It is really time to wake up to the evidence of the benefit of using tourniquets. The first aid mythology surrounding their use is alive and kicking. At a recent citizenAID familiarisation session in Surrey, citizenAID Ambassador Dr Peter Johnson was challenged by a first aider in the audience who said, “I’ve been told you should never use a tourniquet, it can damage a nerve.”
The dogma that tourniquets can never be used is one that is still deep-rooted in the first aid community, despite the work of the informed to dig this out. The reality is that tourniquets are used in the operating theatres of our hospitals every day, to control blood loss while undertaking surgical procedures on limbs. In addition, the use of tourniquets during contemporary military operations has saved many lives from otherwise uncontrollable bleeding in amputated or mangled limbs. The evidence is published. And the soldiers who have survived blast injury having suffered single, double and even triple limb amputations are a testament to this.
So why does this mythology persist? The rationale for a tourniquet is life-threatening limb bleeding that cannot be controlled by other means. If this rationale is followed, a tourniquet can only ever do good. The alternative is that the patient will die.
The argument of harm assumes that tourniquets will be applied inappropriately, for injuries that are not life-threatening and that there will be no means of reassessing this within a time period in which avoidable harm occurs.
Unfortunately, the inverted logic of preventing the use of life-saving equipment disenfranchises the very patients that can be saved by the public in the early minutes following severe injury. It is a lazy logic of risk aversion, with the assumed belief that there will be no blame attached to withholding a tourniquet. This is a dangerous assumption. With the wealth of evidence that now surrounds the value of using a tourniquet, it will be difficult to argue that a death attributed to limb bleeding is anything other than avoidable. Where an active decision has been taken to dissuade the use of a tourniquet in these circumstances, how will that decision be justified morally and legally?
There is a widespread national culture of training the public to undertake cardiopulmonary resuscitation and to use automated defibrillators. There are risks associated with these procedures. They have been minimised by effective and standardised training. The same culture can be achieved for the judicious use of tourniquets. We can change the prevailing narrative from one of “never use tourniquets as they cause harm” to “use a tourniquet to save a life for uncontrollable bleeding”. The potential for military-style injuries in the civilian community demands this. Our public deserves it.
If you have a story of how a tourniquet has saved a life, why not share it with us?