Two Letters Re: Tourniquet Pros and Cons

You were right on with your advice as far as setting tourniquets. One thing that I totally fail to understand when it comes to some of my preparedness oriented brethren is their desire to mickey mouse/improvise a solution when one already exists.
Also, thanks for the recommendation on TraumaDEX, it looks to be as good or better than some of the other offerings, and wow is it cheap! ($11/50 applicators).
While all of these gizmos are neat, just like in your novel “Patriots” there was someone there with honest to god medical training. While becoming an RN or LVN is a bit much for most. Taking an EMT class a few nights a week, or even taking one of the first aid and CPR classes offered by the American red Cross (ARC)–most are just a few hours or a day–will put them in a much better place than taking the advice of other amateurs.
Cheers! – Drew

I was slightly distressed to read your [warning] statement on tourniquets. I am not a doctor, but I am a Marine (Rifleman and Force Recon) and am also a EMT-B who has used those skills here (Volunteer) and in Iraq. I would like to pontificate briefly on the use of a Tourniquet. What you posted was the predominate mindset in the medical community, but it is changing due to ‘real world’ experience in Iraq.
As I’m sure you know if you have an arterial bleed you have about 90 seconds to do something about it before you pass out. At that point unless someone else can help you you are a dead man.
What you can do (If the injury is on a limb) is to slap on a Tourniquet. I recommend the Cinch Tight for two reasons: It is cheap, and in military testing it is in the top three in effectiveness.
-A bungee cord will also work pretty well.
Once you have a tourniquet on you can begin to apply a pressure dressing… (Or move the casualty out of the line of fire so that you can work on him without becoming a casualty yourself.)
-If you don’t apply a tourniquet he may die before you can work on him, or before you can control the bleeding.
As for losing a limb… once the bleeding is under control (Israeli bandages and the Cinch Tight ‘H’ bandages are both excellent)
You simply remove the tourniquet one wrap at a time… if the bleeding is under control leave it above the wound in case it is needed later, but unwrapped.
You will not lose a limb within about four hours, and you can control bleeding and remove the tourniquet in a much shorter amount of time.
On the placement of a Tourniquet:
A hands width (About 4 inches) above the injury (Arteries retract up into the body when harmed that much, remember the ‘bloody scene’ in Blackhawk Down?)
If below the knee or below the elbow, put ‘packing material between the Tibia and Fibula, or between the Radius and Ulna due to the fact veins and arteries go between these bones, and will be hard to ‘pinch off’.
In review, a tourniquet is an immediate method to stop the arterial bleeding, which will give you time to treat the wound with other measures, and then [promptly] remove the tourniquet. – Nomad, 2nd

JWR Replies: Where did you read the four hour figure that you cited? I have read that the use of a tight tourniquet for as little as 45 minutes can produce local necrosis, neurapraxia, hypoxia, pain, and injury to veins and arteries. I’ve also read that leaving a tourniquet in place for more than 120 minutes can lead to extensive necrosis, which can result in the eventual loss of a limb. There are very few wounds for which Carlysle-type bandages and direct pressure won’t minimize bleeding. Granted, a tourniquet might be apropos for a very short term application. (I’ve read about the “one-hand” US military issue Combat Application Tourniquet and some competing varieties.) But once one is applied, do not lose track of time! For a patient that will be medevaced or otherwise handed-off, you can mark time that the tourniquet was applied on the patient’s forehead with a magic marker. Perhaps something like: “L. Leg Tourn.@0845Z” Medics carry Field Medical Cards to record that sort of data. The bottom line: Minimize the period of time a tourniquet is in place by applying other dressings/wound packing promptly, and then remove the tourniquet as soon as possible.