Using Tourniquets, the New Guidelines

August 22nd 2017

If someone is bleeding from a major artery or vein a substantial amount of blood can be lost very quickly. It is estimated that with extremely heavy bleeding an adult could lose 40% of their blood volume in 3-4 minutes. With this amount of blood loss, the body is no longer able to continue, resulting in Hypovolaemic Shock. Hypovolaemic Shock is the failure of the circulatory system due to low volume of blood, if untreated the person will die.

The prevention of the loss of blood is crucial to save lives. The European Resuscitation Council (ERC) First Aid Guidelines state “When direct pressure cannot control severe bleeding, tourniquets and haemostatic dressings are now advised and this is fully supported by ILCOR” (International Liaison Committee on Resuscitation).

Hands-on practice for the correct use of a tourniquet is included in the First Aid at Work course!

This statement is supported by a wealth of evidence from military and civilian research demonstrating the effectiveness of tourniquets when dealing with life-threatening bleeding. This has resulted in the military adding tourniquets to soldiers’ individual first aid kits and requiring training for proper use. Use of tourniquets is now widespread in military applications, as they have the potential to save lives during major limb trauma.

What has changed?
The first step when treating a catastrophic bleed is always to apply direct pressure, this is likely to stop the flow of blood. However, if the blood flow cannot be stopped using this method, tourniquets have now been introduced as additional options to treat severe bleeding.

Previously the use of tourniquets was considered a last resort due to the understanding that if all blood flow below the application of an emergency tourniquet is stopped, it would kill the tissue, leading to eventual loss of the limb. However further research has stated that uncontrolled haemorrhage is the most preventable cause of deaths in both military and civilian cases. Studies show up to 50% of combat fatalities and 39% of civilian fatalities are due to uncontrolled blood loss. Furthermore, the European Resuscitation Council 2015 guidelines now state that haemostatic dressings and tourniquets should be used when direct pressure to the wound is either not possible or ineffective.

Applying direct pressure remains the initial choice of treatment as it will control the bleed in the majority of cases.

Further changes in the new European Resuscitation Guidelines relating to bleeding

The guidelines encourage the use of SEPD:
• Sit
• Examine
• Pressure
• Dress

These steps should be the first procedure when treating blood loss, further explanation of each step is provided:

Sit or lie them down:
Assess the location of the wound and the amount of blood lost. Once this is established you can find the most appropriate position for them to sit or lay down. Be aware of any early signs of shock including dizziness, if you can see signs of this raise their legs.

Examine the wound:
It is vital to examine the wound as quickly as possible. Establishing the source of the bleeding, the type and extent of bleeding and if there are any objects embedded in the wound. If objects are found in the wound do not remove them from the wound, instead apply pressure directly to either side of the object.

Apply direct pressure to try and control the bleeding. If this treatment is effective and the bleeding is controlled do not stop. Continued pressure must be applied for a further 10 minutes as this will allow for clots to form.

Dress the wound:
Once you have established that the bleeding is controlled dress the wound. If blood continues to flow through the dressing apply another dressing on top. If the wound bleeds through the second dressing you should then consider an alternative method such as the use of a tourniquet to stop the bleeding.

In environments where a catastrophic bleed is likely, tourniquets and haemostatic dressings should be an integral part of the first aid kit and all first aiders should be trained in their use.

As a company, EMP Medic First Aid, we include the topic of the use of the tourniquet, both professional and improvised version, in our advanced first aid courses. If you are interested in learning more about this and having hands-on practice then we recommend the First Aid at Work 3 days course.