eli5 : why do ordinary soldiers carry multiple tourniquets but tourniquets are mostly not used in civilian first aid?
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Tournequettes are considered a last resort to stop bleeding and save a life, especially in a combat zone where access to advanced medical treatment may not be available.
If applied correctly, there’s a pretty high chance a tourniquet will lead to the death and amputation of the limb.
Tournequettes are considered a last resort to stop bleeding and save a life, especially in a combat zone where access to advanced medical treatment may not be available.
If applied correctly, there’s a pretty high chance a tourniquet will lead to the death and amputation of the limb.
EDIT: When I got here, there was only one comment but it was duplicate-posted 3-4 times. As a dumb gag, I copied and pasted that same response. I assumed it was a correct answer: it was not my intention to duplicate incorrect information, and I apologize if that was the result.
~~Tournequettes are considered a last resort to stop bleeding and save a life, especially in a combat zone where access to advanced medical treatment may not be available.~~
~~If applied correctly, there’s a pretty high chance a tourniquet will lead to the death and amputation of the limb.~~
Because tourniquets are one of most the last-ditch things you’d use in terms of medical equipment, and only very rarely in civilian life are they useful.
Not only are they astonishingly painful to apply (many people say it’s the worst pain they’ve ever experienced, some amputees say the tourniquet was worse than the actual loss of the limb), but they in invariably result in at least some tissue loss due to lack of circulation. They’re generally only used in case of massive blood loss, commonly a missing limb. Given that missing limbs don’t happen often, and safer, less extreme measures can be done with a little more time in most circumstances, they’re not common in run-of-the-mill medicine.
However, injuries resulting in massive blood loss *are* a real risk in the military, and not only does everybody need to be prepared to administer first aid, but they have to be ready to do so while being shot at.
Because in civilian first aid, you are generally not very far from definitive care. If you suffer an extremity bleed during combat, you don’t have time to go through the process of wound care and evacuation that you could in your neighborhood. You put a tourniquet on the limb and are reasonably certain that the casualty won’t bleed out from that wound and can go back to engaging the enemy. It takes less than a minute to get a combat application tourniquet (CAT) on an arm or leg.
Once things have calmed and you can readdress your casualty, you can be more deliberate in your care and can then decide whether or not to keep the tourniquet on or if the wound can be managed with a dressing.
It’s both about speed and the fact that you could be away from a hospital for several hours.
Edit: Also, statistically, the vast majority of preventable deaths on the battlefield are from exsanguination from the extremities.
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#1 reason: Most civilians do not know how to use a tourniquet correctly.
#2 reason: emergency response times in most western areas is pretty good and often orders of magnitude better than a battlefield.
Controlling bleeding, airway and shock are the golden triad of keeping someone alive until advanced life savers get to a scene.
Everyone, EVERONE! Should take a basic first aid course.
I was an Army medic. ☺️ Extremity hemorrhage (really bad arm and leg bleeding) is the most common cause of preventable combat death. That’s why.
A lot of studies were done in the 1970s through 2000s centered mostly on WWI and II, and Vietnam. Out of the battlefield deaths that *could have been prevented on the battlefield*, extremity hemorrhage was the cause of most.
This is because body armor does not cover arms and legs very well, and lots of arms and legs get hurt by gunshots and explosions during a war. Tourniquets are small, lightweight, easy for a layman to use, and VERY good at stopping bleeding.
As a result, in the 1990s the U.S. military developed a method of medicine called Tactical Combat Casualty Care or “TC3” for short. TC3 was immediately made the new standard for all American military medics, who then taught it to non-medical service members as well, and then the US military taught it to all of our ally countries.
There are some other interventions that can help stop preventable battlefield deaths, like a needle that goes in someone’s chest to help them breathe. Those are also part of TC3! It also talks about WHEN during combat to use a tourniquet (or any other intervention).
Extremity hemorrhage is NOT the most common preventable cause of civilian deaths. This is because there are less shootings and explosions in the civilian world, and lots more other causes of death. Civilian EMS does carry tourniquets and uses them when they need to, but they don’t need to as much.
Tourniquets are a last-resort thing for when you have the combination of
* huge bleeding injuries like getting your hand or leg blown off, and
* actual medics/hospitals being too far away to reach in time
In civilian settings, these types of injuries are quite rare, and that size of injury happening away from actual paramedics/hospitals is even rarer. In a battlefield I don’t want to say it’s *common*, but that combination comes up often enough to be worth carrying a few tourniquets.
I think the reason is twofold:
The type and frequency of major trauma injuries are much higher on the battlefield than civilian life.
Time and evidence. Prior to the Boston marathon bombings there wasn’t much evidence regarding the complications of using TQs. This is why you have a lot of people here saying incorrectly that the use of a TQ would lead to the loss of limbs and generally be a last resort. The Boston bombings showed the use of TQs both improvised and the relatively new at the time Combat Application Tourniquet (CAT) gave significant better clinical outcomes than expected. This helped support a renewed interest from researchers into their use. Since then, there has been a flurry of papers which show that limbs can have TQs applied for hours without major complications. Due to this, clinical advice to use TQs to control major bleeds has become much more standard (at least in the UK) and are being taught and carried by more people.
I think as time goes on, they will become more standard for civilian use. It just takes time for the clinical advice to filter through to these changes.
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