Mr Matt Pepper1
1Royal Flying Doctors Service – Western Operations
Biography:
Matt is an Intensive Care/Special Operations Paramedic with over 19 years of clinical experience. He has worked across multiple state ambulance jurisdictions, was the founding President of the Australian Tactical Medical Association, and jointly built the Tactical Medical Operations capability and Tactical Paramedic Team in NSW Ambulance.
Matt is a Churchill Fellow, Fellow of the Academy of Extreme Environment Medicine, and Fellow of the Australian Tactical Medical Association.
In his current role as Head of Paramedicine and Industrial Health at RFDS – Western Operations, Matt oversees multi-disciplinary prehospital medical teams working in aeromedical, offshore, austere and remote settings.
Abstract:
RFDS Western Operations has recently implemented a Clinical Practice Guideline for application and de-escalation of arterial tourniquets. This presentation will give an overview of the evidence, best practice considerations and implementation of the CPG, and it’s application in prolonged, aeromedical retrieval.
Aeromedical retrieval often involves prolonged response, treatment and evacuation times. In the setting of major trauma haemorrhage is the number one cause of death, and catastrophic limb bleeding can be expediently stopped through the use of arterial tourniquets. The combination of the use of arterial tourniquets and prolonged application times in aeromedical settings requires an evidence-based approach to understand optimal approaches for improved patient outcomes.
The Global War On Terror saw the renewed acceptance and use of arterial tourniquets, with a large body of evidence showing the huge positive effects on battlefield mortality as a result. This change transferred into the civilian medical and prehospital fields, once again having significant effects on reducing mortality from catastrophic limb haemorrhage.
The current conflict in the Ukraine has highlighted major issues with this emphasised and early application of tourniquets. Prolonged evacuation times, difficult and dangerous tactical situations and targeting of medical and first aid personnel and resources have all pushed out evacuation times, limiting access and proximity of more advanced care from the point of injury.
This dilemma, and the burden of resultant, unnecessary limb loss, has hastened the push across all remote and prolonged settings for improvements in tourniquet de-escalation knowledge, procedures and education.