Tourniquets should only be used as a last resort.
This is a dangerous and antiquated approach to trauma. There is an overwhelming amount of substantiated data that dispel this myth. If you're attending a class and that's what you are being told, contact us at Trauma Monkeys ASAP and we will find a course in your area that is teaching the current protocols.
In combat zone, Tactical Setting, Active
shooter, dynamic type event a Tourniquet should be the First choice if there is any suspicion that a casualty is bleeding from an extremity. For many years Extremity Hemorrhage was the number one cause of preventable death on the battlefield it has since been surpassed by junctional hemorrhage (armpit, groin, neck).
Significant improvements in training, coupled with the availability of tourniquets have directly resulted in a marked decrease in mortality. Through education and persistence the military has been able to convince all hands to completely change how they view tourniquets. No easy task considering the how many times we have all been told “only as a last resort”.
2. Placing a Tourniquet (TK) equals loss of limb.
The fact is loss of a limb is extremely rare. The risk of hemorrhage far outweighs the minuscule risk of limb damage. The old "Life over limb” adage applies here. There are many well-documented cases of patients that have had commercial tourniquets in place for greater then eight hours, with no loss of limb. In the cases where their have been a loss of limb(s), they are directly attributable to a gunshot wound, blast injury, shrapnel, fragmentation, high velocity trauma and not as a result of restricted blood flow from tourniquet placement.
3. Belts make great Tourniquets.
This is Utter Nonsense. Belts make terrible tourniquets; it is extremely difficult if not impossible to completely occlude arterial blood flow using a belt. Utilizing a belt and its buckle will never be tight enough and attempting to tighten the belt with a makeshift windlass is problematic due to it’s rigidity. The makeshift windlass would need to be substantial (i.e. leg of a chair) to have any chance of tightening the belt enough. Belts are readily available and certainly work better then nothing, the point here is to promote commercially made Tourniquets or more suitable makeshift tourniquets (cravat / stick) see our article here on improvised Tourniquets and another great write up by First CARE Provider.
4. improvised Tourniquets are proper Medical equipment.
Using what you have on hand in extremis is not only acceptable its commendable. There are no shortages of great stories of people doing self-aid or acting as a first responder, I prefer First Care Provider, more on this in future posts). Read more about Brian Ludmer, the schoolteacher shot in the calf in the LAX shooting. Ludmer crawled to a shop, scrambled into a storage room and shut the door. He found a sweatshirt and tied it around his leg to slow the bleeding. Key phrase there “Slow the bleeding”, that’s what makeshift tourniquets do, commercially made tourniquets STOP the bleeding. Hospitals, EMS agencies, Fire Departments, and anyone in the business of saving lives is negligent if they are not equipped with commercially made Tourniquets.
This is what the city of Boston had on standby and utilized in the aftermath of the bombing. It’s surgical tubing, and a pair of hemostats to secure the tubing after wrapping it circumferentially around an extremity. It’s important to note that 100% of these were found to be ineffective tourniquets and had to be converted to a commercial tourniquet. That's not to say they did not slow the bleeding and contribute to the high survival rate. Please do not think this is a criticism of those brave folks that responded and undoubtedly saved countless lives.
Boston has since purchased commercial tourniquets and discontinued the tubing policy. When someone is bleeding significantly from an extremity it is hardly the time for arts and crafts. If you are in the business of saving lives then make it your business to have the gear you need to do so.
5. There is a best Tourniquet out there.
Commercial Tourniquets just like any other piece of gear all have advantages and disadvantages, strengths and weakness, pros and cons. They all have subtle nuances and general rules of thumb regarding their use. I’m often asked what tourniquet I recommend, and my answer is always the question “recommend for who, when, and where?” The Tourniquet that works well for a Marine on his body armor, may not be the best choice for someone doing undercover work. The tourniquet I carry on SWAT missions to treat a wounded Police Officer would be a poor choice in a school shooting with expected pediatric patients. The tourniquet I would use in a controlled emergency room setting would be difficult to use in a low light stressful environment.
Tourniquets come in all different shapes, sizes, colors, and accomplish the job in a myriad of ways. As with any other job, task, or mission the sensible answer is to choose the right tool for the job. Please visit our YouTube channel and other Blog posts for an extensive review of the common commercially made tourniquets and as always feel free to email or leave a comment below.
References
J Trauma Acute Care Surg. 2014 Sep;77(3):501-3
Boston marathon bombings: an after-action review.
Boston Trauma Center Chiefs’ Collaborative.
Collaborators: Millham FH, Burke P, Gates J, Gupta A, Mooney D, Rabinovici R, Yaffe MB, Velmahos GC.
QUOTES:
Aid by First Responders
“Another unusual feature of the Boston Marathon bombing was the proximity of a generously staffed medical resuscitation tent in immediate proximity to the blast zones. Injured patients were able to receive immediate care from nurses, physicians, paramedics, emergency medical teams, Boston Police, and National Guardsmen, some of whom had experience in the management of blast victims in war. The early and liberal use of tourniquets on bleeding extremities, possibly reflecting knowledge gained in combat,7,8 may have contributed to patient outcomes. However, not all tourniquets were applied effectively. Several makeshift field tourniquets such as belts or other articles of clothing did not control bleeding sufficiently. Proper tourniquet technique, such as frequent tightening and occasional double tourniquet application on large extremities, were not used. Training for first responders should address this critical need.”
Tourniquets
“(1) Effective use of tourniquets as first aid should be part of the national first aid curriculum. (2) Military tourniquets should be stocked in all emergency vehicles in sufficient quantity to deal with multiple trauma patients.”
A Tourniquet is the one piece of gear you should never leave behind, it's saved countless lives and if you don't have one when you need it, you're in trouble. We strongly advise you have tourniquets in your home, your vehicle, your first-aid kits, bug-out bags, workshop and anywhere else disaster could strike. Don't let your spouse try to stop the bleeding with a towel or an arts & crafts tourniquet. We would love for you to buy one from us to help offset the cost of the site but what's most important is that you get one somewhere.
