The torniquet is back with a vengeance. Taken back in from the cold by the armed forces, it’s also worked its way back into civilian pre-hospital medicine. Its comeback has come with the war in the Middle East. The increasing numbers of rather effective IED’s is countered by the equally effective body armour, protecting the soldier’s head and torso. Result: Soldiers survive IED’s. But lose limbs and bleed.

The tourniquets used in the armed forces are effective at stopping bleeding from severed arms, but from the army’s experience they’re not really powerful enough to compress the arteries in a soldier’s thigh. We had an interesting presentation from Dr. Clare Hayes-Bradley, who’s done several tours with the British MERT (Medical Emergency Response Team) in the Middle East. MERT’s experience is that all lower extremity amputations take two to three tourniquets to stop the bleeding. Apply them just above or below the initial tourniquet.

A final tip from MERT is to check the inner thigh after applying a high tourniquet. Apparently, they had a case of testicular strangulation during treatment of a IED lower limb amputation. No wonder that patient needed extremely high doses of opioids…

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