The topic of having tourniquets in SAKs has come up at various times in these forums. This article on NBCNews speaks to the use of makeshift ones in Boston on Monday. I'm not qualified to speak to the efficacy of their use but it seems that in this case their use helped.

I definitely noticed when the media mentioned tourniquets about the Boston bombing, too. I even saw mention of people using shoelaces!

Unlike 10-15 years ago, there were probably a number of police and EMS (and bystanders even) on scene at the finish line who are ex-military and who were actually trained to use tourniquets in the service within the last 10 years or so. Military medicine seems to have come around and now recognize tourniquets as a useful tool.

Then again, that's partly the history of a particular confict. Combine a conflict(s) where IED's and massive blast injuries are the weapon of choice, plus the evolution of more effective body armor where limbs are still relatively unprotected, and that seems to set up a scenario where severely mangled or even amputated limbs becomes a specific type of wound that medics and surgeons see a lot of.

Seems like amputations and near amputations would be a no-brainer for tourniquets. It's those other situations, like cutting an artery, where I can still see controversy. You'd hate to see someone lose a limb from tourniquet use when other measures could have stopped the bleeding and still saved the limb.

Boston does make me wonder, though--if someone decides to go to the trouble of packing a tourniquet, how many to pack? If gunshots are the primary risk envisioned, then one tourniquet is likely sufficient for a first aid or "blow out" kit. But if you're worrying about blast injuries, seems like having more than one might be prudent. The Army IFAK contains one tourniquet, but in actual use, I wonder how times a soldier ends up needing more than one?

Now you medical professionals weigh in on this. I once had surgery to remove shrapnel from a foot, and instead of anesthesia, the doctors placed a restricting band around the ankle that cut off all feeling after it was on for a while. I was given a sedative and the restricting band, and it was on for more than three hours. My foot is just fine. Is a tourniquet really that dangerous to the limb?

As for the military IFAK, each soldier has one, and most I knew carried extra tourniquets, especially when the roadside bombing campaigns really got started. That way there are plenty of them for use, as not everyone will need one, but everyone will have one. The normal procedure was to reduce the threat, slap on tourniquets, and get out of the kill zone. Then the medical personnel would sort it out, but people rarely bled to death.

I will always default on stopping the bleeding, and worry about other issues later.

Dr David Johnson of Wilderness Medical Associates has a nice blog post about the use of tourniquets. I think I posted this sometime back in another thread, but it seems appropriate to post it again.

In most situations severe bleeding should be controlled by direct pressure. Where this is not possible, a tourniquet is indicated. A Mass Casualty Incident like Boston is another case where they could be a lifesaver. One rescuer can't hold direct pressure on multiple victims at the same time. Being able to quickly apply a tourniquet to stop bleeding on one person, so that you can move on to care for others, could save many lives. Likewise, for the military, under fire it is crucial to be able stop bleeding fast, then do proper treatment of the wounded after the shooting stops.

Thanks for posting that article. His comments ring true, especially in light of recent events.

Montanero, that is an interesting question. Is a restricting band truly a tourniquet? That is pretty good that the pressure was maintained and the bleeding stopped, right. Perhaps the blood loss site and rate did not warrant a tissue-crushing, bone mashing tourniquet. Still, three hours is quite a long time.

I am not a medical professional and never have been. I've also never served in the military.

With that said, one of my instructors had been a combat medic and a civilian paramedic. He taught us that purpose-made tourniquets (like the SWAT-T or CAT) had to be on for quite a while before endangering the limb. Field-expedient tourniquets made with a wide belt were similarly unlikely to cause that sort of problem. Using cordage or other material that doesn't spread the pressure over a larger area can, however, cause nerve damage.

I have also used tourniquets as a holder for a pressure bandage, and for straps to hold on an improvised splint. They are useful.

Tourniquets are being "re-introduced" in the Seattle/King County EMS system. Very few places in this area are far from trauma hospitals but the Drs that decide what we do have decided that we need to bring tourniquets back into our daily tool kit. That must mean something eh?

Our local Police carry tourniquets as well. That's the only medical supply they carry on their person! I just spent a week doing drills with them and that's what they had. No pressure dressings just tourniquets.

I personally carry a 4" and a 6" Israeli Battle Dressing in my IFAK and a 6" in my EDC bag. Both can be used as regular pressure dressings and as tourniquets.

Wilderness First Aid began providing basic instruction in applying tourniquets a few years back, and as Dr. Johnson's blog shows there is still some debate about their efficacy in remote or wilderness settings. My WFA instructor's view was although he had never applied a tourniquet in the wilderness, for an uncontrolled bleed you might as well apply it. On 3 day trips into the wild (24 hrs from trail head) I will often carry the tourniquet with my wilderness FAK. There's no expiration on them unlike other blood stopper options, so why not.

Based on WFA I began to carry a SOF-T tourniquet in my car FAK which I nickname the Blood Stopper 3000. Its in the back of my car and intended for breaking out if I encounter a serious bleed, and contains several options to bring bleeding under control, including ABD pads, kerlix, 4x4 gauze, and the SOF-T. This isn't a WFA setup, its meant if medics are called and responding within minutes. I will stop for MVAs if its safe. Call 911, assess scene for safety, glove up, stabilize the patient, apply pressure, and await the cavalry which should arrive directly. If I'm busy applying a tourniquet by the time the medics arrive I may be rushing that decision in an urban setting. But I have stabilized an accident victim's neck for 25 minutes before and after medics arrived (the PD arrived 10 minutes earlier but engaged in traffic control). When you're way out there rapid response isn't always possible, for me its comforting to have a tourniquet in the bag (and the basic training to apply it).