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BeneficialWarrant t1_j9e6uto wrote

Reply to comment by davtruss in when a limb gets amputated, how do they stop the flow of blood? by EnchantedCatto

Its debatable whether an untrained person could help more than harm by applying a tourniquet. Some sources say yes, some say no. If you are familiar with how it works and there is uncontrollable bleeding from an appendage, then yes, wind that sucker down tight.

Edit is to reflect more up-to-date instruction. You can see discussion in below comments for context.

Tourniquet use is appropriate for a bleed from a limb which cannot be controlled by direct pressure alone. Without training or instruction, an improvised tourniquet applied by a layperson isn't likely to be effective. Fortunately, proper tourniquet use can be learned in only a few minutes and an emergency services dispatcher can instruct you on tourniquet use if you find yourself in a situation where it is necessary and you don't know how to do it. If in doubt and the patient is conscious, it may be a good idea to first attempt to control bleeding with direct pressure alone. Note that direct pressure is not appropriate if there are significant amounts of sharp, foreign bodies within the wound which may make the injury worse than it already is. In that case, elevation, manual arterial compression, and tourniquet use as needed will be the appropriate first-aid.

Tourniquet or not, you can help by finding a clean and dry cloth, garment, towel, applying firm pressure, and don't remove the cloth. If it bleeds through, put another cloth on top and keep the pressure on! You can also apply pressure to the artery above the bleed. Groin for the leg and under the biceps for the arm.

Don't remove any foreign object that may be sticking out of the person, don't put yourself in danger that might cause a second casualty, and don't move a patient who may have suffered a spinal trauma unless absolutely necessary.

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RuhrowSpaghettio t1_j9gg01s wrote

It’s really not debatable. If someone is hemorrhaging, they will die of blood loss. Anyone who can do anything to help stem that blood loss is saving their life, no debate.

Plus, tbh, the risks of tourniquets are greatly over-stated in both popular culture and even in the medical world. All of the time limits people discuss for tourniquets are essentially made up theoretical limits without much data to back them up.

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I_am_Jo_Pitt t1_j9gzapz wrote

Stopping blood loss is so critical that even the military changed from the ABC's of first aid (airway, breathing, circulation) to MARCH (Major hemmorage, airway, respiration, circulation, hypothermia). No one survives massive blood loss.

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LogicJunkie2000 t1_j9hlrue wrote

I vaguely remember the aid training shifting in the late oughts from a kinda checklist/hierarchy of things to do before applying a tourniquet into something close to "when in doubt if they might need a tourniquet, put a tourniquet on it."

Aside from the reasons you gave, I think it probably came down to the fact that there was an expectation that you would be getting treated by an expert in a hospital or purpose-fitted vehicle within an hour (whenever life/limb/eyesight was in jeopardy)

I have a lot of mixed feelings about my country and my service, but am still very impressed/proud of the extreme lengths the medical corps and supporting units went through to make MEDEVACs and treatment such a priority.

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BeneficialWarrant t1_j9uwe3q wrote

OK, prior caveat: This will be a long post and will not directly cite publications for every claim

So first off, I'll say that my advice on the topic is informed by (but not infringing on any intellectual property) my time working as a 911 dispatcher using data-informed protocols for prehospital treatment by laypeople (created by a Salt Lake City-based organization that is generally recognized as the standard for these protocols, and which sells them to most public-safety emergency answering centers.) [Bohm and Kurland, 2018] While this raises doubts about its accuracy, it establishes its uniquity] I understand that instructions for tourniquet use by non-healthcare personnel is changing as newer data shows that, as you said, improperly applied tourniquets are not as harmful as once believed and that laypeople can apply tourniquets effectively and quickly with proper instruction. [Scott, et. al. 2020] I believe that the previously mentioned company may have altered their product to reflect this, but I've been out of that gig for a few years now.

That said, the reason why (at the time) laypeople were generally not advised to apply tourniquets in the absence of unambiguously lethal, uncontrollable hemorrhage was not that a poorly applied tourniquet could worsen the outcome for a person with an otherwise lethal hemorrhage. Instead, it was to discourage the use of tourniquets when not necessary, as it was believed that a layperson may not be able to make this distinction and thus use them excessively. The vast majority of prehospital appendicular bleeds probably do not require tourniquet use (anecdotal, but it was probably close to 1 in 100 during my time answering phones). This is probably due to the low threshold some people have for requesting emergency medical transport. For a layperson who may have trouble telling the difference, attempting to control bleeding by direct pressure first is often a good idea in the absence of unquestionably uncontrollable, arterial (or massive venous/tissue capillary bed) hemorrhage.

TLDR: Until recently, tourniquet use by untrained laypeople was generally discouraged, but things have changed within the past few years.

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RuhrowSpaghettio t1_j9ve58w wrote

This is true, but the amount of damage done by tourniquets is overstated, whereas the damage done by uncontrolled hemorrhage is…death.

Let’s say that, as you posited, only one of every hundred wounds needs a tourniquet to prevent death. If the perception is that tourniquets cause minor injury every time they’re used and permanent damage one time in 10, then you’ve hurt 99 people and caused permanent damage to 10 for every life saved with a torniquet.

Now let’s do the math if, say, you see minor injury one time in 10 and permanent damage once in 1000 applications. All of a sudden, you’re only causing 10 people minor harm for each life saved. Completely different math.

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