Like many Americans, we have followed the events in Boston bombing over the last week closely. While many aspects of the bombing were horrible, one uplifting aspect was the brave and heroic response of untrained bystanders who rushed to aid the injured, many of whom received complex lower extremity wounds.
An interview today done by Anderson Cooper with Adrianne Haslet-Davis and her husband revealed that after they were injured they attempted to tourniquet their wounds with leather belts that they looped through the buckle and then pulled up tight. They should be commended for keeping cool enough in a terrifying situation to try to staunch the blood flow.
Another way that an emergency tourniquet is sometimes fashioned in the field and is based on the military technique for placing tourniquets is as follows:
1. Obtain an article of light-weight, flexible clothing such as a large t-shirt, neck tie, ladies’ scarf, pants, or men’s dress shirt or any sturdy cord or rope if readily available. A large black trash bag can also be used
2. If a T-shirt or dress shirt is used, the cloth is rolled like a cigar wrapper from sleeve to sleeve to make a fabric roll that is as long and thin as possible and roughly resembles a rolled marijuana cigarette. It may be necessary to partially tear the garment to create increased dimension. The longest, thinnest piece of fabric that can be quickly fashioned is preferred.
3. The tourniquet is then placed under or around the limb that is injured leaving about 1-2 inches of non-traumatized tissue between the injury and the tourniquet.
4. The loose ends are then tied into a double knot so that the material has about 1-2 inches of slack above the skin.
5. Any straight stiff object such as a flat soled shoe, stick, hairbrush, comb, pen or pencil or a cellphone to act as a tourniquet tightener is procured.
6. Ideally, the straight tightener is at least 3 times longer than the width of the tourniquet.
7. The tightener is then threaded under the tourniquet and above the skin surface closest to the responder and then turned either clockwise or counter-clockwise.
8. In about 1-2 turns the slack in the fabric will be taken up and the tourniquet will start to cinch down on the skin.
9. Tightening is continued until the bleeding stops or lessens.
10. The tightener should be held in place by the patient or the person giving first aid.
11. If this is not possible, the loose ends of the fabric are then pulled over the tightener and then tucked under the now cinched down tourniquet to prevent the tourniquet from loosening. It does not require a lot of pressure to prevent the tightener from loosening.
12. If possible the time that the tourniquet was placed is written on the cloth so that trauma surgeons will know the approximate ischemia time.
13. Generally, the easiest and most readily available tightener at a field trauma scene is a shoe with as stiff a sole as possible.