On that horrific night at the Orlando nightclub, nursing student Joshua McGill took off his shirt and wrapped it around a bartender’s bleeding arm.
“I took it upon myself to let him know that I’m going to try to stop the bleeding,” McGill told ABC’s “Good Morning America,” gaining national accolades for apparently saving Rodney Sumter’s life by applying makeshift tourniquets to both of his arms.
While tourniquets are not new — desperate soldiers have used them for centuries to save their peers from bleeding to death — the June 12 shooting has renewed attention to the tourniquet as a simple, cheap solution to save lives in civilian mass shootings.
The shooting at Pulse has already spurred discussion among regional EMS staff about the need for more public education about tourniquets, said Dr. Joseph Ibrahim, who heads the trauma unit at Orlando Regional Medical Center, where many of the shooting victims were treated.
Even before Orlando, the White House was boosting a “Stop the Bleed’’ campaign promoting tourniquets. And two days after the tragedy, the American Medical Association voted to adopt a new policy calling for first responders to carry kits that include tourniquets, and calling for the general public to be trained in bleeding control.
But some doctors cautioned in interviews with STAT that tourniquets are not always the lifesaver people may think: Many gunshot victims can’t be helped by tourniquets, and proper training is key.
Dr. David R. King, a military surgeon who advocates for widespread training and access to commercially manufactured tourniquets, said improvised versions that civilians throw together in a crisis are rarely effective in stopping blood flow.
“We can’t possibly discourage bystanders from helping,” King said. “That’s the wrong message. They should help. We just want to teach them a way to do it better.”
Ibrahim said that after the Orlando shooting, he saw four or five patients come in with commercial tourniquets, which are carried by police and EMTs. One helped stabilize a patient who had been shot in the leg, he said, but tourniquets help only wounds to the extremities.
Unfortunately, he said, a large portion of the bullets, which killed 49 people and injured dozens more, hit clubgoers in the throat, thorax, chest, or abdomen.
Tourniquets, which fell out of favor after World War II, made a comeback in recent years.
Dr. Jesse M. Ehrenfeld, an AMA board member and US Navy combat veteran, said the physician group’s tourniquet policy came after the military saw success in reducing the number of people who die from uncontrolled bleeding in combat.
The “Stop the Bleed” campaign has trained hundreds of private citizens and first responders on blood-loss techniques, a senior Obama administration official said. The campaign targets civilians, he said, because a victim with severe wounds can bleed to death within five minutes, before emergency responders arrive to help.
Tourniquets were heralded in the response to the Boston Marathon bombings. But King and other researchers found that of 27 tourniquets put into use, all were makeshift devices, not commercially made ones, and they didn’t work well.
“They were improvised and rarely effective,” said King, a surgeon who works at Massachusetts General Hospital and for the military special operations community, and who treated victims of the bombings.
“That’s not to say that you cannot improvise an effective tourniquet. You can,” King said, but most people don’t know how to do it. And “the people who know how, fail to do so properly under duress.”
Makeshift tourniquets “just don’t work as well,” Ibrahim agreed. They may be pulled tight at first, but “as the pressure drops, the tourniquet becomes more loose, and it becomes less functional,” he said. With a commercial tourniquet, “you can grab the strap and pull it tighter,” which is easier than having to adjust a belt or retie a shirt.
“T-shirt material is not able to hold the pressure for a significant amount of time,” Ibrahim added. “I’d rather somebody just hold direct pressure.”
The Orlando shooting has “rejuvenated the discussion” about educating the public about tourniquets as well as distributing them in public places, Ibrahim said.
Meanwhile, King has started such trainings with schoolteachers, hoping to save more lives in the event of another mass shooting.
King and other members of the Hartford Consensus, a group of public safety, legal, and medical officials who came together in the wake of the Sandy Hook school shooting, have recommended public training on, and access to, tourniquets.
“They should be next to every AED [automated external defibrillator] and every first aid kit in every public place,” said King. A manufactured tourniquet costs just $18, he said — cheap enough to keep on every ambulance, fire truck, and police cruiser, and in the trunk of every car.
The “Stop the Bleed” campaign has placed bleeding control kits, including tourniquets, next to AEDs in schools, hospitals, universities, and sports venues.
However, Dr. E. Reed Smith, operational medical director for Arlington County Fire Department in Virginia, called the “Stop the Bleed” campaign “myopic” in its emphasis on tourniquets, especially in the case of mass shootings.
Smith and colleagues at the Committee for Tactical Emergency Casualty Care examined autopsy reports from 12 US mass shootings between 1996 and 2012. They found that no one died because of blood loss from their limbs. “Nobody died where a tourniquet would have kept them alive,” he said.
“Tourniquets alone will most likely not have the same effect on death rates in civilian active shooter situations” that they do in combat, he said. Combat involves fragmentation injuries from explosives, where tourniquets are helpful, while civilian shootings involve more wounds to the head and torso, he said.
Smith said public training needs to go beyond tourniquets. Civilians need to learn other techniques, such as how to clear a person’s airway of vomit and prop them on their side so they can breathe, and how to prevent hypothermia, he argued.
“We need to stop the dying,” he said. “Stopping the dying is more than just stopping the bleeding.”