Recently, the recommended guidelines for using tourniquets for heavy bleeding have changed to much more in favor of using them. Much of this change has come about because of their increased use by the military in recent U.S. combat operations in Afghanistan and Iraq and from mass shootings and bombings in the USA.
Large multi-casualty incidents, including Sandy Hook Elementary school in 2012, the Florida Nightclub shooting and the Boston Marathon bombing, highlighted the benefit of improvised tourniquets used by bystanders prior to the arrival of emergency medical personnel.
As you are aware, uncontrolled heavy bleeding can quickly lead to death in as little as a few minutes, often before the arrival of EMS responders.
If you have heavy bleeding on a limb, circumferential pressure around the limb on the torso side of the wound can squeeze soft tissue down against a central long bone and collapse large blood vessels, shutting off all forward blood flow and stopping bleeding. Not a difficult concept to understand.
Using a tourniquet for heavy bleeding control has been done for centuries. However, the use of tourniquets has been always been somewhat controversial, especially in the last 30-40 years:
- Shutting off all forward blood supply to the point of bleeding is certainly effective, but it will also shut off the blood supply to all the uninjured tissue past the tourniquet as well. Lack of oxygen to this tissue can result in tissue death at some point.
- Improvising a tourniquet with readily available materials can prove to be difficult. Thin bands can cut into and injure tissue. Cinching mechanisms can result in poor compression and bleeding control.
- A reasonable attempt at using an easier and less damaging technique, such as direct pressure or a pressure bandage, may prove to be effective and eliminate the need for the use of a tourniquet.
These cautions shaped the recommendations for using tourniquets for many years and still influence our feelings today. The phrases “Life or Limb” and “Last Resort” became a common way of expressing caution in the use of a tourniquet.
Secondarily, the presumed risks of using tourniquets seemed to have been overstated. Even with tourniquets on for extended time periods, limb damage, and other complications, from the use of a tourniquet was much lower than expected. And most importantly, injured soldiers were surviving combat wounds that were nearly non-survivable in the past.
All this evidence prompted the American Academy of Surgeons into convene the Hartford Consensus Compendium in 2013, a gathering of experts in bleeding control to determine the best way forward in approach and training.
As a result, widespread layperson training in the use of a tourniquet for bleeding control is recommended. The White House has even established a “Stop the Bleed” initiative to promote the idea. Like the placement of public AED’s for layperson use to treat sudden cardiac arrest, public access to tourniquets could result in much quicker treatment for bleeding emergencies.
To get to as many people as possible, training should be short and simple. Hands-on practice is highly recommended as part of it.
The ASHI and MEDIC First Aid Advanced Bleeding Control training programs have been designed to effectively teach layperson bleeding control techniques, including the use of tourniquets. The programs can provide specific training on the devices available and are flexible enough to train a wide variety of providers, including law enforcement officers, lifeguards, event security, and workplace safety providers.
