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April 30, 2009
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One more piece of life-saving equipment you should carry

Provided by Force Science News

Not that you need more stuff to hang on your duty belt, but here’s an addition you might consider: a pouch you can reach with either hand that contains a one-handed tourniquet. If you or another officer are wounded and bleeding badly, it could make the difference between life and death.

Although a number of hemostatic agents are being advertised to the law enforcement market to stanch bleeding while waiting for EMS, the tourniquet is gaining renewed respect for first-aid intervention.

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“Direct pressure and the use of a tourniquet are all that are necessary in most police and civilian trauma situations,” advises an emergency room physician and instructor with Defense Training International, Inc., who uses the pseudonym “Doc Gunn” in law enforcement circles.

Recently Gunn passed along to the law enforcement community (via the popular listserv conducted by Chief Jeff Chudwin of Olympia Fields [IL] PD) what he considers “a good summary” of treatment options, which evolved from an online discussion of the subject.

“Before you buy hemostatic agents, be sure you understand proper wound management and packing,” this report says. “Direct pressure is the first line treatment. The American College of Surgeons and the Pre-Hospital Trauma Life Support Guidelines no longer recommend elevation and pressure points for severe bleeding. There is no evidence that these techniques work and you may be wasting precious time. It is possible to bleed out from a femoral artery injury in as fast as 3 minutes.

“If direct pressure does not work, for extremity trauma go directly to a tourniquet. For bleeding that is not amenable by a tourniquet, such as a high femoral artery injury, go to hemostatic agents. Apply the agent and pack the wound with gauze and apply constant pressure for 2-3 minutes. Wrap with compression bandage to keep pressure on the wound. The most important step is to pack the wound and fill the void.”

(You can click here and click on Videos to view a proper wound-packing demonstration.) Gunn told Force Science News: “I concur with these well-stated observations, and I teach the very same thing” in classes related to treating gunshot wounds.

Dr. Matthew Sztajnkrycer, a technical advisor to the Force Science Research Center and chairman of the Division of Emergency Medicine Research at the Mayo Clinic, agrees that the emphasis on the tourniquet is “very appropriate and accurate.”

He serves as a SWAT team medic and equips every officer on his team with a SOFTT (SOFTM Tactical Tourniquet) and wound dressing. Chudwin issues a SOFTT and 2 wound bandages to each of his patrol officers. “If you pick one additional thing for your belt that has been shown to save lives, it would be a tourniquet,” Sztajnkrycer says. “And we should not think of them as just for tac teams. Patrol officers are the ones who tend to be under fire and subject to being wounded before SWAT even gets there.

“Hemostatic agents, while they can save lives in rare circumstances, have very limited facility. You have to think of them as last-ditch efforts when all else has failed. Tourniquets are clearly cheaper and they’ve been effective for hundreds of years. When you see a commercially made medical kit advertised with a hemostatic agent but no tourniquet, think twice before buying it.”

Gunn’s listserv report recommends either SOFTT or the C-A-T® (Combat Application Tourniquet), noting: “Both are approved for use by the military and both can be placed one-handed—and just plain work. The C-A-T is the current issue to U.S. Special Operations soldiers.”

Sztajnkrycer adds that the selected tourniquet should be equally easy to apply to both upper and lower extremities, and he wants to dispel the myth that all tourniquet application carries a risk of causing limb loss. “We have a lot of data now, from Israel, Afghanistan, and Iraq, indicating that a tourniquet can be left on for 4 to 6 hours with no significant risk. There would be few situations in law enforcement where it takes longer than that to reach professional medical treatment.”

Finally, he poses some questions with important training connotations: “If you are shot, can you reach your tourniquet? Can you apply the tourniquet with your non-dominant hand? Can you transition from your weapon to the tourniquet and back to your weapon?

“Just having a tourniquet available doesn’t mean anything by itself. If you don’t train with it, you won’t think about it when you need it.”

He cites the case of Albert Johnston, a leading Confederate general during the Civil War. At the Battle of Shiloh in 1892, he was shot in the knee and bled to death. He died with his issued tourniquet forgotten in his pocket.

 

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