A tourniquet appears to be straightforward. It’s just a piece of sturdy material at its most basic level.
It’s simple to understand how it can be used. You just tighten it until the bleeding stops. There you go. The problem is solved.
The tourniquets have been given more complicated recommendations as a consequence of studies completed in recent years, which has prompted emergency personnel to alter their tourniquet usage.
Here’s the most recent thinking, according to the research I’ve been reading. I’m interested in hearing about any tourniquets you’ve used in the field. What works and what doesn’t work for you?
How Quickly to Use a Tourniquet
In most situations, placing direct pressure on the wound to stem the bleeding is the best approach. However, in circumstances where this does not work, experts are now encouraging the use of tourniquets more frequently and faster than previously thought. Tourniquets have been found to be less likely to cause serious arm or leg damage than previously believed in studies conducted during recent conflicts.
The earlier a tourniquet is applied, the more blood loss is prevented, which means the patient has a better chance of survival. That appears obvious, but the message here is that you should not procrastinate; if someone needs a tourniquet, use it immediately.
The Medical Complications of Tourniquets
Tourniquets are not completely safe, and you shouldn’t apply one on your next paper cut. Serious issues can arise as a consequence of these revised criteria.
Even if used correctly, a tiny percentage of tourniquet users will develop nerve damage—pain or partial to complete paralysis of the region. This can last for months or years in some cases and go away. In other situations, it’s permanent.
Don’t be mistaken. Cutting off blood supply for many hours might result in a limb loss.
On the other hand, when a tourniquet is needed—when there’s a lot of blood loss from an extremity and direct pressure isn’t working—the faster you apply one, the better your chances of saving a life.
The majority of the time, most of the harm to a limb after tourniquet usage is due to artery and nerve injury rather than the tourniquet.
The Advantages of Business Tourniquets
Although there are a variety of methods to produce a DIY tourniquet, many professionals recommend having a commercial tourniquet in your emergency kit. Due to muscle or fat or whatever, getting a significant artery to stop bleeding might be more difficult than you think.
The Combat Application Tourniquet (C-A-T) type is backed by significant research. It may be used with only one hand, and it has a unique design. Consider purchasing one, maybe two (one to keep in the car). Make sure you get familiar with how it works before you need it.
Guidelines for Makeshift Tourniquets
While it’s true that a commercial tourniquet is the best, my experience is that emergencies happen when and where you least expect them. Let’s assume you’re hiking and someone stumbles or you’re in a crowd and a bomb goes off (I can’t fathom doing so 20 years ago). You must be able to utilize whatever resources are available to make a tourniquet. You may get an excellent sense of what constitutes a decent one by looking at the commercial label.
The ideal makeshift tourniquet is one that will most likely stop the bleeding and least likely to cause damage. Here are some of the findings from recent studies on how to construct one. (Please share your real-life experience if you’ve ever used a makeshift tourniquet in the field. I’d value any input.)
- It’s critical that the strip be at least one and a half inches wide. It just doesn’t apply enough pressure over all that flesh to the artery if it’s narrower. If you only have tiny materials, use them, but if your tourniquet made with them does not stop bleeding, add another tourniquet adjacent to it if needed.
- The tourniquet’s material and the instrument used to tighten it must be sturdy. According on studies, if one of them breaks while tightening, you’ll have to start over, decreasing your chances of stopping the bleeding.
Updated Guidelines on Using a Tourniquet
Here’s what research tells us about how to use a tourniquet:
- Remove as little slack as possible from the tourniquet before you begin tightening it. This improves your chance of stopping the bleeding. Even with a commercial tourniquet, it’s been found that if you make sure there are no loose areas or gaps between the material and the skin when you start to tighten, you’ll have a better success rate. I think this is where many critics of belt usage have a valid point. Some belts are inflexible. It’s ideal if the material is rather flexible since it will offer greater comfort for your patient during treatment.
- Applying a tourniquet across the injured area only (on the side nearest to the heart rather than toes or fingers) works as effectively or even better than putting it higher up in the extremity. To put it another way, if the damage is in the mid-calf, apply the tourniquet between your calf and knee, not over on your thigh.
- The less you tighten the tourniquet beyond what is required to stop the bleeding, the better. The more you tighten past that, the greater damage you will do to the tissue beneath the tourniquet just from direct pressure. This can lead to unnecessarily killing fat and muscle. In addition, damaged tissues may swell significantly, causing a permanent tourniquet ( compartment syndrome) that must be relieved by having a surgeon cut all of the way to the bone to release pressure.
How Long to Keep a Tourniquet On
The old adage was that you should loosen the tourniquet every so often to allow blood flow to the limb. Experts have changed their tune on this, however.
They also say that if the bleeding is stopped, you should keep the tourniquet on. There’s a lot of evidence that leaving it in place for two hours rarely causes irreversible damage that would not have occurred otherwise. And there’s a lot of evidence that removing it occasionally reduces the likelihood of long-term survival.
Many experts now believe that, in most situations, leaving a tourniquet on for several hours is less likely to do permanent damage than previously believed.
However, after six or eight or more hours, the danger of long-term harm increases. (I read of one example in which a tourniquet was applied for 18 hours without causing major damage; however, I am doubtful that this is typical.) So what can you do if assistance does not arrive soon?
I’ve heard that after several hours of pressure release, I should consider tightening it back gradually to see if any clotting has occurred. Then tighten it back if the bleeding stops, or maintain the same tension and apply direct pressure if necessary.
Tourniquets save lives. Knowing a few pointers may make them more successful, as well as reduce tissue damage.
You may have noticed that much of this information is based on what “I have read.” Please share your thoughts if you’ve used a tourniquet before with personal experience. Do you think any of my conclusions are incorrect? Can you provide any more guidance? Have you ever utilized a makeshift one that worked or didn’t work? If so, please speak up.
Photo credit: J.H. Savigny/Wikimedia Commons