There's always time for Tourniquets (or is there?)
There were a few changes in the new guidelines that were released in October of 2015. Apart from the usual CPR guideline updates, there was the reintroduction of one of the oldest forms of treatment in history.....The tourniquet!
Tourniquets were removed from First Aid years ago due to concerns of limb loss due to inappropriate placement, along with many other concerns, however it is now back in an effort to reduce the number of deaths due to significant blood loss, that could have been prevented.
What is a tourniquet?
Well, a tourniquet is defined as: Any device for arresting bleeding by forcibly compressing a blood vessel. As a bandage tightened by twisting. (Oxford English dictionary)
Simply put a tourniquet restricts or stops the flow of blood to an area that has catastrophic bleeding or a ‘pumping bleed’, these devices have saved countless lives in conflicts of every era from the Napoleonic era to the conflicts in the middle east of modern times. The tourniquet has been successful in civilian applications for centuries too and is still used daily. Ever had a blood test? Then you have had a tourniquet on your arm so that the medical staff could visualise the vein!
Tourniquets were originally removed from conventional First Aid Training due to concerns that incorrect application and prolonged use of the tourniquet could result in unnecessary limb loss, however recent clinical case studies have proved that this was far from the case. The Clinical studies, conducted over 76 patients, admitted with tourniquets revealed that only 2 patients had minor complications such as loss of nerve sensation and these were after nearly 2 HOURS of the tourniquet being in place. As for limb loss well only one case resulted in limb loss and the tourniquet had been in place for 6 HOURS.
The conclusion of the study was that tourniquets if used correctly are still an amazing lifesaving tool and should be taught to the general public.
Does that mean I will learn about tourniquets on my next First Aid Course?
Well not necessarily. The reintroduction of tourniquet training has been focussed on HIGH risk environments such as Construction, Tree surgery, heavy engineering etc., this is due to the nature of the work and equipment being used. Such equipment could result in significant injury to limbs causing severe arterial or venous bleeding.
However, it is recommended that First Aid instructors teach the use of an improvised tourniquet on all Courses, however this is dependent on risk assessment and instructor experience/certification. If you feel that your needs warrant adding tourniquet training, then by all means request it.
Manufactured vs improvised tourniquets what’s the difference?
Well one is bought, ready to use and purpose built for the job. There are many to choose from but I recommend that you receive appropriate training in the use of the equipment once purchased or the one time you need to use it you will not know how.
An improvised tourniquet is using standard First Aid equipment and everyday items to create a tourniquet which is more simple than you may think and just as effective.
A good example of the effectiveness of improvised tourniquets was during the Boston Bombings where everyday people and emergency responders were forced to make improvised tourniquets, just look at the story by the daily mail at this link: http://www.dailymail.co.uk/news/article-2311118/Boston-bombing-brings-tourniquet-Once-doubted-medical-device-stop-bleeding-saved-countless-lives-amidst-bloodshed.html
How do I make one? Well look at the diagram below:
The only equipment needed here is a non-elastic strip of material such as cotton, a scarf or a triangular bandage folded in half. NOTE: to be effective the tourniquet material has to be 1.5 inches (4cm) wide. A long solid object such as a stick, metal cutlery, pair of scissors etc, this will be used to tighten the tourniquet and a smaller piece of material to hold the stick etc. in place once the correct tightness is achieved.
For a visual demonstration please take a look at the video link below.
A tourniquet should only be used after applying direct pressure has failed to stop the bleeding or you can immediately identify the bleed as severe venous (vein) bleeding or Arterial bleeding.
Once the tourniquet is applied LEAVE IT ON! Only Doctors should remove tourniquets. Inform medical staff what time the tourniquet was applied so that they can inform the Doctor who will be releasing the tourniquet.
Tourniquets WILL hurt!! If the correct tension is applied the circulation to the limb will be cut off, the pain will only be temporary.
NEVER apply a tourniquet to the neck!!
Neck ties and belts DO NOT make effective tourniquets as you will not be able to achieve correct pressure.
Never apply a tourniquet to a joint like a knee or elbow, as the blood vessels we are trying to compress are shielded by bone.
Tourniquets should be applied 5cm above to wound site to avoid placing undue pressure on the wound.
In conclusion this life saving skill is now back to make its mark again and interestingly enough the first recorded use of the tourniquet was by the Roman Empire! 2000 + years of use must mean it makes a difference.
Until next time stay safe.