Updated: Nov 18, 2018
Many of the developments in treatment of traumatic injuries comes from military medical units.
There has been, and continues to be, in recent years many military conflicts which have provided the evidence base to warrant change to some procedures.
One of these is the use of a tourniquet to control haemorrhage.
Their use has been avoided for many years due to the possibility of limb amputation caused by ischemia after application of the tourniquet.
Now a new study from Texas Study Group shows that civilians with severe injuries odds of survival was dramatically improved by use of a pre hospital tourniquet.
The study also showed that 9.6 of the study group had amputations but the mortality rate of those receiving amputations was significantly lower in victims who had received tourniquets than those who didn’t. 2.9% compared to 7.9%.
Recent combat experienced has demonstrated that victims who had a tourniquet applied before they went into shock had a 9 times greater survival rates than those who had it applied after they went into shock.
Military studies also demonstrated tourniquets can be safely applied for a period up to 2 hours with no concerns about amputation.
So what does this mean for major haemorrhage in a first aid situation?
The current ILCOR guidelines recommend tourniquets only be used if unable to stop the bleed with direct pressure.
However, in my opinion, it could be suggested that in the event of an obvious major life threatening bleed their use be considered sooner rather than later without fear of worsening the situation.
Commercial tourniquets are clearly the best option, having been designed for the task, however improvised versions can be used. Care should be taken however to ensure these can be tightened sufficiently to stop blood flowing through the artery. If these cannot be tightened sufficiently as in, for example a leather belt, they tend to only compress the vein and not the artery resulting in no bleeding control.