Opinion piece from The Wall Street Journal

I am not a medical professional, but I have received professional training on the proper design and use of tourniquets, and know from previous discussions of the topic here that ignorance and misinformation abound. If the last time you learned anything about the devices was in a Boy Scout first aid class 30 (or more) years ago, you owe it to yourself to refresh your knowledge.

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The Military Learned to Stop the Bleeding

By Frank K. Butler And John B. Holcomb

Robyn Gardner lay bleeding by a river near Sacramento, Calif., her thigh ripped open by a boat’s propeller. A former Army medic happened to be nearby. He applied a tourniquet, which immediately stopped the bleeding and stabilized Gardner. But when the ambulance arrived, the crew removed the tourniquet, because tourniquets weren’t an approved trauma intervention in the jurisdiction. EMTs tried other techniques to control the bleeding, but Gardner died at 38 in 2003.

Tourniquets save lives, but an exaggerated fear of tissue damage led medical authorities to ban them from use on both military and civilian trauma patients. Some 3,400 American lives were lost in Vietnam from failure to use these simple devices.

That realization prompted a four-year review of battlefield trauma care, which led to the development of Tactical Combat Casualty Care, first described in 1996. TCCC recommends tourniquets for life-threatening extremity bleeding until the casualty reaches a surgeon. But most U.S. military units ignored the advice at first and didn’t carry tourniquets into Afghanistan and Iraq.

That changed as casualties mounted. In 2005 the U.S. Special Operations Command and the U.S. Central Command both mandated tourniquet use. Studies since have found hundreds of American lives have been saved on the battlefield with tourniquets and little danger of tissue damage. [Emphasis added.]

Civilian trauma care has always benefited from military wartime experience, but the process can be slow. By 2010 tourniquets were routine in the military but rare outside it. Civilian tourniquet use increased significantly after 2013, when Hartford, Conn., trauma surgeon Lenworth Jacobs convened a group of experts to study ways of saving lives in civilian mass casualty incidents such as the Sandy Hook school shooting. The Hartford Consensus led the American College of Surgeons and the American College of Emergency Physicians to endorse tourniquet use by professional first responders.

Yet scores, perhaps hundreds, of first-responder organizations still don’t use tourniquets. [Emphasis added.] EMS systems, fire departments and other such agencies are local and autonomous, making it hard to hold them to national standards.

Civilian studies show that deaths related to extremity hemorrhage increase 600% when prehospital trauma systems don’t use tourniquets. By using recently published, high quality regional data, we estimate that up to 5,300 deaths a year could be prevented throughout the country through the use of these simple devices. Money isn’t an issue: A tourniquet costs less than $30.

Too many Americans bleed to death every year from severe extremity hemorrhage. Every professional first responder needs to have a tourniquet in his medical kit. Nobody should face Robyn Gardner’s fate because first-responder organizations fail to keep up with evolving standards in trauma care.

Dr. Butler, a retired U.S. Navy SEAL captain, is a former command surgeon for U.S. Special Operations Command. Dr. Holcomb, a retired U.S. Army colonel, is a former commander of the U.S. Army Institute of Surgical Research.

LINK

Thank you for posting. A valuable nugget to save.

quote:

Originally posted by sigfreund:
If the last time you learned anything about the devices was in a Boy Scout first aid class 30 (or more) years ago, you owe it to yourself to refresh your knowledge.

^^^^^^^ THIS!!!!

In the last couple of years I have been fortunate to take several first aid classes from local first responders, which included stop the bleed (tourniquet and wound packing), CPR and AED use. You owe it to your family and friends to keep a tourniquet in your home, car(s) and range bag.

And get some training, too!!!

I always have a tourniquet on me when out and about. I generally have one on me at home as well when I'm in the shop.

When going to the range I always carry at least two and a more extensive trauma kit. I seldom go to the range alone.

Back in the early to mid 80s as a first responder I was trained in the use of tourniquets.
We were trained in placement and management.
A tourniquet was taught as a last resort if we could not control bleeding through methods used at that time(bandaging,direct pressure and elevation).
We were taught to apply the tourniquet and at certain intervals to release some pressure to allow some blood flow to tissue to keep it from being damaged from lack of blood flow. This of course was done in conjunction with other blood loss control measures.
I think at one point we were retrained that once the tourniquet was on you were not to release any pressure at any time.
Lucky in my entire time as a first responder I always carried one in my crash bag, however I never had to apply one nor did I ever see one used.

quote:

Originally posted by 71 TRUCK:
Back in the early to mid 80s as a first responder I was trained in the use of tourniquets.
We were trained in placement and management.
A tourniquet was taught as a last resort if we could not control bleeding through methods used at that time(bandaging,direct pressure and elevation). We were taught to apply the tourniquet and at certain intervals to release some pressure to allow some blood flow to tissue to keep it from being damaged from lack of blood flow.

And that's where the big change has come in the last decade or so...

Tourniquets are now the first resort, for what is obviously serious traumatic bleeding on an extremity. Is it bleeding heavily, is it on an arm or a leg, and do you have a tourniquet? If yes to all, apply TQ immediately, do not pass go, do not attempt gauze and pressure first.

And once it's on, it stays on, until they get to the operating room. No loosening in intervals, etc. (We've learned through experience that tourniquets can remain on for many hours without long-term effects to the limb, and that scenario is going to be very uncommon in civilian first aid situations. Even if it happens to have to stay on so long that they lose the limb, it's better to be a live guy missing a limb than a whole dead guy.)


I always have numerous tourniquets. I have them stashed in various vehicle, in trauma/first aid kits, in my range bags, on my body armor, in my uniform pockets, etc.

It's an important tool for self aid, or for trauma first aid, especially in mass casualty/active shooter events.

If you're going to have TQs on hand, make sure that you get trained on how to use them, and practice applying them not only to someone else, but applying them to yourself, including one-handed. Like any skill, don't wait until it's life-or-death to try to figure out how to do it.

quote:

Originally posted by 71 TRUCK:
once the tourniquet was on you were not to release any pressure at any time.

That has been the guidance I have received for many years now.

It works. We shot a guy in the leg (yeah yeah) and used a tourniquet on him while waiting for ems.

Moron kept saying he couldn’t breathe. Lol. That’s from 200lbs tackling ya. The tourniquet is on your leg not your neck.

What a BS article! Don't condemn the tourniquet for the incompetency of the "EMT's"! Yeah, a tourniquet is not the 'best' solution, but it is a solution! Just avoid wire and rope if possible but then you have to decide, limb or life? Granted, a tourniquet around the neck for a head wound in NOT a good solution!

Practice is good as mentioned above, but remember. Use a TQ you've set aside for training purposes. Don't use a TQ you plan to deploy in the field for training.

quote:

Originally posted by Skull Leader:
Practice is good as mentioned above, but remember. Use a TQ you've set aside for training purposes. Don't use a TQ you plan to deploy in the field for training.

Excellent point.

Also, make sure you're training with the type of TQ you're going to have on hand.

There are various different styles out there, and while the basic underlying concept is the same, the specific methods of application and tightening can vary pretty broadly.

I've seen folks who carry one type of TQ show up for refresher training with a different cheaper type, because they wanted to save their "good" TQs for field use. But then all their training reps are with a different model of TQ than what they're actually going to be using in real life.


Also, it's vastly superior to have actual purpose-made TQs available than to try to rig up some ersatz TQ using your belt, or a shoelace, or whatever. Half-assed TQs might possibly be better than nothing in an emergency, but they often can't be compressed tight enough to fully stop blood loss, or the materials will fail when put under tension, or if the loop material is too narrow they can end up causing further trauma.

Dark Angel medical sets aside a few minutes near the beginning of the DART course to talk about all the data behind TQ use and the "old think" on the subject.

quote:

Originally posted by RogueJSK:
or if the loop material is too narrow they can end up causing further trauma.

Or simply not work. One of the pictures we saw in my last combat care class was of a thin cord used in the attempt to stop femoral bleeding, and it was ineffective even though it had been tightened so much that it cut deeply into the flesh.

Good info thanks. I am upgrading two first aid kits for home and cabin. Can you recommend a good one to buy?

North American Rescue CAT Tourniquet

https://www.narescue.com/comba...ourniquet-c-a-t.html

(Make sure you buy from NAR or a known first aid supplier. There are fakes CAT TQs out there, so don't risk buying off Amazon/eBay/etc. to save a couple bucks.)

I like the CAT (Combat Action Tourniquet) because I’m familiar with it. I’m sure there are other good ones.

https://www.narescue.com/comba...ourniquet-c-a-t.html

I am not, however, impressed with the stretchy rubber “SWAT” type. Perhaps it would be better if I had gorilla hands, but doubt I could ever make one work effectively in a real situation with slippery, bloody hands.

quote:

Originally posted by sigfreund:
I am not, however, impressed with the stretchy rubber “SWAT” type. Perhaps it would be better if I had gorilla hands, but doubt I could ever make one work effectively in a real situation with slippery, bloody hands.

Agreed. This rubber SWAT-T is a noticeably inferior TQ to something like the CAT. Especially for self-aid, since it's nigh-impossible to apply to yourself one-handed.

However, I'll add the caveat that it does have one limited application: It packs down smaller than the CAT or similar TQs, and it can be used along with a gauze pad to create a pressure dressing for an injury that doesn't require a TQ (or where a TQ couldn't be applied).

So if you're having to making some ultra-flat/compact trauma kit with only room for a few items, and for whatever reason you don't have room for a better TQ like a CAT, the SWAT-T might be of potential use there as "better than a belt but not quite a real TQ, and serving double duty for fashioning a pressure dressing".

But that's a pretty narrow niche.

When I took my first first aid class there where thought, mid-late 80's. Then they removed them saying they where more dangerous. I never believed this.

Later I would teach first aid/CPR/O2/AED/Lifeguard classes. There where times I would mention them but there where not part of the curriculum. If I remember right there was a time we where forbid from talking about them when teaching.

So glad they have been brought back and the ones out there are infinitely better then what I was shown in my first class.

I have one myself and should likely get more so I have one in my car, home and range kit.

quote:

Originally posted by RogueJSK:
[I]t can be used along with a gauze pad to create a pressure dressing for an injury that doesn't require a TQ (or where a TQ couldn't be applied).

I had not thought of that application. Thanks for the tip.

I think that a super basic flat “IFAK” that can fit in a back pocket is more useful than the CAT that is left in your car. I always thought that the SWAT would be better if they stamped finger holes in them to get around the bloody handling problem. I also wonder how useful tourniquets are in stateside shootings, where you are less likely to be wearing rifle rated plates to protect against torso wounds.