In Davidson County in 2016, the Metropolitan Nashville Police Department reported 306 people shot.
If a bullet hits a major artery, it could be a matter of minutes before the person loses too much blood and dies. But if that artery happens to be in an arm or a leg, a tourniquet can be placed to save the person’s life.
The first person on the scene when a person is shot, stabbed, or otherwise seriously injured is rarely a medical professional. Sometimes it is a police officer or firefighter, or often a bystander. That is why local doctors and police as well as a national campaign are striving to get more and more people prepared to act in the event of arterial bleeding.
Dr. Oscar Guillamondegui, trauma medical director at Vanderbilt University School of Medicine, estimates that Vanderbilt Hospital sees about 700 total penetrating injuries a year — which include gunshot and stab wounds — and he estimates 80 percent of those are non-torso injuries. He believes that anyone is qualified to place a tourniquet.
If someone is bleeding, the bystander should first be sure that they are not compromising their own safety by helping the victim. The next step is to put pressure on the wound.
With typical bleeding, this pressure will stop the flow of blood, but with arterial bleeding it simply will not stop.
“If somebody has arterial bleeding, it’s pretty identifiable. It’s brisk, it’s bright red, it’s flowing,” Guillamondegui says.
The arterial bleeding is a sign that a tourniquet should be placed to cut off blood flow. To use a tourniquet, first a velcro strap is tightened around the arm or leg above the wound, then a small rod is turned to further tighten the tourniquet. The rod should be secured and the time should be written on the attached strap for emergency medical professionals to prevent limb loss.
Dr. Guillamondegui warns against buying a tourniquet that is not certified by the Tactical Combat Casualty Care (TCCC), which sets the standard for care in battlefield medicine. He added that a belt or cloth tied around the limb will never give enough pressure to stop arterial blood flow — it has to go to a point of pressure that it actually hurts and stops the bleeding.
“A good one costs you about 30 dollars,” he says. “It’s not cheap but it’s cheaper than dying.”
In 2015, the Nashville Metro Police officers began carrying a tourniquet along with quikclot gauze, gloves and a pressure wrap on their person, rather than keeping it in a kit in the car. Officer Jason Rader of the Metropolitan Nashville Police Department Special Response Team says he feared that officers would not have enough time to run back to the vehicle and risk the life of the bleeding victim. In his experience, the tourniquets typically come into play with stabbing and gunshot wounds.
“Several emergency medical personnel have said on multiple occasions that if the officer who was first on the scene, if he they had not done what they had done by applying those tourniquets, then these people more than likely would have died,” Rader says. "It’s been a really good thing.”
The efforts of both of these local professionals fall in line with the Stop the Bleed campaign, a national awareness campaign rolled out by the White House in 2015. The campaign supplies instructions for how to react in an emergency bleeding situation and looks to raise awareness, but does not supply tourniquets or funds. According to the campaign’s website “Stop the Bleed is intended to cultivate grassroots efforts that encourage bystanders to become trained, equipped, and empowered to help in a bleeding emergency before professional help arrives.” Nashville does not have an official Stop the Bleed campaign set up.
Tourniquets have actually come back into mainstream use in recent years after a period of rejection.
Guillamondegui says tourniquets got a bad reputation around the time of the Vietnam War. While they were effective, the use often resulted in limb loss.This was a time before trauma systems were in place and it would take the injured a long time to get into an operating room or to know that they needed to go, he says.
“The initial use of tourniquets was to stop bleeding, but what would happen was they would leave the tourniquets on too long,” Guillamondegui says. “Once it goes past a certain point, the tissue dies and it can’t be brought back to life.”
The re-introduction of tourniquets came during the Gulf Wars of the '90s and early 2000s. Because of the use of body armour, soldiers saw more limb injuries and the military began using tourniquets again more frequently, Guillamondegui says.
“What we realize now is that if you get a tourniquet on a patient, in the appropriate amount of time in the appropriate fashion so it stops arterial blood flow, then you get them to a center where they can take care of it within one to two hours, you’re saving lives and saving limbs,” he says.
With nearly one gunshot wound per day happening in Davidson County, it’s not unlikely that residents of Nashville could come face to face with someone who needs help stopping the bleed.
“We live in a world in which we’re pushing that everyone should have narcan available because of opioid overdosing — this is even simpler than that,” Guillamondegui says.