Tourniquet: Encyclopedia II - Tourniquet - Risks of a tourniquet

Tourniquet - Risks of a tourniquet

As the tourniquet stops the perfusion of the limb, the resulting anoxia can cause the death of the limb, forcing the later surgical amputation of the limb just below the level the tourniquet is applied. This is likely to occur when the tourniquet stays in place several hours. In any event, once a tourniquet has been applied, advanced medical care from a doctor or hospital will be required to salvage the limb if not save the life of the patient.

The status of the tourniquet varies widely according to the country. This situation can be illustrated by the opposite philosophies applied in the United States and in France.

In any case, the first aider/rescue should act according to the local conditions (laws, rescue organisation and philosophy).

Tourniquet - In the United States

The decision to employ a tourniquet should be made by a paramedic or preferably a doctor if at all possible. But when severe external bleeding cannot be controlled by other means, a tourniquet may be the only way for a first-aider to save the casualty. (A medical professional would use a hemostat or resort to field surgery.)

The first aid instruction no longer teaches the use of the tourniquet for the following reasons:

• the effectiveness of direct pressure, elevation and pressure points (controlling severe bleeding in up to 90% of cases as estimated by US medical sources)
• the vastly increased difficulty of reattaching an amputated limb when a tourniquet has been applied to the victim
• unnecessary use by poorly trained bystanders
• the unavoidable risks to both limb and life even when properly employed
• the rare nature of injuries that require tourniquets, which typically occur in unusual settings such as working with agricultural or industrial machinery and the battlefield

The use of a tourniquet by a layperson in countries where it is considered outside the scope of practice of first aid may result in civil lawsuits and/or criminal charges, especially if the application was later found to have been unnecessary.

Tourniquet - In France

In France, the tourniquet is taught to the general public, in the first level of first aid course (Attestation de formation aux premiers secours, 10 hours without any prerequisite). The French emergency medical service (Samu) considers that the rhabdomyolysis (destruction of the muscle cells due to the anoxia) is not likely to endanger the limb before six hours, i.e. the casualty receives advanced medical cares by a physician (either a medical prehospital team or at the emergency room of a hospital) long before the risk occurs.

The act is thus considered as proportional to the risk (death by blood loss), and the first aider/rescuer is not likely to be condemned in case the limb is lost (although the legal risk is not totally absent): this loss would be attributed to the wound and not to the saving act. Especially, the tourniquet is considered as an alternative to avoid infection by contact with the blood of the casualty when the first aider has no protecting device (e.g. plastic bag, piece of cloth etc.).

Adapted from the Wikipedia article "Risks of a tourniquet", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki