Confidence to Care
Life has a way of moving through trends. Butter or no butter ? Salt or no salt ? Tourniquets are unacceptable OR Tourniquets are life savers ? So what is the truth ?. A tourniquet is a strap or bandage or tie (of some sort) to stop the flow of blood to a limb (arm or a leg). The use of Tourniquets is an traditional method of stopping excess blood flow but it fell out of favour with general first aid many years ago. The argument was that applying a tourniquet to stop really heavy bleeding was so drastic that serious damage would be done to the soft tissues (muscles, skin etc) to the point that the victim would undoubtedly be destined for amputation. However the use of tourniquets in the armed forces to save wounded soldiers, sailors and airmen continued as a vital part of the first aid process.
So, why give instructions to armed forces personnel and completely different guidance to civilians. Do they not trust civilians to do a good job ? No, quite simply No !, they don’t and not without good reason. Army first aiders have regular and repeated training. They do it often and they are watched, assessed and judged on their abilities to save others under circumstances in which they expect to use those skills. As civilians we might do training once every three years (if we are good :)), or maybe never at all.
In 2015 the European Resuscitation Council decided that the use of tourniquet in cases of catastrophic bleeding, was the right thing to do. What does catastrophic bleeding mean ?. It is when the bleeding is so bad that the use of direct pressure on the wound just isn’t doing its job. Best example: On a construction site or a farm. Someone has cut of part of their extremities (hand, foot, leg etc). There is so much blood that you don’t know what to do. It is everywhere and either pumping or flowing. Either way its outside not inside the body. Applying direct pressure and elevating isn’t working, there is still lots of blood coming out. Time for a tourniquet. What can you use ?
Not a leather belt (it doesn’t twist well), but a strap, tights, triangular bandage or anything that you can turn to make it tighter (hence the name tourniquet, its a French word that means ‘to turn’). Back to basics for a minute. Blood doesn’t just flow everywhere in the body, its supposed to stay in tubes, like a central heating system. Water flowing out of your boiler or radiators is bad. Blood flowing too quickly out of the body’s pipes is much worse and potentially fatal. So, if there is lots and lots of blood then you need to apply direct pressure, but if that wont slow down blood flow then acting quickly is good. Tie a strap about 5cm up from the wound (not over a joint – it wont work).
Sometimes the artery or vein will retract a little bit when it is damaged, so you need to be sure that you can tie off the end of an artery or vein effectively. Tie it tight, use a stick to twist the strap even tighter and watch for the blood flow to slow down to a stop. As soon as it stops, write down the exact time that you applied the tourniquet. The doctors will need to know because time is important here. The US National Library of Medicine website states that damage can occur from a tourniquet after 2 hours of use. By 6 hours continuous use we are back to the amputation scenario. That’s why the doctors need to be clear about when it was applied.
Tourniquets are a last resort for general first aid. Let us be clear, using a tourniquet will cause the casualty a lot of pain if one needs to be used, but pain is better than bleeding to death. As with many things in First Aid, you need to work to a system of priorities. If the casualty is not breathing then CPR is your priority. If the casualty is bleeding so much that you cant stop it with direct pressure and elevation then using a tourniquet is better than losing so much blood that he/she cant be saved. I shall be including the use of a Tourniquet for catastrophic bleeding in my first aid courses in the future. I hope that I will never have to use one but if i ever did, at least I will know how and be clear that I am working on best advice from todays protocols as well as using a time held tradition treatment.