On returning from his orientation programme from the city’s swimming pool, where he works as the Swimming Instructor and Life-Guard, I asked our son Nikhil, “What’s new this time?” The Swimming Instructors have to undergo an orientation programme prior to commencement of any teaching session – a ritual once in three months. They are assessed for their swimming ability and life saving techniques. The incidents that occurred during the quarter in all the swimming pools are discussed in detail and the correct methodology to deal with them are brought out. Any changes to the existing protocols of First-Aid, CPR, Child Psychology, etc are also covered during this programme.
“The age old tourniquet is back in” was his reply.
His reply made me dwell back into my memory of the Cadet days at the National Defence Academy (NDA) where the tourniquet and a blade adorned our Field Service (FS) Cap. The tourniquet was in fact two pencils, four inches long, wound neatly by a shoelace. The ends of the shoelace were neatly tied on to the two holes on the left side of the FS Cap. Luckily never heard of anyone untying the knot and using it during the Academy days.
On commissioning as a Second Lieutenant, I still carried the blade and the tourniquet as an integral part of my FS Cap. The blade was the first to go as the Indian Army found that the blade had a great chance of infecting the wound rather than saving a person from a snake bite.
By the late Eighties, Indian Army recommended doing away with tourniquets. The tourniquet meant to stop circulation of blood through the limb where a poisonous snake might have bitten was found to be more damaging than allowing the poison to spread across the victim’s body. In case a limb that had a tourniquet applied for hours, with no blood or lymph flow, caused a huge buildup of toxins in the limb. When the tourniquet was released, all those toxins spread into the victim’s entire body.
The simple tourniquets was employed as an effective means during many wars to stop serious bleeding wounds. It saved many a lives that would have been lost due to blood loss. The tourniquet, in case applied over a prolonged period of over two hours, may damage tissues due to a loss of circulation. This may result in permanent nerve injury, muscle injury, vascular injury, etc.
Periodic loosening of a tourniquet in an attempt to reduce tissue damage may often lead to blood loss and death. Further, the victim suffers immense pain when a tourniquet is applied and may need heavy dose of pain killers. For the tourniquets to be effective, the person applying the tourniquets must be well trained and must be aware as to what he is doing, how to do it and why.
In today’s world where the threat of a militant attack, industrial accidents, natural disasters, man-made disasters like stampedes, etc may result in mass civilian causalities with serious limb injuries. The first responders and medical aid, even if available, may not be sufficient enough to treat all casualties. Hence there is an urgent need for all responsible citizens to be trained in First-Aid and in use of tourniquets. A casualty with multiple injuries, including serious bleeding limb injuries may be effectively managed by the immediate application of a tourniquet as a temporary measure to stop bleeding.
In most cases there is a need to improvise a tourniquet. One must use a broad band to provide adequate compression. A shoelace is a last resort, being thin, may not provide adequate compression. The tourniquet must be applied just above the injury. onto bare skin to prevent slipping.
The first tourniquet may be applied ‘high and tight’ over clothing until a more considered assessment and reapplication may be considered. The tourniquet should be tightened until bleeding stops. Insert something rigid under the tourniquet and next to the knot to keep the tourniquet taught. In case it is ineffective, the tourniquet should be tightened or re-positioned. One may even consider applying a second tourniquet above the first if required. Always write the Time and Date on the tourniquet.
Releasing the tourniquet once the casualty has been stabilised will, theoretically, avoid or limit the complications of prolonged use of a tourniquet. Release the tourniquet, observing the wound and If bleeding continues, tighten the tourniquet until bleeding stops.
The tourniquet should remain in place if :-
- The transit time to medical care is less than one hour.
- The casualty has other life threatening injuries.
- The casualty has unstable vital signs.
Tourniquets are an effective method of controlling serious bleeding which may not otherwise be controlled by simple measures but only if applied effectively. The greatest risks of serious complications are due to inappropriate or incorrect application of tourniquets, not the tourniquet itself.
Sgt Dakota Oklesson, senior line medic with Apache Troop, 1st Squadron (Airborne), 40th Cavalry Regiment, helps an Indian Army soldier apply a tourniquet during their first day of joint training for Yudh Abhyas 2010 Nov 1 at the Battle Command Training Center and Education Center on Joint Base Elmendorf-Richardson, Alaska.