Tourniquets No More
July 17, 2021 12:15 AM   Subscribe

Where did I see an article stating that tourniquets are no longer recommended for certain types of injuries?

I remember reading such an article in the past year or so in a major publication but I can no longer find it!
posted by Dansaman to Health & Fitness (5 answers total) 5 users marked this as a favorite
 
Direct pressure on the wound has been the generally advised first aid option for blood loss control for decades now, but tourniquets still have their place.

Explicit advice against the use of tourniquets that I frequently see concerns using them to treat snake bites. Was that what the article you read was about?
posted by flabdablet at 1:55 AM on July 17, 2021 [2 favorites]


Using a tourniquet without having sufficient training (or fashioning a tourniquet out of makeshift materials) can be really hazardous to the person you’re caring for. As a volunteer Neighborhood Emergency Team member (CERT training), but not a trained medical professional, I have been told to avoid using tourniquets as it’s very likely I’ll do more harm than good. Instead I’ve been trained in direct pressure and wound packing. There’s a cool training called Stop The Bleed that I’d recommend if you’re interested in learning more.

So maybe you read something about the general push-back against the pop-culture “bleeding?? Slap your belt on it and walk away!”
posted by Secretariat at 8:15 AM on July 17, 2021 [6 favorites]


Tourniquets have been in and out of "style" a few times in the past few decades.

When I did my first round of First Responder training, circa mid-1990s, my recollection was that they were "out". There was a belief that they did more harm than good in many situations, and could contribute to limb loss and even death if clots were suddenly released into the rest of the body. The advice at the time, IIRC, was direct pressure combined with IV fluid therapy to maintain blood pressure. MAS trousers were a thing for lower-leg and pelvic wounds for a while (they are no longer recommended), at least as late as the early 2000s.

More recently, and largely as a result of experience gained in the Iraq and Afghanistan wars, tourniquets have come back "in". But there are caveats: modern tourniquets are fairly wide bands (at least 1" wide), and should never be made from thin cordage materials (such as shoelaces). They should be tightened enough to stop bleeding but not overtightened. And contrary to previous guidance (that I have seen, among other places, in old Boy Scout manuals) they should not be released until the patient is at a trauma center / definitive care. Modern anticoagulant drugs and other therapies now mean that you can leave tourniquets on for surprisingly long amounts of time and not suffer limb loss; the bigger risk is now considered to be death due to hemorrhage (blood loss) from a severe wound or traumatic amputation prior to arrival at definitive care.

The military standard is currently the CAT-style tourniquet, which is designed for self-application with one hand. They are also used by many civilian EMS agencies and protocols now.

I know personally of at least one case where a patient suffered a significant limb injury (due to IED) and had a lower-limb tourniquet applied in-theater in AFG, and it was kept on until the patient arrived at Landstuhl, Germany. They made a full recovery.

"Stop The Bleed" is good training and I would totally recommend it, especially to anyone working in/around machinery, firearms, or any other situation that might cause significant limb injury. It's probably second only to CPR and Heimlich Maneuver training in terms of its lifesaving potential.
posted by Kadin2048 at 10:56 AM on July 17, 2021 [11 favorites]


Years ago, we were advised to carry a roll of clingfilm /saranwrap in the car in case of emergency . . . for wrapping round bleeding limbs. Had the advantage that it was clean enough and clear so it didn't get in the way of EMT effectives when they arrived. Does that still sound sensible?
posted by BobTheScientist at 12:55 PM on July 17, 2021


> Does that still sound sensible?

I've been certified in First Aid a million times, and Wilderness First Aid, and am also a CERT volunteer who enjoys talking about what we should have in our kits, and that's the first time I've heard of that. I'm curious: who recommended it? What country?
posted by The corpse in the library at 2:39 PM on July 17, 2021


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