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BeneficialWarrant t1_j9uwe3q wrote

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

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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