By MICHAEL S. SCHMIDT
JAN. 19, 2014
As far back as Alexander the Great’s campaigns, tourniquets were wartime staples, used to stanch the bleeding of wounded soldiers. But they became a last resort for both military and civilian emergency personnel after World War II, when medical experts blamed the prolonged cutoff of blood for frequent amputations.
Transportation was so poor in those days that it took the wounded hours, if not days, to receive adequate medical attention — far too long for a tourniquet to remain in place. “The treatment was initially worse than the disease,” said Dr. Lenworth M. Jacobs, the head of the Hartford Consensus, a group of experts in emergency medicine who have studied how to respond more effectively to mass casualties.
But now law enforcement agencies across the country, responding to an increase in mass shootings over the last decade and to new guidelines from the federal government, have placed a new emphasis on training and equipping officers to treat serious wounds by reviving the use of tourniquets. The Virginia State Police, along with departments in Dallas, Philadelphia and other major cities, have distributed tourniquets and special bandages to officers in recent months, in a break from traditional police procedure.
The tourniquet’s resurgence results in part from lessons learned in Afghanistan and Iraq. Only 2 percent of soldiers with severe bleeding in those countries died compared with 7 percent in Vietnam in part because tourniquets were in widespread use and the injured were quickly transported to doctors.
In the past year, civilian trauma doctors, realizing that emergency personnel in much of the country can transport the wounded to a trauma center in less than 30 minutes, have followed the lead of the military. The success of the rapid medical response to the Boston Marathon bombings, where bystanders used their clothes as tourniquets, has bolstered their efforts.
“As we began to take a hard look at how to respond to these types of incidents, what became clear was that the sooner you can stop victims from bleeding, the higher likelihood you will have for reducing fatalities,” said John Cohen, a senior counterterrorism official at the Department of Homeland Security and a member of a committee appointed by President Obama to study gun violence after the mass shooting in Newtown, Conn. “And the things that make the biggest difference in stopping bleeding are tourniquets and other bandages.”
As part of a broader effort to encourage the public to help treat victims, the committee has been developing plans to put tourniquets in public places, like malls and schools, and to train teachers and others how to use them. In September, committee members also released new recommendations for emergency responders after studying the Boston bombings and other attacks. Among their ideas: Paramedics wearing body armor should be prepared to enter into “warm zones” where there may still be gunmen or unexploded bombs.
“Along with encouraging police, who are often the first emergency personnel to arrive at the scene, we have been trying to figure out how to get the public trained and educated in how they can help, because they are almost always the closest to the victims,” Mr. Cohen said.
In June, the Hartford Consensus reported that “hemorrhage control” was one of the most important factors in saving lives after mass casualties occur. Four months later, the Major Cities Chiefs Association, a group of police commissioners from the 63 largest urban cities in the nation, unanimously endorsed guidelines to equip police officers with tourniquets.
Modern tourniquets resemble a belt with a large clamp and a metallic rod, known as a windlass, used to tighten them around a wounded limb. Officers carry them on their belts or keep them in first-aid kits in their vehicles. For many, it all is something of a cultural change.
“Until recently, there was an anecdotal bias against using them in the pre-hospital phase of treatment, but it wasn’t based on any real studies,” said Dr. William Fabbri, the head of the F.B.I.’s emergency medical support program.
Charles H. Ramsey, the police commissioner in Philadelphia, said that when he started in law enforcement, “we had directives that said not to move a victim when you found them at a scene, and wait for rescue personnel.
”“It always took time for them to get there, and a person lost a tremendous amount of blood,” Commissioner Ramsey continued.
Speed is still an issue in treating someone whose bleeding has been stanched, and Commissioner Ramsey said his officers were now instructed to take victims who were treated with tourniquets directly to the hospital if emergency responders have not arrived at the scene.
These tactics have raised concerns among some police officials, who question whether their officers will be diverted from catching criminals if they are also responsible for treating victims. “Chasing and catching bad guys is part of what we do,” Commissioner Ramsey said, “but there is nothing more important than saving a life.”
Although the expanded use of tourniquets has encouraged some medical experts, they believe more needs to be done.
Dr. Jacobs said that “when they began putting $15,000 defibrillators in public places 15 to 20 years ago, there was no concept” that terrorist attacks or mass shootings might one day be more common.
“There’s no reason a $15 tourniquet can’t be right beside the defibrillator,” he said.