Posted on: Tuesday, 2 August 2016

IBA UK is now offering advanced first aid courses in the use of tourniquets and haemostatic dressings for those in the security industry and workers in high-risk industries. In this post, we’ll look at the controversy over tourniquet use, and why we think it remains an indispensible procedure.

To tourniquet or not to tourniquet?

We’ve all seen tourniquets at the movies. The hero tears off his shirt and ties a makeshift tourniquet round the leg of his badly-injured buddy.

The reality is a bit more complex than that. The use of emergency tourniquets is one of the more controversial areas in first aid. The problem is that using a tourniquet is a powerful intervention that can have all sorts of repercussions for the human body.

For example, improper tourniquet use carries the risk of ischaemia. The restriction of blood flow by a tourniquet can cause damage to the tissues as the cells are starved of oxygen and nutrients. And when the tourniquet is removed and blood flow is restored, there can be more bad news. reperfusion injury can occur. When the oxygen-starved limb is suddenly flooded with rich, oxygenated blood, the result is inflammation and a cascade of chemical reactions referred to as oxidative stress. This poses a further challenge for an already weakened body.

These and other undeniable risks have seen tourniquets get a bad press in recent years.

However, what’s also undeniable is that every year tourniquets continue to save lives.

The case for tourniquets

In many cases, bleeding from a limb can be slowed or prevented by direct pressure. Where this is possible, there may not be any need for a tourniquet.

However, in real life there are many circumstances where direct pressure isn’t possible. What if the injured person is unconscious, or has a limb trapped where pressure can’t be applied to the wound? What if he has more than one injured limb, or there are multiple casualties that need attention? In all of these circumstances, properly applied tourniquets may make all the difference.

Up to 39% of civilian trauma fatalities occur from loss of blood, and death from blood loss from a major artery can occur in minutes. Tourniquets can prevent many of these deaths if no other measure is available.

Furthermore, a number of recent studies have shown that when applied appropriately, tourniquets can save lives with very little risk. The bombing of the Boston marathon was a case in point, where the tourniquet proved itself in a real-life situation.

With the recent rise in terrorist attacks against soft targets such as shopping malls or concerts, we feel more and more first-aiders will be confronted with situations where tourniquet training will be invaluable. Outside of this, workers in high-risk injuries also need first-aiders with tourniquet training. Forestry workers, for example, may operate in regions where emergency services will take some time to arrive. In this case, a properly-applied tourniquet can save lives.

It’s all down to equipment and training

The success of tourniquets as a life-saving measure depends critically on two factors. One is the tourniquet itself. Improvised tourniquets may take too long to make, or apply inappropriate amounts of pressure. This lowers their effectiveness and increases risk of injury. A number of commercially produced tourniquets are available and there is a strong case for first-on-scene first-aiders with appropriate training being equipped with these.

The second factor, of course, is training. Anyone employing a tourniquet must be equipped with appropriate knowledge and skills. They need to know what circumstances to use a tourniquet (and crucially, when not to use one), lengths of times they need to be applied for, and where and how the tourniquet should be applied.

Overall, we feel there’s a reason why tourniquets have been used for centuries. They are an essential part of the first-on-scene first-aider’s training.

Find out more

We are running tourniquet and haemostatic dressing training courses, aimed at high-risk workers and those within the security industry. You can book yourself or your staff on these courses, or find out more, by getting in touch.

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