Tourniquets, now carried by Boston police, weren’t always standard

When a Boston police officer was shot in the leg on Friday, he tried to tie a tourniquet on his own leg. He was “bleeding pretty good,’’ according to Boston Police Commissioner William Evans, and an officer at the scene tied it for him.

The officer, Kurt Stokinger, was transported to Boston Medical Center where he was treated in the intensive care unit.

Evans said it was fortunate the officer hadn’t been more seriously injured.

“It’s an example of absolutely how effective they can be,’’ Boston police spokesman James Kenneally said of tourniquets.

The Boston Police Department issued tourniquets to officers shortly after the Boston Marathon bombing, according to Kenneally. The Boston Fire Department also began carrying tourniquets on every fire truck following the bombing.

Boston Public Health Commission public safety officials and Boston EMS also carry the tools, according to a commission spokesperson.

But police carrying tourniquets hasn’t always been the standard.

Tourniquets fell out of favor following World War II — when incorrectly applied tourniquets resulted in more limbs and lives lost than saved. It wasn’t until the 1990s that tourniquets came back into favor. The military began recommending them as standard issue to soldiers in 2003.

“Tourniquets were used historically a lot by the military mostly because of the types of injuries that they often see,’’ Dr. Alok Gupta, a trauma surgeon at Beth Israel Deaconess Medical Center, told Boston.com. “More and more often, we’re seeing those military-style injuries in the civilian population.’’

Boston isn’t the only place where first responders have changed their practice regarding tourniquets.

In 2013, officials from the American College of Surgeons, the Federal Bureau of Investigations, along with police and fire organizations, concluded in the “Hartford Consenus’’ that the primary cause of preventable death in mass casualty events — such as the shooting at Sandy Hook Elementary in Newtown, Connecticut — is blood loss. And the best way to stop blood loss is through a properly applied tourniquet.

The American Red Cross updated its guidelines in October to align with the White House’s “Stop the Bleed’’ initiative, acknowledging the importance of tourniquets and clotting agents in stopping life-threatening bleeding when “standard measures’’ are not possible or not working.

Trooper Paul Sullivan, a spokesman for the Massachusetts State Police said troopers are trained by EMS and follow current medical standards for first responders but don’t carry tourniquets.

Troopers began using QuickClot, a product that helps coagulate the blood flow quickly, about two years ago. Sullivan said packet comes with a cloth, which can be used as a tourniquet. Most police officers should be trained in how to create a tourniquet, he said.

Many members of law enforcement are also veterans of the armed forces with previous combat and lifesaving training and can “make-do’’ with whatever they have available, Sullivan said.

Within the medical community, Gupta said there’s been “important education’’ about when and how to use a tourniquet.

He said there is also support within the medical community for making tourniquets more readily available in the civilian sector. Gupta said he and his colleagues at Beth Israel saw many improvised tourniquets on patients who arrived for treatment following the marathon bombing in 2013.

“The use of tourniquets has been controversial for years, but since the Boston marathon bombing where clearly tourniquets saved lives, it’s becoming better understood that in the right setting, tourniquets can be very effective and lifesaving,’’ he said.

The risk of using a tourniquet and cutting off the blood supply to a limb is that the extremity could be rendered dysfunctional and the patient could lose that limb. But Gupta said that risk is reduced in cities where level one trauma centers are nearby.

“We’re lucky to live in a city like Boston that’s like that,’’ he said. “There are many parts of the country where transport times to a level one trauma center might be six, eight, 10 hours. In which case, the consequence of putting on that tourniquet are far greater. On the other hand, the benefits may be far greater too, because you’re preventing blood loss over a long period of time.’’

Gupta said the best condition for a tourniquet is if the following statement applies: “This patient will not survive if they continue to bleed from this extremity, and I’m willing to take on the consequence of having lost the patient’s leg, so as to save that patient’s life.’’

What is key with tourniquets, according to Gupta, is that there is good training for who needs one, how to apply one, and then making them available.

“Like any other tool that we have in medicine, the tourniquet is an important tool that in the right clinical setting, when used, can really save lives,’’ he said.

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