Tourniquet Makes a Comeback as Lifesaver

Jul 17, 2017

Trajarvis McMurry tried to fashion a makeshift tourniquet from his friend's shirt, but he was too weak to tighten it enough to stop the bleeding coming from his own arm.

McMurry was riding in a truck that rolled over in the predawn darkness in June near Houghton Road on Interstate 10. Bystanders stopped to help. The 23-year-old U.S. Army veteran asked if anyone had a tourniquet. No one did.

Moments later, two U.S. Border Patrol agents happened on the chaotic scene. Agent Joseph Tukovits came upon McMurry, who was lying on the ground, still bleeding. Tukovits applied a tourniquet to McMurry's upper right arm. Veteran agent Adam Alessi tightened it. The bleeding subsided, and McMurry was transported to the Level 1 trauma center at Banner University Medical Center – Tucson, where he was met by the trauma team.

Although the tourniquet has been used since antiquity, especially in military settings, it fell out of favor because of concerns over complications such as tissue damage, limb loss and ineffective hemorrhagic control, says Dr. Andrew Tang, associate professor of surgery and trauma medical director at Banner University Medical Center – Tucson.

But lately, because of improved technology and better training, the tourniquet is making a comeback — and making the difference between life and death.

In the aftermath of mass-casualty incidents, such as the one at Sandy Hook Elementary School in Connecticut in late 2012, the White House and the American College of Surgeons launched the national Stop the Bleed campaign in October 2015, to provide the nonmedical public with the knowledge and tools to stop life-threatening bleeding.

One of those tools is the tourniquet. Should compression and packing of a wound not stop bleeding coming from an extremity, the application of a tourniquet is the next order of business.

Because of the effectiveness of body armor and the increased use of improvised explosive devices during recent wars, a significant number of deaths resulted from injuries to the extremities, Tang says. Military physicians took note.

"That's when tourniquet use was revisited by the medical profession, particularly the military medical profession," Tang says. "Every soldier is trained on tourniquet use with the thought that every soldier can help himself or help his fellow soldiers."

Including McMurry, who was trained to use a tourniquet during his time in the Army.

Although tourniquets are key to reducing the number of mortalities at the scene of mass-casualty incidents, Tang says the use of tourniquets in the aftermath of vehicle crashes should not be underestimated, given their frequency.

"As trauma goes, it's far more common that it's car accidents we're dealing with," Tang says. "And tourniquets really have a use in these particular scenarios, as evidenced by Trajarvis' case."

In fact, the Border Patrol recently implemented a training program called IFAK, which stands for Individual First Aid Kit.

"It has scissors, duct tape, since duct tape really does solve most problems," Alessi explains. "It has chest seals for puncture wounds, gauze, compression bandages, and most important, the tourniquet. It was incredible to see it work on this patient (McMurry). I will always have a tourniquet with me. To see how it worked, I'm a believer."

For those who are concerned that tourniquets can damage limbs, Tang says that's why training and proper use of the tourniquet are paramount.

"Generally speaking, tourniquets are applied to compress the blood vessels to cease any further blood flow distal to where the tourniquet has been applied," Tang says.

"The lack of blood flow to the tissue can be tolerated up to a certain number of hours. And within the United States, most cities have a very robust EMS system. We're talking transport time from the scene to the hospital of well under half an hour. And that's well within the time for the limb not to have ischemic damage."

A week after the accident, McMurry was preparing to be discharged from the hospital. He was headed home to Hearne, Texas, to his 4-year-old daughter and physical therapy there.

Seated at McMurry's bedside in the intensive care unit, Tang reflected on the importance of having a Level 1 trauma center in southern Arizona.

"Still," he said, "what those officers did was lifesaving."

Original story: https://uanews.arizona.edu/story/tourniquet-makes-comeback-lifesaver

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