6 Common Myths of Tourniquets DEBUNKED!

Myth 1: Tourniquets are a last resort and should only be used after all other means of hemorrhage control have been exhausted.

 WRONG! An arterial limb hemorrhage can kill in a matter of minutes – a tourniquet should be your first treatment option when faced with these types of injuries.

Myth 2: If you use a tourniquet, they will lose that limb.

INCORRECT! Over the last twenty years, the Joint Theater Trauma Registry has logged numerous data points proving that tourniquets are safe, effective, and do not result in limb loss.

 

Myth 3: A properly applied tourniquet should not be uncomfortable, right?

WRONG! A 2017 position statement put forth by the Faculty of Pre-Hospital Care at the Royal College of Surgeons outlines the dilemma of pain associated with tourniquet application: “A properly applied tourniquet is painful; a casualty may require significant pain relief to apply the tourniquet to the appropriate pressure. And this is the crux of the argument; tourniquets are effective and appropriate but only if their use is warranted and the person applying the tourniquet understands what they are doing, how to do it, and why… The tourniquet should be tightened until bleeding stops.”

A tourniquet applies a high volume of pressure to stop traumatic bleeding. Therefore, when used properly, a tourniquet will be uncomfortable.

 Myth 4: Tourniquets do not work on “two bone” compartments.

 NEGATIVE! When there isn’t time to fully assess the injured limb in the Care Under Fire phase, placing a tourniquet “high and tight” is often advised.

The primary determinant of effectiveness in well-designed tourniquets is the ratio of limb circumference to device width. A tourniquet placed at a narrow part of the limb requires less pressure to achieve occlusion than the same tourniquet placed at a vast portion of the limb, suggesting that tourniquets are more effective when placed as low (distal) on the limb as possible.

 

 Myth 5: Tourniquets can be left in place for 8 hours or longer

INCORRECT! The Academic Department of Traumatology found that preventing arterial blood flow to a limb will result in ischemia. Continuous application for longer than two hours can result in permanent nerve injury, skin necrosis, muscle, and vascular injury. Muscle damage is nearly complete by 6 hours, likely requiring amputation.

Numerous studies have been performed to determine the maximum duration of tourniquet use before complications. The general conclusion is that a tourniquet can be left in place for two hours with little risk of permanent ischaemic injury but that every minute it remains in place after that increases the likelihood of complications.

 

Myth 6: Using a belt is as effective as a commercial tourniquet

NOPE! A prospective study evaluated commercial and non-commercial devices to determine their effectiveness in treating limb hemorrhage.

Using a standard leather belt was the fastest way to secure the limb and stop it from bleeding. However, it required continuous pressure on the part of the person applying it to maintain hemostasis. When available and used correctly, an improvised windlass was as effective as the commercial devices.

In an emergency setting where commercial devices are unavailable, improvised tourniquets may effectively bridge definitive care. However, this should not be an excuse to be unprepared, as a suitable belt or improvised windlass may not be readily available when the need arises.

Watch as Dr. Mike Simpson takes on the most common myths of tourniquets.

For more information about the variety of tourniquets and other massive hemorrhage solutions available from Safeguard Medical, click here.