping sooner!
Thanks
http://www.donationto.com/Help-Ammon
Re: [OLopez] Ammon McNeely
OLopez wrote:
All the info is in the ST thread. Iirc, old velcro rig with a Fox. New brake lines too short or brake setting too deep made it open in a stall.
he had a 180, so what is the stall you are talking about?
Re: [Dadsy] Ammon McNeely
Why don't you ask him? http://www.supertopo.com/...g=2262859#msg2262859 As a wild speculation DZ.com style, i'd hazard a guess that an asymmetric stall recovery could have spun him 180, but i'm not Ammon, and i wasn't there, so i'm just talking shite.
Re: [OLopez] Ammon McNeely
i dont need to ask him, I have read what he said happened. Im just confused why you would add things to his story
Re: [Dadsy] Ammon McNeely
Dude, read the fucking link before you go around accusing people of making things up. Or if that's too much effort or too complicated for you then sit back and let me help you:
In reply to:
ElCapPirate
Big Wall climber
Reno, Nevada
Nov 4, 2013 - 08:17am PT
(...)
Looks like similar situations, though. My brake lines were set too short opening in a collapsed stall. Like I said on my first post, I take full responsibility and should have jumped something more overhanging and forgiving after the repair.
(...)
YYYYYYAAAAAAAARRRRRRR!!!!
Re: [OLopez] Ammon McNeely
settle down princess, i was going on what he said happened on hear thanks for the update
Re: [Dadsy] Ammon McNeely
Yeah, sorry again. I ran out of my favourite lipstick today and that gets my feathers ruffled
Re: [Ammon] Ammon McNeely
Hi Ammon I don't mind admitting it's taken me quite a while to pluck up the courage to look at the images you posted, let alone watch the video. I had a similar accident back in 2008 (although by the look of it, not as extreme) which resulted in bones protruding and a foot hanging limply off and since then I've become very emotionally sensitive to this kind of thing. Anyway, I watched the video and i just wanted to say two things. Firstly, the fortitude you displayed is beyond me and I sincerely, humbly, salute you. What many here might not appreciate is that, whilst the pain is undoubtedly incredible, the psychological trauma of seeing a part of your body in some form of disconnect can be harrowing beyond comprhenesion and the fact that you felt certain you would lose the leg makes it doubly so. Again, i'm in awe at how you managed the situation.
Secondly, I am so pleased for you that the foot was saved. You undoubtedly have a tough battle ahead of you but judging by the strength of character you've already displayed, you'll breeze it. I wish you the very best with your recovery, i really do.
Oh, and don't skimp on the physio.
Re: [OLopez] Ammon McNeely
Any idea what the approximate wingloading was? I don't see it in any of the posts so far.
Re: [jws3] Ammon McNeely
http://www.liveleak.com/view?i=52d_1383223053 Found this, parts of the jump from some distance.
Edit: description says thats the same jump, but I do not really know...
Re: [Gasperus] Ammon McNeely
Gasperus wrote:
http://www.liveleak.com/view?i=52d_1383223053
Found this, parts of the jump from some distance.
Edit: description says thats the same jump, but I do not really know...
It is 100 percent, not the same jump.
Re: [Ammon] Ammon McNeely
Wondering how you are certain that the new brake lines were set too short ? Also ,am not familiar with "collapsed stall " please explain. I only know "deep stall" and "full stall" which allow canopy to sink at high rate straight down and backwards. Best wishes on your recovery my friend.
Re: [flite] Ammon McNeely
I'm not certain of anything and I don't know what a collapsed stall is, either. I seriously need to quit posting until I'm off these meds, it's been a blur since the last surgery. I'm out... of it.
Re: [JBag] Ammon McNeely
JBag wrote:
Holdfast wrote:
Should be released and retightened every 15 mins.
How long does it take for gangrene to set in? 15min? 16min? 13min?
It takes several hours for gangrene to set in. Typical foot surgeries last ~1hour and some may last 90min or more with a tourniquet applied at the ankle or sometimes the thigh.
In reply to:
If you try this method you may release gangrene back into your system where you dont want it to be.
There are different types of gangrene (dry & wet).
Dry gangrene is what we are worried about in an accident like Annon's. It is due to a lack of oxygenated blood. There would be no risk of releasing dry gangrene into the blood stream. The tourniquet still should not be released but it should not be released because you do not want the patient to bleed out & die.
Wet Gangrene is something Annon will have to be concerned with after the surgery.
Even if you cared more about saving your limb & were willing to risk bleeding to death, it still would not make sense to release the tourniquet because in an injury like Annon's the circulation was compromised. How much blood would actually make it to the foot even if you released the tourniquet? Also every 15 min would never be necessary. Your skeletal muscles are far more resilient than brain or other internal organs.
In reply to:
apply the tourniquet, mark t in blood like a real man, and the time you applied it. sit back, drink a beer.
Agreed (except for the beer)
Pretty badass Ammon. Stay tough. Hope the foot survived.
Re: [shibu] Ammon McNeely
Agree or disagree; no two injuries are likely to be the same, they will vary in geographical location as well as complexity and severity, therefore solutions will differ as opinions to solving them. No surgeon or patient will thank you for the excessive loss of limb, even if you act in apparent best interest, which rears the ugly head of legal liability with any civilian intervention.
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
No surgeon or patient will thank you for the excessive loss of limb, even if you act in apparent best interest, which rears the ugly head of legal liability with any civilian intervention.
Ahh, no. The Good Samaritan Laws protect first responders. Stop arguing this. You can't dig any deeper into wrong.
Re: [OuttaBounZ] Ammon McNeely
Samaritans became extinct with Capitalism. Wrong in your opinion, by default or in your imagination? Review, read and understand.
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
Samaritans became extinct with Capitalism. Wrong in your opinion, by default or in your imagination? Review, read and understand.
So a lay person is completely safe, and a professional is safe as long as they don't just go making shit up.
All 50 states have these laws.
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
Samaritans became extinct with Capitalism. Wrong in your opinion, by default or in your imagination? Review, read and understand.
Shutup hippy!
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
Agree or disagree; no two injuries are likely to be the same, they will vary in geographical location as well as complexity and severity, therefore solutions will differ as opinions to solving them....
Agreed.
Re: [Holdfast] Ammon McNeely
Holdfast wrote:
Agree or disagree; no two injuries are likely to be the same....
"....In the worst cases, tourniquets are used. Although there is a real risk of limb loss with a tourniquet, blood loss must be stopped to save the life of the patient. Commercially available simple small windlass tourniquets that can be applied with one hand are used by many military services. Those venturing into austere environments of combat should ensure their availability. Any flexible material of enough length (rope, wire, cloth strips) can be used to encircle the limb and be tied in place. A rigid device (a rod or stick) is placed through the loop and twisted to tighten it until bleeding ceases...."
from pgs 310-311 of the eighth ed of the student course manual of "Advanced Trauma Life Support for Doctors" It is from Appendix G "Austere Environments: Military Casualty Care and Trauma Care in underdeveloped areas and Following Catastrophes."
BTW, it looks like Ammon read this before he applied his makeshift bridle-tourniquet.
Re: [platypii] Ammon McNeely
Ammon hits Tosh.0! Ammon is cool and I wish him the best, but Tosh made me laugh... http://tosh.comedycentral.com/...down---bad-base-jump
Re: [douchekiller] Ammon McNeely
douchekiller wrote:
Ammon hits Tosh.0! Ammon is cool and I wish him the best, but Tosh made me laugh...
http://tosh.comedycentral.com/...down---bad-base-jump
I think Ammon would laugh at that too.
Best part of that video was the reaction from the hotties in the audience.
Worst part was that I am middle aged... What does he mean "the craziest thing about this video is that his mom is still alive"?
Re: [shibu] Ammon McNeely
shibu wrote:
douchekiller wrote:
Ammon hits Tosh.0! Ammon is cool and I wish him the best, but Tosh made me laugh...
http://tosh.comedycentral.com/...down---bad-base-jump
I think Ammon would laugh at that too.
Best part of that video was the reaction from the hotties in the audience.
Worst part was that I am middle aged... What does he mean "the craziest thing about this video is that his mom is still alive"?
I love that the doctors office had a Craftsman tool box.
Re: [platypii] Ammon McNeely
It's really amazing how calm you were in the video, but controlling your breathing and lowering your heart rate probably contributed to not bleeding out too much to survive. Best wishes for a speedy and full recovery.
Re: [OuttaBounZ] Ammon McNeely
In reply to:
douchekiller wrote:Ammon hits Tosh.0! Ammon is cool and I wish him the best, but Tosh made me laugh...
http://tosh.comedycentral.com/...down---bad-base-jump
"Wiggle your bone". Haahaa! I better get a web redemption. Too funny!
Re: [Ammon] Ammon McNeely
Agreed, Ammon! I believe the web redemption is in your future. I hope you are doing/feeling better!
Re: [douchekiller] Ammon McNeely
ill tell you what else is in your future ammon. a 30 box of ICE COLD natural ices, as soon as i see you.
Re: [platypii] Ammon McNeely
http://sloemsa.org/files/623BLSTourniquetPolicy.pdf I was on this jump with Ammon, Andy and Hunter. I have been an active EMT for 18 years and this incident has made me a 100% believer in tourniquet use. The above link is the current policy we follow on tourniquet use but it can be drastically different from jurisdiction to jurisdiction, this is just what I'm told to do. Before this we were not encouraged to use tourniquets and were supposed to use direct pressure on the wounds and pressure points on the closest artery. Granted there was always a hospital 5 minutes away. Due to the current war, unfortunately, there has been plenty of time for statistical studies showing the life saving benifits of tourniquets. These studies caused our department to bring back the use of the tourniquet. Keep in mind, the tourniquet is the last ditch effort to SAVE THE LIFE. You may lose a limb, you may die later from other complications but you will most definaty die at scene if it is not used promptly in situations that call for it. Ammons situation called for it and his ability to stay calm, identify the need, apply a makeshift tourniquet and elevate his leg, I believe, saved his life. The quick actions of the moab monkeys (too many to name) to get to him, apply the second tourniquet, work with the rescue team as well as help with patient care most definaltely saved his leg, without them the rescue would have taken a lot longer.
Long story short, he had 3 tourniquets on for just over 5 hours from impact to surgery table and they saved his leg. We did not remove or loosen them at all throughout the incident. The staff that did the surgery said the likelihood of being and to save the limb goes down drastically after 6 hours, that is new to me, I always thought you lose the limb much sooner than that......always learning I guess.
Cheers Ammon, hope to jump with you again soon!!
Re: [Mitchpee] Ammon McNeely
Mitchpee wrote:
Hey guys,
Want to help Ammon out? Let me rephrase, help our goddamn friend get a pirate logoed canopy so he can return to jumping sooner!
Thanks
http://www.donationto.com/Help-Ammon
Just a heads up to Ammon or the friend that posted the Youtube video on his behalf, the link on the Youtube video to donate is broken.
Healing vibes to you Ammon, your part in The Sharp End was awesome, the film that inspired me to pursue these wonderful activities!