Within seconds of the two blasts that ended the Boston Marathon, doctors and emergency personnel were faced with decisions that are only usually made in combat, life or limb. Confronted with horrific lower extremity injuries the life saving device that was used over and over was the tourniquet. Around for millennia but fallen into disfavor years ago, tourniquets were only to be used as a last resort to stop life threatening bleeding from a limb when direct pressure, elevation and pressure above the wound did not work. The common belief was that the prolonged cutting off the blood to the limb would lead to amputation. The problem was that there were no good studies to prove it. So up until recently the tourniquet was a last resort.
Then along came the wars in the Middle East. Studies showed there that the timely use of a tourniquet resulted in survival rates as high as 90 percent. Contrary to past fears, the tourniquets themselves didn’t cause any limb loss, even in the rare cases when patients had to keep them on for two to three hours. Considering that blood loss is the leading cause of death in a trauma patient and a person can bleed to death in three minutes from a severed femoral artery, the large blood vessel in the upper leg, the choice is simple. Every paramedic is now trained to apply a tourniquet. Since 2006, a tourniquet is issued to every soldier.
Here are some simple guidelines to use if you are ever confronted with a major limb bleed:
First, apply direct pressure with your hand or a cloth. Don’t worry about clean, at this point it doesn’t matter. If you’re not alone have someone call 911. If you are alone do it first, you can always put the phone down and yell into it while you’re applying pressure.
Elevate the extremity if possible.
If you’re unable to control the bleeding quickly, or the injury is really big, or an partial or full amputation, then you need a tourniquet. Find something long, strong and pliable. Shirts, pants, something that can be torn onto a long strip; belts (Should be at least 1 1/2 inches wide).
Place the tourniquet around the arm or leg between the wound and the heart.
Tie a half-knot – the same as the first part of the knot when you tie a shoe, but have not finished the knot.
Place a strong stick on top of the half knot. Anything long and rigid will do, improvise. If at home, a large serving spoon or kitchen utensil; in the workshop a screw driver; a pen, pencil, you get the idea.
Tie a full knot over the stick.
Twist the stick until the material is tight around the limb and/or the bright red bleeding has stopped.
If you have enough length, loop the loose ends of the tourniquet over the ends of the stick. Bring the ends around the arm or leg and tie the ends together around the limb. This is so that the tourniquet cannot loosen. Or, tie other material around to hold the stick.
Belts of course can be pulled as tight as needed to stop the bleeding but you may be “married” to holding it tight until help arrives, if it can’t be secured so it won’t come loose.
Outside a controlled hospital setting, this is called damage control, or how to save a life.