Stop the bleed

Speaking of rescue, a neighbor recently lost control of a power tool of some kind and gashed his leg badly, apparently at least knicking the femoral artery. A volunteer fireman across the street arrived quickly and used a "Stop the Bleed" kit and recent "Stop the Bleed" training to control a fairly dramatic hemorrhage. Although the nearest hospital is nearly an hour away, our neighbor was treated successfully and is home and doing well.

The news inspired me to put a "Stop the Bleed" kit in our kitchen and to read up on the controversy over tourniquet use. The "North American Rescue Tourniquet" is said to enjoy a good reputation. The manufacturer's website had a link to an article discussing tourniquet use throughout history, ending with this (paraphrased) summary of the current thinking:

Normally, we should leave tourniquet use to civilian or military personnel with proper training. Most hemorrhages even from amputation can be controlled with direct pressure, elevation, and packing of the wound.

Having said that, no patient should bleed out because we're afraid of a tourniquet. The complications from tourniquet use can be very serious indeed, but not in comparison with death. A tourniquet is a viable backup measure even for amateurs if other strategies aren't enough to save life, especially if transport to a hospital must be delayed.

If the safety of the patient or of caregivers requires emergency movement, use a tourniquet to control a life-threatening hemorrhage, but reevaluate it ASAP once in safety.

Place the tourniquet about a palm's width "upstream" (proximal, not distal) from the wound, or more if necessary to avoid a joint. If there is an impaled object, don't let the tourniquet press down on any part of it.

Remove all clothing from under the tourniquet (note that your first-aid kit should include fabric shears), and leave the tourniquet exposed, with no bandage wrapped over it. Mark the presence of the tourniquet prominently, including the time it was applied (note that your kit should include a Magic Marker to write on a bandage away from the tourniquet but easily visible to the next worker). Tell a conscious patient to inform every medical worker he comes in contact with when the tourniquet was applied.

Generally, you may need to tighten a tourniquet in the field but should almost never loosen it. Tighten the tourniquet if the wound continues to bleed below the pressure point, other than oozing from exposed marrow. Do not loosen a tourniquet in the field in any of these situations: (1) obvious signs of shock, (2) amputation, (3) resumed hemorrhage upon trial release of the tourniquet, or (4) (in a long-term emergency rescue) after the tourniquet has been in place for 6 hours. Even if hemorrhage no longer is an immediate danger, restoring long-blocked flow to blood-starved tissues can cause deadly problems that require more intensive medical care than you can possibly give in the field.