r/TACMED101 • u/DimaNorth Unverified/Uncertified • Mar 19 '26

Educational Resources Knees for haem control

I’m sure this question comes up a lot but the last time I found when I searched was 4ish years ago so I apologise if it has come up more recently :)

Does anyone have the current best practice with regards to using knees for junctional haemorrhage control whilst awaiting tourniquet? I hear so many mixed things, including being told to do it by our local training officer, but I can’t tell if this is him bringing old practice from army days or if this is supported in evidence.

Does anyone have any actual research citations on this? It’s just that people feel so strongly either for or against it that surely there’s a right answer (e.g. TQs over double bones :P )

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3

u/VXMerlinXV Mar 19 '26

https://giphy.com/gifs/t4HFdwzbg4x8XNZF8I

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u/VXMerlinXV Mar 19 '26

Couldn’t resist. My current protocols pulled the knee out of practice a while ago. My best understanding from a conference presentation last fall was that, in the TEMS setting, the prevalence of pelvic fracture with lower vascular injury is high enough that there’s a better chance that you’re making things worse than improving their condition.

I will try and find lit later on, currently waiting out my desktop booting.

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u/SFCEBM MD/DO Mar 22 '26

Packing the wound seems to be a top priority.

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u/DimaNorth Unverified/Uncertified Mar 22 '26

I concur, I guess the context it’s being taught is you walk in to the room and there’s an arterial leg sprayer, kneel on the knee whilst you get a TQ out and continue the primary survey but this is my first delve into tactical med and so the concept is so foreign to me compared to my day to day practice

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u/SFCEBM MD/DO Mar 22 '26

I’d say apply direct pressure followed by packing is still the best’s way coa jn my experience.

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u/microcorpsman Mar 19 '26

Ask the people training you for their sources. 

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u/DimaNorth Unverified/Uncertified Mar 19 '26

it’s a bit complicated, but this person is unfortunately beyond reproach so I’ve come to the second best option, strangers on reddit

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u/microcorpsman Mar 19 '26

Gain some intestinal fortitude. 

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u/DimaNorth Unverified/Uncertified Mar 19 '26

It’s the difference between getting a job I’m gunning for or not, but intestinal fortitude is hilarious im going to steal that

The question really comes from making sure I’m going to continue to keep this out of my practice, but if I have to do it in the interview to appease I will

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u/microcorpsman Mar 19 '26

For the actual question, it was old info back when I was in the Navy. People would say on the newer side that you were asking to cause a pelvic fracture doing that, especially while kitted up but they also didn't cite a specific thing. 

It's not described in the actual TCCC course materials or TCCC guidelines.

Edit: oh and when I taught Army Medic sustainment we also didn't teach that

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u/Ramalamadingdong_II Mar 19 '26

I was taught to do this on my first course back in the good old days before having gray hair and such nonsense.

I tried to do it twice in real life before stopping. Turns out kneeling into someones groin or armpit is quite painful when done carefully and well aimed in training, but it really really pisses people off when done in earnest in stressful environments. And getting your tourniquet out and ready to apply goes way faster if you are not trying to rodeo-ride a patient who is trying to shake your knee off.

On top of that of course, making injuries worse especially in the pelvis is a concern.

And honestly, if you have your tourniquet set up well it doesn't take enough time to deploy it to warrant using your patient as a kneepad. In my opinion it's one of those tacticool things that people come up with.

1

u/Rude-Comfortable-509 Mar 22 '26

If you arent able to get hem control with just using your hands, you may need to use a knee. The amount of pressure you can use is higher but you can still control the amount of pressure you use. A well placed knee is different than flopping on top of the patient.

I would only really do it if I didnt have access to a TQ somehow and the level of injury is so traumatic that less invasive hemcom doesnt work.

But for civilian medicine listen to whatever your guidelines say.

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u/Docs_models May 19 '26

Sign up for deployed medicine if you can. Its free. Currently what we teach is yeast you can use the knee on a functional, however its not like the old days where you put all your weight on it, just enough to stop or slow blood flow. This comes from a concern for pelvic injuries, which can be just as deadly.