Emergency tourniquet

Emergency tourniquets are cuff-like devices designed to stop severe traumatic bleeding before or during transport to a care facility. They are wrapped around the limb, proximal to the site of trauma, and tightened until all blood vessels underneath are occluded. The design and construction of emergency tourniquets allows quick application by first aid responders or the injured persons themselves. Correct use of tourniquet devices have been shown to save lives under austere conditions with comparatively low risk of injury. In field trials, prompt application of emergency tourniquets before the patient goes into shock are associated with higher survival rates than any other scenario where tourniquets were used later or not at all.1. Careful placement of tourniquet proximal to all sites of hemorrhage. Emergency tourniquets are cuff-like devices designed to stop severe traumatic bleeding before or during transport to a care facility. They are wrapped around the limb, proximal to the site of trauma, and tightened until all blood vessels underneath are occluded. The design and construction of emergency tourniquets allows quick application by first aid responders or the injured persons themselves. Correct use of tourniquet devices have been shown to save lives under austere conditions with comparatively low risk of injury. In field trials, prompt application of emergency tourniquets before the patient goes into shock are associated with higher survival rates than any other scenario where tourniquets were used later or not at all. Existing guidelines call for the use of improvised 'rope-and-stick' tourniquets as a last resort to stop severe bleeding. However, purpose-made tourniquet devices that are well designed can provide greatly increased safety and efficacy. Variability in performance has been shown to exist between various designs and application methods. Mechanisms that confer sufficient mechanical advantage are essential for applying adequate pressure to stop bleeding, particularly on the lower extremities. Pressures that occlude venous but not arterial flow can exacerbate hemorrhage and cause damage to healthy tissue. Results from laboratory and field testing suggest that windlass and pneumatic mechanisms are effective where other systems fail due to excessive pain, slipping, inadequate force, or mechanical failure. Pressure underneath a tourniquet cuff is not evenly distributed, with the highest pressures localized around the cuff centerline and decreasing to zero near the cuff edges. A high rate of change of pressure across the cuff width, or a high cuff pressure gradient, is a leading cause of nerve and muscle injury from tourniquet use. Tourniquets with wider straps or cuffs, especially those with pneumatic actuation in contrast to mechanical force, distribute pressure more evenly and produce lower pressure gradients. They are therefore more likely to stop bleeding and less likely to cause damage to underlying tissue, in addition to being significantly less painful than tourniquets with narrow straps and bands. Overpressure protection in certain emergency tourniquets also help to prevent excessive force from damaging the limb. Possible risks of complications—morbidity—related to emergency tourniquet use include Emergency care services implementing routine tourniquet use, especially in the civilian setting, should exercise caution and ensure that training is adequate for optimal results. However, given proper precautions, the occurrence of complications due to tourniquet use is quite rare. Designed tourniquet devices are routinely tightened over healthy limbs during training with no ill effects, and recent evidence from combat hospitals in Iraq suggests that morbidity rates are low when users adhere to standard best practices. Since no better alternatives exist for users to self-apply with only basic training, the benefit of tourniquet use far outweighs the risks.