An emergency tourniquet is a tightly tied band applied around a body part (an arm or a leg) sometimes used in an attempt to stop severe traumatic bleeding.[1] Tourniquets are also used during venipuncture and other medical procedures. Severe bleeding means the loss of more than 1,000 ml (1 litre) of blood. This flow of blood can soak a paper or cloth handkerchief in a few seconds. In such a situation, the bleeding will cause the death of the casualty in seconds to minutes.
In most applications, a tourniquet is a last resort method of bleeding control as all blood flow below the application of an emergency tourniquet is stopped, and can subsequently kill the tissue, leading to eventual loss of the limb below application.[1][2][3]
Even in cases of amputation, most bleeding can be controlled through alternative methods such as direct pressure. The rare exception is when a limb is shattered by massive trauma or when a major blood vessel is torn along its length. Even in these cases, the use of a pressure point above the wound (i.e. proximal to the wound), or application by a doctor of a hemostat to clamp the blood vessel above the tear can be used.
However, the use of tourniquets is widespread in military applications, and have the potential to save lives during major limb trauma. Analysis has shown that in cases of major limb trauma, there is no apparent link between tourniquet application and morbidity of the limb.[4]
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As the tourniquet stops the perfusion of the limb, the resulting anoxia can cause the death of the limb, forcing the later surgical amputation of the limb just below the level the tourniquet is applied. This is likely to occur when the tourniquet stays in place several hours. In any event, once a tourniquet has been applied, advanced medical care from a doctor or hospital will be required to salvage the limb if not save the life of the patient.
Pressure bandages are sometimes confused with tourniquets in non-trained civilian use. A pressure bandage is applied either directly to the wound or just above the arterial path to slow blood flow and reduce blood loss, without occluding blood flow to the injury. In many cases, pressure bandages are effective for premedical first aid treatment.
Tourniquets are still widely considered in the civilian field to be an option of last resort. This practice is changing, with many EMS services carrying tourniquets.
The decision to employ a tourniquet should be made by an emergency medical technician or a doctor if at all possible. But when severe external bleeding cannot be controlled by other means, a tourniquet may be the only way for a first-aider to save the casualty.
Most civilian first aid instruction in the United States do not teach the use of tourniquets for the following reasons:
The use of a tourniquet by a layperson in countries where it is considered outside the scope of practice of first aid may result in civil lawsuits and/or criminal charges, especially if the application was later found to have been unnecessary.
Battlefield experience in Iraq has caused the US military to reconsider the 'conventional wisdom' regarding tourniquets. Life threatening bleeding from extremities is more common because body armor protects the torso. Blast injuries to limbs rarely result in a clean amputation or a salvageable limb, and a rapidly applied tourniquet can be immediately lifesaving when arterial (spurting red) bleeding results from such major injuries.
The US Military has also found (through experience in Iraq) that due to the ability to transport a casualty to a surgeon in less than an hour of being wounded, tourniquets are used far more frequently for injuries from gunshot wounds to amputations. Formerly, tourniquets were not used as much, due to the difficulty of transporting the casualty to a skilled physician in time to save the limb.
All US Army soldiers and US Marines are now required to carry a tourniquet as part of their individual first aid kits. First aid training for soldiers now addresses the "prompt and decisive" use of tourniquets to control life-threatening extremity bleeding. Soldiers are also trained in proper self application of the tourniquet.[2][3]
As with the US military, the Canadian Forces utilizes combat tourniquets. Their use in Afghanistan has greatly reduced the mortality of troops suffering severe extremity trauma. Every soldier is issued a tourniquet and trained to use it as part of his pre-deployment training.
Since 2007, the tourniquet is not taught to the general public. It is, however, part of the basic life support training given to medical and paramedical staff, firefighters, swimming-pool and sea rescuers, and members of first aid associations.
In Australia, people undergoing a first aid course will be instructed to never use a tourniquet. They are further instructed that if you have a first aid certificate there can be legal issues with using a tourniquet.
In Norway, all soldiers are required to carry a tourniquet in their personal aidkits. Under medical training, the instructions are clear on that 15 minutes after applying the tourniquet, one is not allowed to remove it, only professional trained doctors are allowed to remove it.