How Boston Marathon led to widespread adoption of tourniquets

After successful deployment at the Boston Marathon, tourniquets go mainstream

Dr. John Cowin — an orthopedic surgeon from Lake County (Fla.) — and his wife Anna were waiting for their daughter, Lynda, to finish her third Boston Marathon. When the bombs went off, Cowin jumped the barricades. In the middle of the chaos, Cowin used his belt to apply a tourniquet to one of the victim’s limbs while other civilians and medical personnel used belts, parts of clothing and other field-expedient devices.

Besides demonstrating the amazing resilience of Americans, the Boston Marathon incident also reinforced some of the most recent studies, both civilian and military, in the field of trauma: The tourniquet is back, and it works.

In the wake of the attacks, officers of the Boston Police Department began carrying tactical tourniquets. Following the lead, the Philadelphia Police Department purchased 5,000 tourniquets for their officers.

Trends for Tourniquet Adoption
I spoke to Dr. Kevin Gerold, D.O., J.D., the chairman of the National Tactical Officers Association (NTOA) Tactical Emergency Medical Support (TEMS) Section last year. Gerold said that a relatively low level of sophistication and high success level has driven the increase in tourniquet use.

There are two factors in recent history that have changed the success rate of tourniquets. First, the statistics were affected by evacuation success in wartime environments. In WWII, patients sometimes waited for days for an evacuation to a hospital. This decreased the success rate of tourniquet use.

As the protocol and technology in the chain of evacuation changed, so did the success rate. Wartime experience has not only improved the evacuation, it also has improved the post-application protocol. That is, when the patient gets to the hospital, modern medicine is dramatically better.

Gerold told me the tourniquet was originally used in the context of a last resort. This is something that requires somewhat of a cultural change.

The second factor that has changed success rate is the use of body armor. More soldiers and law enforcement professionals are issued body armor. This has changed the percentage of where the wounds likely are to occur, provided the armor is adequate and Murphy is dormant. If the armor worked, gunshots and blast injuries will more likely be to the extremities.

Tips for Buying Tourniquets
When shopping for tourniquets, it is important to keep in mind several features. 

First, there should be a drone product available from the manufacturer such as BLUEGUNS. A drone is a training device that looks and works like the real thing with distinctive markings (a completely different color) and inert operation. For first responders, a training device is a must-have.

It’s that simple.

In addition, tourniquet training should be integrated. That is, there are plenty of schools out there that train medical first responder techniques with shooting and ground fighting. I spent some time at Nor-Cal MedTac observing their Defensive Medicine class at the same range at Safety First Shooting Association, my local training facility. This is a great way to train tourniquet application under cover while delivering accurate fire.

Finally, the tensioning device for a tactical tourniquet should not use any type of Velcro or hook and loop. Velcro is used on almost every quality tourniquet product available. However, Velcro places the device. Something else more rigid, usually a metal buckle, tensions it.

Types of Tourniquets on the Market
Most tactical style products use a windlass that turns to tighten it, unless it is a tourniquet that has a clamping device. These are simple and portable. The SOF Tactical Tourniquet is an example of this style.

The C-A-T Tourniquet is similar to the SOF Tactical Tourniquet. Both use a band of the recommended width and a windlass-style tensioning device. Both can be used one-handed — critical for self-aid and buddy-aid under combat pressure. There are plenty of testimonials of the C-A-T Tourniquet in actual combat use.

The tourniquets with a clamping device generally are not the portable kind and clamp a region, instead of the entire limb. There also are pneumatic products that use the same apparatus as a blood pressure cuff.

While few of these are as portable, some boast superior engineering for the officer in the field, like the Last Resort Tourniquet (LRT) from Delfi Medical Innovations. Like any tactical tourniquet, the LRT can be applied with one hand.

There are pneumatic clamping tourniquet devices designed to clamp areas not as easy to treat as limbs. The SAM Junctional Tourniquet can clamp in the hip region or in high-level amputations for advanced users and EMTs.

Ratcheting types of tourniquets should be mentioned, because they are usually the most portable. They are like trouser belts, one pulls the slack end to tension it, then one uses a ratcheting device in line with the slack end to add tension. They are inexpensive and portable. One such product is the Ratcheting Medical Tourniquet.

There is real promise in some of the lessons learned after the Boston Marathon attacks. Agencies across the U.S. are recognizing tourniquets make sense for law enforcement officers to save lives during major incidents. 

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