The Royal College of Surgeons of Edinburgh (RCS) released a position statement in July 2017 with regard to the oft discussed application of tourniquets. The use of tourniquets has been re-introduced into civilian applications as a result of influences and experience gained in military experiences. The use of tourniquets in ‘normal’ civilian life is restricted but in the case of industrial accidents (remote forestry work, shooting accidents in stalking activity, fishing at sea, and the like), they can be lifesaving.
Catastrophic external bleeds from a limb are thankfully rare and most bleeds can be controlled with direct pressure but in remote areas, time and help may be at a premium.
The RCS maintain that whilst there is a place for their use, they “must be used correctly or not at all”.
It is recommended that the tourniquet is:
- Applied as rapidly as possible
- Applied directly to the skin (to prevent slippage)
- Placed as distally as possible above the wound (to preserve the maximum amount of salvageable tissue)
- Applied tightly enough to arrest haemorrhage (effectiveness will be determined by cessation of external bleed and not by the presence of a distal pulse; if it is ineffective it should be tightened or repositioned; application of a second tourniquet may be required; slight oozing at the wound may occur due to some blood flow from the exposed medullary bone end)
The tourniquet should be left in place, with the application noted, until access to a higher medical capability is available.
The European Resuscitation Council (ERC) First Aid Guidelines 2015 state that when direct pressure cannot control severe bleeding, tourniquets and haemostat dressings are now advised and this is fully supported by ILCOR (International Liaison Committee on Resuscitation). With acute catastrophic bleeds, an adult can lose 40% of their blood in 3-4 minutes. A loss of this magnitude, disables the body from compensating for that amount of blood loss and hypovolaemic shock will ensue, causing failure of the circulatory system and death if untreated.
source: The Royal College of Surgeons of Edinburgh, Position statement on the application of Tourniquets July 2017
European Resuscitation Council First Aid Guidelines 2015