Return of the Tourniquet: Vital Tools Placed Closer to Scene

https://chat.whatsapp.com/AmbulanceTodayDirect

By Audrey Fraizer, Managing Editor,
Journal of Emergency Dispatch
Published in Ambulance Today,
Spring 2020, Issue 1, Volume 17,
Global Warning and the Burning Issues at the Core of Prehospital Trauma Care

Lynne Baird believes her son Daniel would have survived had he been treated with a bleed control kit.

Daniel was 26 when fatally stabbed at a pub in Digbeth, Birmingham, following a night out with friends and, to prevent others from suffering the same fate, Lynn started a foundation distributing bleed kits in London’s financial district.1

Baird’s precautionary contribution is not isolated.

Taxi Alliance Liverpool received training in bleeding control and bleeding control kits from the Aintree University Hospital’s trauma centre as part of a KnifeSavers campaign.

The kits contain scissors, gloves, tourniquets and trauma dressings as well as military-grade gauze and chest wound sealant.2

KnifeSavers was the brainchild of Nikhil Misra, consultant general and trauma surgeon at Aintree University Hospital, who wanted to make tools that could prevent death closer to the scene.

“Equipping people with the knowledge and tools to prevent massive blood loss at the scene of a stabbing is the single most effective step we can take towards improving the chances of survival for victims.”3

Knife crime has reached a new record high in England and Wales, with official figures revealing almost 44,700 offences in 2019.4 UK Office of National Statistics show that the City of London saw a steep rise in knife crime last year, up 43 percent to 57 incidents in 2018-19.5

A fifth of the crimes – more than 4,500 – were committed by children aged between 10 and 17.6

Would you know how to help someone with major bleeding? Uncontrolled, life threatening hemorrhaging is one of the leading causes of preventable death following a traumatic injury, and a person who is bleeding uncontrollably can die from blood loss within five minutes.

1st Lt. Rob Fidler, 19 Regiment Royal Artillery Joint Tactical Air Controller of cer-in-command, applies a tourniquet to a simulated injury on Master Sgt. Scott Piper, 352nd Special Operations Support Squadron Medical Element ight chief. U.S. Air Force members had conducted two-day training with British JTACS from 19 Regiment from Tidworth, Wiltshire, and 3 Battalions. (U.S. Air Force photo by Karen Abeyasekere)

Think tourniquet. They’re back in EMS vogue as a device in hemorrhage control following a decline of the tourniquet in favor of applied pressure during WWI.

Medical tourniquets now play an essential role in complex medical procedures and emergencies to regulate blood flow.

These devices are used to prevent blood loss by compressing blood vessels and assist medical professionals in carrying out medical procedures with minimum blood loss.

Tourniquets are not limited to a one-style fits all description but come in several varieties to accommodate the purpose.

They include tactical, pediatric, military, surgical, and the emergency medical tourniquet.

An emergency medical tourniquet is commonly used to control arterial blood flow.

Numerous studies supporting the tourniquet’s return has the device counted among the essential gear
of re/EMS systems and stationed alongside AEDs at airports, popular nightlife venues, and places of potential mass casualty incidents.

The International Academies of Emergency Dispatch (IAEDTM) is a charter member of the US ‘Stop the Bleed’ campaign and instructions for tourniquet use are available in the Medical Priority Dispatch SystemTM (MPDS) system version 13.2.

Protocol T: Tourniquet was developed by an Academy research team that spent the better part of a year drafting the proposal and pre-testing prior to a volunteer focused study conducted at selected venues in Salt Lake County, Utah (USA), and enlisting 246 volunteers.

Photo courtesy of Emma Hammett, First Aid for Life

The objective was determining whether layperson callers can effectively stop simulated bleeding using an improvised or a commercial tourniquet, when provided with scripted instructions via phone from a trained protocol-aided EMD.

According to the study rationale, if tourniquets are going to be placed in public locations, emergency medical dispatchers (EMDs) should be prepared to answer callers’ questions regarding situations requiring them, and enthusiastically provide instructions on their use.6

At each study sight, participants called a simulated 911 line (comparable to the UK 999 three-digit emergency exchange) and reported a victim with life-threating bleeding to the leg, which is identified in the real world as7:

• Blood that is spurting out of the wound

• Blood that won’t stop coming out of the wound

• Blood that is pooling on the ground

• Clothing that is soaked with blood

• Bandages that are soaked with blood

• Loss of all or part of an arm or leg

The emergency dispatcher verified the catastrophic nature of the bleed and proceeded in giving the step-by-step instructions while a research team member timed how long it took the “caller” to stop the bleeding with the tourniquet, according to the control device.

“We could watch how people reacted [in response to the instructions] but we couldn’t step in,” said Chris Olola, Ph.D., Director, Biomedical Informatics and Research, IAED. “It took a lot of testing and revision before adding it to the existing protocol.”

According to results, a majority of participants (80.49%) were well within the critical five-minute time limit, with an overall median time for all trials (i.e., elapsed time from the start to the end of the simulation) of 3 minutes and 19 seconds.8

Image Credit — stopthebleed.org

“Of course, in a chaotic, uncontrolled, and emotionally charged real-world event (such as a knife stabbing) it might be unrealistic to expect the high success rate of patient survival that was demonstrated here”, Olola said.

“Nevertheless,’ he said, “This study provides ample evidence that life-saving tourniquet application by untrained laypersons is possible with the bene t of dispatch-directed EMD assistance.”

The Tourniquet protocol doesn’t replace direct pressure in most bleeding situations, cautioned Greg Scott, Operations Research Analyst, IAED.

“A tourniquet is the best way to stop the bleeding from catastrophic injury. Direct pressure is still the preferred method for abrasion.”

As in the EMD’s First Law of Safety, the bystander is cautioned against creating “more victims at the scene.”

Bystanders must ensure their own safety and provide care to the injured person if the scene is safe to do so.

If safety is threatened, the bystander should move from the danger, taking the victim if possible, to find a safe location.

Not surprisingly, demand for surgical tourniquets has surged based on their reintroduction to trauma care and the rising adoption rate of trauma care devices, along with increasing numbers of accidents, injuries, and emergencies.

Additionally, the range of new devices being developed offer promise for bystanders, first responders, and surgeons delivering emergency services and these devices are expected to play crucial roles in reducing the emergency response times and improving the survival rates for patients.9

References

1 Wright M. “Pubs and clubs in London’s nancial district to be given stab kits.” 2019; Nov. 19. https://www.telegraph.co.uk/news/2019/11/18/ pubs-clubs-londons-financial-district-given-stab- kits/ (accessed Feb. 10, 2020).
2 Hughes L. “Five minutes is all it takes to bleed to death but this kit could change that.” Liverpool News. 2019; Oct. 21. https://www.liverpoolecho.co.uk/news/liverpool-news/five-minutes-takes-bleed-death-17117547 (accessed Feb. 10, 2020).
3 See note 2.
4 Dearden L. “Knife crimes reach record high as prosecutions fall to record low.” The Independent. 2020; Jan. 23. https://www.independent.co.uk/ news/uk/crime/knife-crime-uk-stabbing-ons-police-england-wales-prosecutions-a9298166.html (accessed Feb. 10, 2020).
5 See note 1. 5 See note 4.
6 Scott G, Olola C, Gardett M, et al. “Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions from an Emergency Medical Dispatcher.” 2020; Jan. 21. Prehospital Emergency Care. http://mc.manuscriptcentral.com/pec (accessed Feb. 10, 2020).
7 Pons PT, Jacobs L. “Save a life: What everyone should know to stop bleeding after an injury.” Chicago, IL: American College of Surgeons. 2016. https://www.bleedingcontrol.org/resources/how-to-stop-the-bleed (accessed Feb. 10, 2020).
8 See note 6.
9 “Surgical Tourniquets – Creating a “Bloodless” Field of Vision for Surgeons.” Future Market Insights. 2 Aug.; 2019. https://www. futuremarketinsights.com/reports/surgical-tourniquets-market (accessed Feb. 10, 2020).

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *