Tourniquets are tight bands used to control bleeding by completely stopping the blood flow to a wound.
The Tourniquet Controversy
Theuse of tourniquetswas first documented on the battlefield in 1674.
Complications of tourniquet use were said to lead to severe tissue damage.
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Eventually, tourniquets developed a bad rap in the field ofemergency first aid.
Applying a tourniquet in the civilian world used to be seen as a last resort.
It was a risk worth taking, went the theory.
A tourniquet can be applied and ignored.
That doesnt mean tourniquets dont work.
Civilians, the thinking went, had time.
We could go methodically through steps to control bleeding.
We were taught to start with direct pressure and if that doesnt work, elevate.
If the bleeding continued, a tourniquet became the dire option.
So maligned, tourniquets were thought to guarantee the loss of a limb if they were used.
Losing that blood flow would most certainly lead to catastrophic tissue damage.
Modern, evidence-based medicine is changing long-held views about tourniquets.Hemorrhageis a serious issue.
When its present, it needs to be stopped.
If not, the patient could die.
Theres no time to mess.
First, you tried direct pressure and, after a while, moved on to elevation.
How long you were supposed to wait wasnt well-defined.
No matter what, its too slow and didnt make sense.
If direct pressure and elevation can work together, do it together.
Number 2 is a lesson learned from combat.
Fighters fight, and tourniquets let them.
That applies to civilians, too.
Hikers need to hike to get to help.
Patients with multiple injuries need treatments that allow the hands to be free.
Long waits for the ambulance lead to fatigue in the hands of the rescuer trying to hold direct pressure.
Tourniquets can also be self-applied by the patient.
Self-utility of direct pressure is much harder.
It meets the requirements of the US military.
Doctors at the hospital could miss the tourniquet if it is black.
The CAT should be prepared prior to use by feeding the tip of the strap through the friction buckle.
SOF Tourniquet
The SOF Tourniquet is similar to the CAT, except for the buckle.
it’s possible for you to simply wrap thetourniquet around the limband snap it into place.
This functionality is only helpful if youre applying the tourniquet to someone else.
SWAT-T
The SWAT-T is a different kind of tourniquet than either the CAT or the SOFTT.
The SWAT-T cant be self-applied, but it can be applied to children and very small adults.
Common Tourniquet Mistakes
The most common problem with tourniquets is putting them on too loosely.
If a tourniquet isnt so tight that its uncomfortable, its not working.
Dont be afraid to apply two or three tourniquets, especially on legs and tooverweightpatients.
2019;154(10):923-929. doi:10.1001/jamasurg.2019.2275
