The use of the tourniquet is now back into the first aid syllabus. This is due to the change in the methods adopted when using a torniquet.

Historically, once a tourniquet was placed on an individual it would be released every 10-15 minutes to allow blood to flow over the area that had been blood-deprived to rejuvenate the tissue. This is because without blood, the tissue would have started to die. 

This seemed a good idea at the time as allowing blood to rejuvenate the tissue was in theory a good thing. However, during the time the tourniquet was in place and tightened, there would have been a build-up of toxins in the blood. When, the tourniquet was released it would allow for the tissue to be rejuvenated but also for the toxins to enter the main circulatory system. 

As a result, this could lead to toxic shock or, in the worst-case scenario, the collapse or breakdown of the kidneys. The kidneys remove waste from the blood and return the cleaned blood back to the body. This is done by removing waste products and excess fluid through the urine. Kidneys also remove acid that is produced by the cells of the body and maintain a healthy balance of water, salts and minerals, such as sodium, calcium, phosphorus and potassium,

One of the challenges for the kidneys is that although they are effective at removing many toxins from the blood, some are difficult to then excrete into the urine. This means they accumulate in the kidneys and as their concentration increases, they can seriously damage the kidneys. 

If a casualty has suffered a life threatening (catastrophic) bleed, a tourniquet is placed on the casualty around the impacted limb, about 2-3 inches (5-7 centimetres) above the source of the bleeding. The tourniquet is always placed between the source of the bleeding and the heart. For example, if the wound is on the forearm, apply the tourniquet to the upper arm. Never place a tourniquet on either a knee or elbow as you cannot tighten it enough to stop the bleeding.

Medical journals recommend two hours as the time limit for tourniquet application after which muscle injury, vascular injury, nerve damage and skin necrosis may be permanent. The tourniquet is now not released; therefore, it is vitally important that the emergency services are mobilised as quickly as possible.

To identify that the casualty has a tourniquet in place it is vital that everyone that has contact with the casualty knows that the casualty has suffered a life-threatening bleed. Therefore, a big T is written on the forehead of the casualty along with the time in which the tourniquet was placed on the individual. This gives the emergency services a quick and easy way of identifying the injury and the time scale.

Myth 1: Tourniquets are a last resort and should only be used after all other means of haemorrhage control has been exhausted.

Wrong: An arterial limb haemorrhage can kill in a matter of minutes; a tourniquet should be your first treatment.

Myth 2: If you use a tourniquet, they will lose that limb.

Wrong: Over the last twenty years the Joint Theatre Trauma Registry has logged data points proving that tourniquets are safe, effective, and do no result in limb loss. 

Myth 3: A properly applied tourniquet should not be uncomfortable.

Wrong: A statement put forward by the Faculty of Pre-Hospital Care at the Royal College of Surgeons stated, “ A properly applied tourniquet is painful; a casualty may require significant pain relief to apply the tourniquet to the appropriate pressure” A tourniquet should be tightened until bleeding stops.

Myth 4: Tourniquets do not work on two bone compartments.

Wrong: The primary determinant of effectiveness in a well-designed tourniquet is the ratio of limb circumference to device width. A tourniquet placed at a narrow part of the limb requires less pressure to achieve occlusion than the same tourniquet placed at a vast portion of the limb, suggesting that tourniquets are more effective when placed as low (distal) on the limb as possible.

Myth 5: Tourniquets can be left on for more than 8 hours or longer.

Wrong: Continuous application for longer than two hours can result in permanent nerve injury. Muscle damage is nearly complete by 6 hours, likely requiring amputation.

Faculty of Pre-Hospital Care, The Royal College of Surgeons of Edinburgh, Position statement on the application of Tourniquets, (2017), 1-2. 

The Joint Trauma System (JTS) Clinical Practice Guidelines (CPGs) 

The use of the tourniquet in first aid

Take advantage of our Deem to Satisfy option at no cost this June.

Deem to Satisfy free in June with SSG Assessed

Health and safety in the construction environment has undergone significant development over recent years. Large scale construction companies have driven up standards across the industry and many of these improvements have been adopted and implemented by the housebuilding sector. The impact of information and messaging by the Health and Safety Executive and their enforcement action has also promoted a more risk-averse approach to health and safety management on site.

Perhaps the most high-profile development in site safety has been the measures taken to combat the impact on personnel of silica and timber dust. The use of Respiratory Protective Equipment in the category FFP3 (and face-fit tested) is now stipulated on site and control measures for equipment involving dust collection bags/attachments, vacuum attachments, water suppression, and segregation measures are regularly applied to dust-generating work activities.

Improvements in standards have been implemented across the full range of construction activities. The site is now identified as a workplace, and the welfare facilities and offices environment now meet specific requirements set out in the Construction (Design and Management) Regulations 2015. Site compound facilities have improved to the point where walkways resemble finished property footpaths with concrete slabs leading to each temporary building. On site, designated walkways provided to segregate site vehicles from personnel have been introduced into roads, footpaths, and general circulation areas around properties under construction along with designated crossing points. These extend into garden and general site circulation areas under construction to minimise the potential for contact between personnel and site plant/vehicles. Extensive use of pedestrian barriers and crossing point ‘hoops’ with gates is commonplace.

Fall prevention and arrest systems have been provided in the form of crash decks, enclosures at the top of ladders where significant fall potential exists and scaffolding incorporating appropriate edge protection. Falling object prevention measures such as brick guards at all working lifts have been consistently provided. Loading bays are regularly included to deliver materials to the point of work, avoiding manual handling. These bays incorporate cantilevered gates and weight capacity notices to avoid the potential for falling objects or the scaffold platform to become overloaded. The management of work at height has improved with the move toward scaffold contractors consistently providing Compliance Sheets, Handover Certificates and carrying out regular recorded scaffold inspections (under the new TG20:21 guidance for scaffold design). The inspections are detailed in weekly scaffold reports and indicated on scaffold tags

Stair edge protection is provided using proprietary products designed to avoid the potential for falls. Pedestal floor-fixed supports for timber guardrails and midrail edge protection have become commonplace at landings and floor openings. Access hatches at stairwells allow crash decks to be installed at first floor level and across the stairwell area which avoid the potential for personnel to fall inwards from the external scaffold at eaves level to the first floor. The hatch and edge protection systems allow safe systems of work to be implemented in the installation of stairs.

Fire safety has taken a higher profile in the preparation for construction projects in the form of Fire Risk Assessments and Fire Plans, particularly when using prefabricated timber-framed products. Regularly updated fire plan information is displayed in site offices. The equipment provided for fire detection and alarm is selected to combat fire hazards in the workplace and has improved significantly. The move to eliminate hot works where possible using plumbing fittings that do not require heat to make seals has been a feature of most modern building projects.

Temporary Works awareness has been raised within the industry. There has been a move to train personnel to act as Designated Individuals, Temporary Works Coordinators and Temporary Works Supervisors within the sector. The preparation of Temporary Works Registers has become part of the pre-construction project planning phase and design information is obtained for all items identified as Temporary Works involving everything from temporary floor support structures to the heras fencing often used to enclose the site boundary. 

Security of the site has taken on a far higher profile. Sites are fully enclosed by heras fencing despite the extensive perimeter of the construction area. Principal Contractors have become more aware of their duty to prevent unauthorised access to site by supplying a suitable, regularly inspected site boundary protection barrier and appropriate substantial gates at the site entrance with appropriate site signs.

Some contractors have provided ladder locks at every access to scaffolding. 

Environmental protection measures have taken on greater significance in recent years. Measures to prevent water run-off and protect the ground at the site silo/mortar mixing areas have been a feature of greater awareness of environmental issues generally.

Construction sites are constantly evolving and reacting to the hazards presented by materials and their installation techniques. Successful construction companies and the subcontractors that provide specialist trade services have embraced modern health and safety development and make every effort to provide a safe working environment. 

Health and safety in the construction environment has undergone significant development over recent years