A New Turn for Tourniquets
Friday, January 30, 2015 09:58 PM

In the last several years, the U.S. military has gathered substantial evidence on the safety benefits of using tourniquets. However, many physicians still may be hesitant to use this potentially lifesaving device. The chief concern: A tourniquet can induce ischemia in an already at-risk extremity, which may lead to an unnecessary amputation. This belief first developed in World War I when evacuation to surgical care took up to 18 hours and was reinforced in World War II.  Prolonged evacuation times and reliance on improvised tourniquets meant surgeons often saw survivors who may have not needed a tourniquet. Those that died in the field from simple extremity hemorrhage just never made it to the surgeon.

So, what's the current evidence? The most recent studies indicate that the tourniquet is safer than previously described. In 2008, Kragh et al. studied 232 patients with 309 limbs that had tourniquets applied and determined that there were no amputations resulting from tourniquet use. The enhanced safety of the tourniquet is in no doubt due not only to technical advances in their design but also because transport times to surgeons have been greatly reduced. This reduction in transport time is not relegated just to the battlefield, but also affects today's civilian trauma systems.

The Committee on Tactical Combat Casualty Care (CoTCCC) recommends three different commercially available tourniquets. All the tourniquets were tested by the U.S. Army Institute of Surgical Research to ensure that they would reliably be able to obstruct arterial blood flow. The Combat Application Tourniquet (C-A-T™) has the advantage of being lightweight and therefore can be operated with one hand, allowing someone to place it on one's own upper extremity with the other hand, if needed. The SOF® Tactical Tourniquet is also a commonly used tourniquet on the battlefield. The third tourniquet is the Emergency and Military Tourniquet (EMT™), by Delfi, which instead of using a windlass rod like the C-A-T™ or SOF® TT, works pneumatically.

In the tactical field care phase of treatment, TCCC recommends:

  • First, place the tourniquet two to three inches above the wound, directly on the skin

  • Then, check for a distal pulse and if bleeding persists

  • If so, consider placing another tourniquet side by side and directly above the first or tightening the existing tourniquet.

Source:  http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/49319