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 Daisy Bautista stuffed a sock into the hole in her sister’s arm, and
the man who was helping them pulled a belt tight above the wound.
That improvisation may have saved Paola’s life, preventing the kind
of massive blood loss that is the single greatest cause of trauma
death.
Bautista, a country music lover from California, is one of several
Las Vegas shooting victims who benefited from the use of a
controversial and centuries-old life-saving tool that is making a
comeback - the tourniquet.
Although it has been around since the Middle Ages, the tourniquet
fell out of favor in recent decades because of concerns that it
increased the risk of amputation. Now, that notion has given way to
a new medical consensus that it is better to save a life than a limb
- and to recent battlefield evidence that the risk of amputation
today is quite low.
The new view entered the medical mainstream after the 2012 mass
slayings at the Sandy Hook Elementary School in Newtown,
Connecticut. Under a directive from then-President Barack Obama to
find ways to improve survival in such attacks, a group of doctors
published the “Hartford Consensus,” a compendium of best practices
and guidelines headlined by a call to revive the tourniquet.
Since then, more than 200,000 police officers in major U.S. cities
have been trained to use the low-tech lifesaver. The National
Security Council, with trauma and emergency care groups, has
launched a “Stop the Bleed” campaign to promote training among
civilians. And shopping malls and airports have begun installing
bleed control kits - including tourniquets - on public walls next to
emergency defibrillators.
“We want to turn it into the next CPR,” said Ian Weston, a paramedic
and executive director of the American Trauma Society.
Weston belongs to a small but growing corps of instructors who teach
bleeding control. The free classes were designed to take less than
an hour - “quick, down and dirty," he said, "in the hopes that more
people would take advantage of the training."
LEGACY OF LOST LIMBS
The tourniquet’s bad reputation has some basis in fact: When limbs
go too long without blood-flow and function cannot be restored,
amputation may be necessary. But while in earlier days, especially
on the battlefield, medical attention was often delayed for hours,
today most trauma victims get help before a tourniquet becomes
dangerous.
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The thinking began to change when a retrospective analysis suggested
that up to 10 percent of Vietnam War combat deaths could have been
avoided had tourniquets been applied in the field. Beginning in the
1980s, the Israeli military demonstrated tourniquets could be
effectively applied on the battlefield with little risk.
The pendulum swung further when studies of early casualties in Iraq
and Afghanistan found that tourniquets appeared to improve survival.
One study done in a Baghdad hospital found that 87 percent of
patients who came in with tourniquets survived. Among those who were
good candidates for tourniquets but did not receive them, there were
no survivors.
By 2005, the military had completely embraced tourniquets and began
issuing them to all American combat personnel.
A "NO BRAINER"
Civilian trauma care was slower to change. Until the Sandy Hook
shooting, the conventional wisdom remained that bleeding could be
controlled well enough with manual pressure for paramedics to get
injured people to hospitals. But that approach proved useless in
“hot zones” - mass casualty scenes strewn with victims at risk of
bleeding to death in minutes with a shooter still active.
In 2013, when makeshift bombs exploded at the Boston Marathon and
wounded more than 200 people, the success of improvised tourniquets
reinforced the growing recognition that they could save lives.
“You can give someone an hour of training and an inexpensive bleed
control kit and empower them to save their own life or the life of
the person next to them,” said Dr. Alex Eastman, medical director of
the Rees-Jones Trauma Center at Parkland Hospital in Dallas. “That
is just a no-brainer for every community in this country.”
The Bautista sisters are home again in Fontana, California. Paola,
who had surgery hours after the shooting, faces at least one more
operation. Daisy is looking after her.
"She's good," Daisy said in an interview. "There's pain. But she's
good."
(Reporting by Lisa Girion; Editing by Sue Horton and Leslie Adler)
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