Tourniquets A Renaissance of the Taboo. We ve always been told never to use Tourniquets over the years by our First Aid Experts. But now this pre-historic skill has come back into the fore and is saving lives daily. As early as 400BC Alexander the Great was documented to have used Tourniquets during battles to save the lives of his men and horses. So what actually is a Tourniquet? It is a device, whether purpose made or improvised, to globally stop blood flow to a limb. This is achieved by securing and tightening a band around the limb to arrest blood flow. Through this article we will look at the 3 key factors with Tourniquets:- Function Simplicity Effectiveness So why the change from the Never Use a Tourniquet Stance? War. plain and simple. There is no dressing this one up to be anything other than that without these basic devices mortality in a war zone would be 10 fold. The British Military re-introduced the tourniquet in 2005, during the Iraq Campaign, which had an impact on the survivability of those targeted by Roadside IED s*. It was not until the battles for Helmand in Afghanistan that the effect of the Tourniquet was truly measured. *improvised explosive devices. The clinical re-enforcement for their use was published in a study carried out by the United States Army Surgical Research Unit in 2010. A short summary of their findings are below, and are quite simply astonishing. the study period included the treatment of 499 Casualties of the 499 casualties, in all 862 tourniquets were applied to 651 limbs Meaning over half of those injured had more than one limb affected, and in some cases 2 Tourniquets were applied to the same limb. morbidity overall was 1.7% (of the 499 injured, 8 died)
With so much confidence around the benefits of Tourniquet use for life threatening bleeding, The International Liaison Committee on Resuscitation (ILCOR)/Oct 2015 published their Recommendation that Tourniquet application should be taught to everyone (FA768). Full Article Here http://m.circ.ahajournals.org/content/132/16_suppl_1/s269.full Let s add context to this these are mostly injuries sustained in a remote, austere and truly hostile environment. Very often the injured party and their rescuers would have been under enemy fire. The emergency response although comprehensive, robust and effective would not have arrived immediately. But the Tourniquet did not apply itself? Very often the injury party self-applied and then team support was provided at the earliest tactical opportunity. This reinforces one of the key aims of this article, Tourniquets are Simple to use. When they are applied by a trained individual/rescuer life giving blood can be stopped so much quicker. Let s take a good look at possibly the most common purpose made Tourniquet, The Combat Application Tourniquet or CAT. It s been in service for about 10 years and in that time has saved literally 1000 s of lives. It is made up of 4 main components. The Velcro Band (fig 1), The Loop (fig2), The Rod or Windlass (fig 3) and The Windlass Clip and Strap (fig 4) fig 1 fig 2 fig 3 fig 4
Complete/stowed CAT Affected limb through here What does it mean for you? But, before everyone stampedes out to buy more first equipment. Consider a very logical approach to identifying as to whether you need Tourniquets within your emergency equipment. Let s not forget, we can improvise if needed. Look at your work/social activities and consider in realistic terms whether you would need a purpose made Tourniquet available. Have a look at the following examples. What about a Tree Surgeon, working with cutting equipment within a small team (possibly away from the main road network/remotely). Then the validity is absolutely there for Tourniquets to be present and we would recommend that. This example may warrant an operative carrying their own. Office Workers, in the main, the risk remains very low indeed and improvisation may be a reasonable substitute. Large public area/area of strategic interest - general work activities might not be of significant risk. BUT, as part of our security and risk management assessments, response to disaster (Fire, Gas, Utility Failure, Flooding or a Terror Attack) we must consider how we may render immediate lifesaving care to those affected. What Types of Tourniquets are there? We have already discussed the CAT, but there are more on the market, all with similar features. Such as the:-
SOFTT SF Tourniquet SOFTT Special Operations Forces Tactical Tourniquet SWAT Tourniquet
SAT Tourniquet Will I get into trouble for using one? If the situation demands the use of these measures, then No. nothing more to add here. Case Study.. Paris November 13 th 2015 saw one of the bloodiest Terrorist Incidents in living memory. 130 people lost their lives during the co-ordinated gun and suicide attacks over a 4 hour period. Many of those that died were killed by instantly fatal gunshot wounds. Of the 302 people injured in the attacks just 4 died after arriving at hospital. Let s analyse the last fact, 302 people evacuated to hospital and from this 4 died. This reinforces the fact that 126 people died on scene. From this there were 4 further fatalities in the hours and days that followed. We can assume that many of the 302 evacuated from the various attack sites were in a time critical * state, so how was the loss of life not greater? Several underlying factors that have been widely reported on include, victims in the main were aged 40 or less (deemed to be fitter, reduced chances of underlying medical issues and anti-coagulation medications), and the authorities not 12 hours prior had rehearsed an emergency plan for the exact type of attack carried out later the very same day. One fact that has gone very much un-reported outside of the medical press is the use of Tourniquets. That s purpose made Tourniquets and improvised devices used in hast. *The Lancet a world renowned medical journal reported that many of the initial first responders in Paris that night had returned to hospital with patients and had used their own belts to control blood loss (makeshift tourniquets). This demonstrates another of the core aims of this article, the effectiveness when a Tourniquet is applied correctly, it is lifesaving.
Application.. So initial recognition of Catastrophic Bleeding is essential and aggressive control options must be then used. Tourniquets should be applied rapidly to a casualty, over their clothes, at least 5 cm s above the wound. Avoid joints like the elbows and knees, and if required go above them. At least 5 cm s or 4 Fingers width above the wound site. Once they are on, they stay on.! The purpose is to stop bleeding completely, so don t work against it by offering any period of release. The body will be trying to build its own haemorrhage control in the form of a clot/s. If the Tourniquet was to be released the flow of blood will displace the clot and bleeding would then restart. No Pain, no gain! If the casualty is fully alert or has a moderately reduced level of consciousness (AVP), then application of an effective Tourniquet will hurt a great deal. This obviously should not stop you applying the device. This may save their life, so no pain, no gain. What next? Has the bleeding stopped? If yes, use a bandage (possibly haemostatic agents) and move onto other life threatening issues. But don t forget to re-assess the bleeding periodically*. *following an injury, the body releases large amounts of Adrenalin which constricts blood vessels. Like any release of Adrenalin, it s shortlived, so initially sites may stop bleeding, but as Adrenalin levels reduce, the blood vessels relax and wounds may re-bleed. If not tighten the initial Tourniquet and consider applying a second Tourniquet, 5cm s above the first.
The Bleeding is bad and I don t have a Tourniquet..! As documented in Paris makeshift or improvised Tourniquets were used to great effect! So what handy things make a good Emergency Tourniquet? A Belt is normally one of the first considerations. Adjoin the ends, tighten and use an improvised windlass A suitable length of strong material, such as dish cloth, T- shirt, leg of a trouser or a thin towel
A Shoe Lace might not be the best choice, but if it s the only choice. Tighten and tie, then use a windlass to stop blood flow. This is a strap from a laptop bag, a strap from a rucksack or handbag again would do similar. Tighten and tie, then use a windlass to stop blood flow.
The use of broad fold bandage made from a triangular bandage is ideal. By keeping the Tourniquet broad this exerts damage limiting pressure on the limb. A set of tuff cut shears has been used as the windlass. This is great option as both items can be found in any First Aid Kit. Use of improvised windlass is very simple. These items were within hands reach and are ideal to tie into which ever band you choose. Locking off the device may mean either the rescuer, if possible, maintaining a firm hold, or security could be achieved by tucking in the end.
Conclusion.. If you wanted to implement any of the points raised in this article, then firstly assess your own working practice and that of those around you. Maybe also consider your hobbies as well; accidents happen allot more often at play away from Workplace Safety measures. If you decided that you might want to implement this equipment, make a selection on simplicity and durability (all of the Tourniquets we have listed will meet that criteria). Ensure if possible you get some form of training. Any reputable First Aid Training provider will now be including this into all workplace First Aid courses following the recent recommendations. In Safe Hands Training has been delivering this to high risk workplaces for the last 3 years and with 2 documented applications; we are glad we did. If the worst should happen, be aggressive in your efforts to stop the bleeding, apply the Tourniquet firmly, so the blood stops! (this can be confirmed by checking pulses in the wrist and foot). Rapid transfer to medical aid is crucial so get help as early as possible. Why not watch our short video on Youtube Just here:- https://www.youtube.com/edit?o=u&video_id=1tj1ooodvpm Thank you for your time and attention. Please call or email if we can help advise you. Best Regards, Tim Puffer Cert Ed.