Boston bombings: Have we (finally) ended the tourniquet debate?

If you still need "proof positive" that tourniquets save lives, perhaps you should go talk with a survivor of the Boston Marathon bombing

If there was any remaining doubt (and according to folks I speak with, there definitely was), the Boston Marathon bombing should put to rest any “debate” on whether or not patrol officers should train to use tourniquets — and carry at least one while on duty. 

The day after the Boston Marathon bombing, I was between ILEETA seminar sessions and engaged in a hallway discussion with another attendee when the topic of tourniquets came up. We both speculated that given what we knew about the nature of the explosion and the reported ratio of dead to injured persons, there had to have been a whole bunch of tourniquets used that day. We agreed that some of those would have been commercially-produced tactical tourniquets such as SOF-T, but many others were sure to be improvised from available materials. Many, we also concurred, would have been applied by bystanders or even the victims themselves.

Well, our mutually-held “conclusions” formed from afar (and less than 24 hours after the event) were clearly correct.

The Associated Press ran an article which detailed how responders and ordinary citizens used “belts, shirts, and other materials” to stem the worst of the bleeding “in fast-acting bids to prevent major blood loss, shock and death.”

“Without a doubt, tourniquets were a difference-maker and saved lives.” Joseph Blansfield, Boston Medical Center’s trauma program manager said in that AP article.

Blansfield, who spent a year as chief nurse of a combat support hospital in Iraq, added that bleeding was stanched and patients “arrived in a better physiologic state and didn’t require as much resuscitation as they otherwise would.”

USA Today followed up on that AP piece, stating that hospital workers saw “many patients come in with tourniquets. Some had multiple tourniquets. They definitely saved patients’ lives.”

From the Sandbox to the Streets
The historical perception that tourniquets could do more harm than good has been slowly eroded by data gathered on the battlefields of Iraq and Afghanistan. There are American warriors who are walking the streets today on prosthetic limbs as a consequence of injuries sustained from IED attacks over in “the sandbox.”

The operative phrase there, as you surely have figured out, is “walking the streets today” — had they not had a tourniquet applied, many of those heroes would be dead. 

Michael Yaffe, a trauma physician at Beth Israel Deaconess Medical Center in Boston, where 24 patients were treated said in that USA Today article that “a lot has emerged from the Iraq and Afghan wars.” 

USA Today said that tourniquets have been “carried by every U.S. servicemember in combat since 2006, with an estimated 3,000 lives saved.”

Yaffe, who is a lieutenant colonel in the Army Reserves added that “a tourniquet is a standard piece of equipment for a soldier to carry now. They might wear one out on an assignment and not tighten it unless they have to.”

We’ve covered tactical tourniquet use many times here on Police1, including in an excellent column by Steve Rabinovich.  

“It’s inexcusable in this day and age,” Rabinovich wrote, “to lose an officer in the line of duty simply due to an extremity bleeding.”

Can a tourniquet be used inappropriately in cases where they aren’t completely necessary or applied incorrectly, even dangerously? Sure, on both counts. But with proper training, we can mitigate those risks — if not eliminate them altogether.

•    Select a tourniquet (or have one selected by your agency quartermaster) 
•    Seek and attend quality training on its use (and, importantly, its non-use)
•    Strap it to your person (I like the ankle holster, but it has obvious issues)

On battlefields in Iraq and Afghanistan, and on the streets of America’s cities and towns, American Warriors have successfully saved their own lives, the lives of their partners, as well as the lives of victims of atrocities such as what happened on Boylston Street. 

To paraphrase Rabinovich somewhat, if your agency is still debating the subject of tourniquets, then there are some decision-makers there who either don’t have the facts or for whatever reason, they’re choosing to ignore them.

You might direct their attention to this article. 

Stay safe my friends. 

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