I was interested to read an article about the use of tourniquets in Ukraine, particularly because it contrasts between their use in a rapid-evacuation situation (such as US troops mostly encounter) versus taking hours or even days to reach anyone more advanced than a field medic.
The tourniquet has saved many thousands of lives and limbs in war zones around the world, but misuse of the device is causing huge numbers of excess amputations and deaths in Ukraine, say top military surgeons.
Captain Rom A Stevens, a retired senior US medical navy officer who has served in Iraq, Afghanistan, and East Africa, estimates that of the roughly 100,000 amputations performed on Ukrainian soldiers since Russia’s full-scale invasion in 2022, as many as 75,000 were caused by improper use of tourniquets.
“I’ve seen tourniquets that have been left on for days, often for injuries that could have been stopped by other methods. Then [the patient] has to have their limb amputated because the tissue has died,” Captain Stevens told The Telegraph.
Tourniquets are strong bands used to stop catastrophic bleeding by cutting off blood flow, and are standard issue for most modern armies.
But if left on over two hours, they can cause tissue death, meaning the arm or leg which has the tourniquet on is no longer viable and requires amputation.
The device became standard-issue in the 2000s wars in Iraq and Afghanistan, where rapid air evacuation to military surgical teams was possible in under 60 minutes. If the tourniquet was unnecessary it was removed, and no harm was done.
But in Ukraine, where the skies are infested with drones, injured soldiers are evacuated by land, often far exceeding the safe time window for tourniquet use.
This critical delay has caused tens of thousands of amputations, say experts, many of which were unnecessary because the injuries didn’t require a tourniquet in the first place.
There's more at the link.
I remember our field first aid training in the South African military. We didn't carry IFAKs (Individual First Aid Kits) - just a single field dressing, a bandage that could be tied in place over an injury to absorb at least some of the bleeding and keep contaminants away from the wound. Field medics carried a relatively comprehensive kit, with more supplies available aboard our transports: but none of them were at the level of a medical station or field hospital. If we were lucky, helicopter evacuation might be available, but not always - our air support was frequently hundreds of miles away, and had to thread its way through the most comprehensive Soviet air defense system outside the Warsaw Pact. It might take hours to arrive. For that reason, if a medic applied a tourniquet, he would usually try to note down exactly when it was tightened, and make sure that a record of every time it was tightened and loosened accompanied the patient whenever possible. That way, permanent damage to the limb might be avoided. It didn't always work.
It worries me that I see so many "civilian" IFAKs being marketed today. I have no problem with as many people as possible carrying them; it's far better to have them available on the spot rather than miles away. However, relatively few of those carrying them have had any first aid training at all, let alone how to deal with serious blood loss. The use of blood-clotting powder or bandages is a case in point: another is the use of a tourniquet. Neither is as easy as it looks, and one can inflict a lot of damage by doing the wrong thing. For untrained users, I think of individual IFAKs as being useful supplemental kit for a paramedic or EMT (Emergency Medical Technician) or firefighter or police officer (both of the latter are usually trained in first aid to at least some extent). If he/she runs out of their own supplies (not impossible where more than one or two casualties are involved), they can offer your IFAKs to provide additional essential gear.
The entire article is worth reading to show how a battlefield situation affects what gear may be useful, and what might not. A tourniquet is very valuable indeed under certain circumstances, but as noted in the article, might lead to a much greater injury through cutting off the blood supply to a limb for too long. I hope it motivates those who carry a tourniquet without undergoing training to at least watch a video or two on the subject, or perhaps motivate them to get proper training from local instructors. One could even attend evening classes for a semester or two and graduate with a basic EMT qualification (like, for example, this course), which puts one head and shoulders above those less well trained.
Peter
12 comments:
Point about personally carried IFAKs, tourniquets and other medical supplies: Around here, the medic or whoever gives field first aid, is supposed to use the *patient's* supplies first, if any are available / accessible.
The responding medic may go on to treat any number of more patients, but the patient is unlikely to if they already needed the help.
This just goes to show the woeful lack of training for Ukrainian troops. It seems they get grabbed off the street, tossed in a van, and three days later they're on the front lines.
The war has been going on for long enough now they should have incorporated basic first aid training into the general education program at schools.
If one is available in your area, I strongly recommend the taking the Stop the Bleed class. They specifically cover when tourniquets are appropriate and when other methods should be used. https://www.stopthebleed.org/
Exactly, you always use the patients supplies/materials first. This is taught in wilderness first aid courses since anything you use on a patient, is something you'll probably never see again. You're not carrying supplies to use on someone else, you're carrying stuff to be used on YOU...
If you don't want go the full EMT route, you can get valid, recognized training online to the Wilderness First Responder level. There is no reason not to have some medical training, calling 911 is not medical training...
We have an AED and two "stop the bleed" type trauma kits at my sportsman's club, but only I and one other guy knew how to use them. Members requested some basic training, so I put together a Power Point presentation with photos and videos, as well as having some hands-on training aids. It was such a big hit I will be running it again next month for the guys that missed it.
Many (many) moons ago, I was an American Red Cross CPR and First Aid (and Basic Life Support for Professional Rescuers...but hardly anyone has heard of that one) instructor.
For a good while the Red Cross stopped recommending the use of tourniquets and stopped training it in non-professional first aid classes for that very reason.
Too many people were using them improperly or when not needed and patients were losing limbs as a result.
It's a tradeoff. Lives saved by using them to stop catastrophic bleeding versus people maimed by improper use. More recently, I believe even the Red Cross is back to teaching their use because I guess they decided some people losing limbs is better than other people outright dying.
At any rate, you're exactly right...training and proper use is the key. I'm not an instructor any more, and I don't do it as often as I should, but still try to go through some refresher first aid training every few years or so. Techniques, equipment and procedures change (last year I got trained on the use of those portable, almost automatic, defibrillator machines you see in malls and public places these days...good training to have) so it's good to stay current even if you've been through the training before.
Sounds like a business opportunity in Ukraine ... artificial limbs.
Tourniquets are like ALL other medical interventions. They can do good or they can do harm. Having something is NEVER a substitute for training and knowledge. At the very least EVERYONE should take a basic first aid class. And take a refresher if it's been a while since you took one. If you have the time and inclination take an EMT course. Most community colleges offer them. Doing so can save a life....perhaps your own.
I taught Basic First Aid/CPR/AED for many years. For most of that time, tourniquets were NEVER to be mentioned. Then, all of a sudden, they became a standard part of the curriculum. It was brought home to me when one of our Sheriff's Deputies was shot in both legs in a rural part of the county. He was so shot up that his fellow deputies ended up putting three tourniquets on him to stop the bleeding. Luckily, he survived with all limbs intact. Still, it caused me to teach my students to have the supplies they needed AND some more that they didn't think they would need.
I spent over 35 years making steel in a melt shop. As part of our training, every year we received a basic first aid/CPR class given by the local paramedics. When our shop got AED's, they had a top notch Cardiologist from the local hospital come in and give not only training on their proper use, but he also gave education for us covering things like how to understand an EKG, how to recognize a heart attack when it might not be the classic fall on the floor unconscious type of thing.
Our floor workers had 2 AED's and the office had one. On the floor we had around 75 men. One time just before my shift started, a 35 year old man had a massive heart attack.
The supervisor happened to be a volunteer firefighter Capt. and an EMT. So he hooked the AED up to the man, and it called for a shock to be delivered. Apparently when they hit the button and gave him the jolt, the guy jumped up off of the floor with such a strong response that it took nearly 6 other men to hold him down.
The ambulance team had to shock him twice more on the way to the hospital. Sadly, my friend didn't make it. But it drove home the need to be prepared for anything, no matter how remote the possibility may seem.
I did pretty much every job in the place over the course of my employment. When I worked pouring steel, we always took care of each other. Meaning that we made certain that nobody got dehydrated or started to have signs of heat exhaustion.
After an explosion and a death of another of my friends, the place started to make us wear the aluminized suits that we should have been wearing in the first place. So the danger of heat exhaustion or even heat stroke became even worse. With the temperatures on the melt shop floor often as high as 150 degrees F., you could go from doing just fine to being ready to pass out in minutes.
As far as Stop the Bleed classes, I looked around in my area and so far have not been able to find one.
When I was in the Boy Scouts, First Aid merit badges included explaining how to make a tourniquet. But depending on the decade, they alternated between "Periodically loosen them" and "Never loosen them." No idea what's correct any more.
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