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31 March 2017

Tourniquets Save Lives

Tourniquets Save Lives

By Tim Puffer

First Aid experts have argued against the use of tourniquets in recent years, but now this age old skill has made a comeback and is once again saving lives.

What is a tourniquet?

A tourniquet is a device used to stop blood flow to the limb. It can be purpose built or improvised. Blood flow to the limb is achieved by securing and tightening a band around the limb to arrest blood flow.

Why have viewpoints on Tourniquets changed?

Conflicts worldwide have been an extensive factor in why tourniquets have been accepted more-so in recent times. Without these devices, mortality rates in active war zones would be 10 times higher than they currently are. Our own Military reintroduced the tourniquet in 2005 during the Iraq war and had a great impact on the survivability of IED attacks.

The clinical re-enforcement for their use was published in a study carried out by the United States Army Surgical Research Unit in 2010. In summary; 

‘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)

This led to great confidence 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

These injuries mainly occurred in remote and hostile environments, meaning that emergency medical response would normally not have been immediate, and that the injured would have self-applied with team support at the earliest available opportunity.

This is another reason why Tourniquets are so highly recommended. They are simple to use. When applied by a trained professional, life endangering blood loss can be stopped much faster.

CAT Tourniquet

The CAT (Combat Action Tourniquet) is probably the most common purpose made tourniquet on the market. It has been available for roughly 10 years and in that time has saved many thousands of lives. It is made up of four compartments, and can be applied by the following method;

  1. Wrap the tourniquet at least 2 inches above the wound
  2. Pass the tip of the CAT into the slit of the buckle and pull it tightly.
  3. Twist the rod in either direction until the bleeding stops
  4. Place the rod inside the clip of the tourniquet to secure it

Cat tourniquet

Some key points we can’t stress enough

  • Once a tourniquet is on, it stays on, the body will be trying to clot to prevent blood loss, so releasing a tourniquet will displace a clot and bleeding would then re-start
  • If a casualty is fully alert, correct application of a tourniquet will hurt, a lot. But do not stop applying the tourniquet, it may save their life so is definitely worth the pain.
  • If the bleeding has stopped, use bandages and other haemostatic agents and move on to other life threatening issues, but continue to monitor the bleeding.
  • If one tourniquet does not stop the bleeding, consider applying a second, 5cm above the first.

The following video also provides a great insight:

Do you need a Tourniquet in your emergency medical kit?

It is important to identify whether there’s any need for Tourniquets within your emergency medical equipment. A tourniquet is usually a worst case scenario and there are generally other methods of controlling blood loss to equal effect. So look at your workplace/activity and consider whether you may need a purpose built tourniquet.

For example, a tree surgeon, working with cutting equipment in a small team and remote environments has a much greater need for a tourniquet than say an office worker, in a low risk environment. Large public areas need to be prepared for almost any eventuality, including the likes of fires, gas explosions, flooding and even mass casualty incidents, so it is essential to consider how one may administer immediate lifesaving care to those affected. At SP, we can assist with strategic disaster management plans, custom first aid kits and readiness plans for you and your business. Contact us for more information.

HSE Guidance on employers and First Aid Kits

The following extract is taking directly from the UK HSE website;

‘The recent European Resuscitation Council review of a number of first aid protocols suggests there is a need in certain circumstances for first aid kits to contain haemostatic dressings and tourniquets.  The view of HSE is that the inclusion of these items is based on your First Aid Needs Assessment. 

Where your needs assessment has identified a requirement for tourniquets and/or haemostatic dressings you should make sure:

·Your haemostatic dressings are always in date;

·Workplace first aiders are trained by a competent provider in when to apply a tourniquet and the correct technique to use.  For example, competent training providers should be teaching clinical protocols as described by the Faculty of Pre Hospital Care; and,

·Workplace first aiders have training in when and how a haemostatic dressing is applied.’

You will generally not get in trouble for using a tourniquet if the situation demands that one needs to be used.

In conclusion, assess your own working practice and that of those around you. Consider hobbies and activities that may determine a need for a tourniquet. Select a simple and durable tourniquet and get training in the use of them if possible.

Most reputable first aid training organisations now include tourniquet use in workplace first aid courses.

If worst comes to worst, do not be afraid to apply a tourniquet and be aggressive in your attempts to stop bleeding. You can check if it is done correctly by checking the pulse in the wrist/foot.

Finally, call for medical help as soon as possible, the earlier care is given, the higher the chance of survival.

If you have any queries regarding tourniquets or haemorrhage control, then please don’t hesitate to get in touch.

Long time SP customer Tim Puffer of In Safe Hands Health and Safety Training and Consultancy Ltd has kindly written the above article on tourniquets for us.


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