Tourniquets, once out of favor, helped save lives in Vegas shootings

[October 13, 2017]  By Lisa Girion

LAS VEGAS (Reuters) - When the sniper’s bullet shattered Paola Bautista’s arm, her sister and a stranger in the crowd at the Route 91 Harvest Festival got her to cover. Then they focused on the bleeding.

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.

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.

People react at gunshots heard at music festival in Las Vegas, U.S., October 1, 2017 in this picture obtained from social media. @RTBLECKvia REUTERS

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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