Each year, emergency rooms across the United States see roughly 70 trauma cases in which a patient arrives at the hospital wearing a tourniquet.
The number is minuscule, given that 2.3 million Americans are hospitalized each year for trauma. But military physicians say more lives would be saved if members of the general public had access to, and knew how to use, tourniquets.
Speaking Wednesday from the Military Health System Research Symposium in Kissimmee, Florida, Defense Department combat trauma experts said the skill should be as widely taught as basic first aid and CPR, especially with mass shootings and terrorist attacks on the rise.
"We are after 'zero preventable deaths' from trauma injury … it's our cancer moon shot. Is it a long stretch? Is it a high goal? Yes, but it's not any different to me than saying we are going to cure cancer in five years," Air Force Col. Todd Rasmussen said.
In the Nov. 13 Paris attacks, 133 of the 484 people who died perished before arriving at a medical facility. Retired Navy Capt. Frank Butler said with most caused by uncontrolled bleeding, there might have been an opportunity for bystanders to help by applying a tourniquet, a specialized dressing to clot the blood or by applying pressure using any available material to a wound.
"There's an obligation to save every single life that can be saved," said Butler, a former Navy SEAL and command surgeon for Special Operations Command. "The U.S. military has made some remarkable advances in the last 15 years and there's an obligation to take some of these advances home to help care for our friends, loved ones and fellow citizens."
A makeshift tourniquet is credited with saving at least one life in the June 12 shootings at an Orlando nightclub. But the military doctors would rather see commercial tourniquets or specialty dressings, which are far more effective than a twisted t-shirt, available in public spaces, near fire extinguishers or automated external defibrillators.
"At this conference, one of our residents is presenting on tourniquet use, having documented almost exactly what we saw on the battlefield. Pre-hospital tourniquets in the civilian world, in everyday civilian trauma, save lives and are much more effective than waiting to put a tourniquet on in the hospital," said retired Army Col. John Holcomb, now at the University of Texas Medical School, Houston.
A study of combat deaths among U.S. special operations forces from 2001 to 2004 showed that 85 percent were not preventable, but of the 12 "potentially preventable" fatalities, half were related to uncontrolled bleeding.
Applying these findings to Paris, as many as 70 deaths may have been preventable if first responders had advanced combat medicine training or bystanders took action to slow bleeding in victims, the military doctors said. The National Academy of Medicine issued a report in Junecalling for the creation of a national trauma system – an integrated emergency medicine system of military and civilian hospitals with physicians and surgeons trained in the most advanced trauma skills.
NAM also recommended advanced training for first responders to ensure that victims receive the best care possible before they reach a hospital.
At the same time the IOM was asked to study the feasibility of an integrated trauma system, the Department of Homeland Security rolled out a "Stop the Bleed" campaign to encourage citizens to learn proper tourniquet techniques and promote the availability of tourniquets in public spaces.
Tourniquet use by non-medical personnel had been discouraged for years in first aid courses for fear that applying a tight band could damage a limb so severely it would need to be amputated.
During and after the Boston Marathon bombing, however, tourniquets were proven to save several lives. Boston police and firefighters now carry tourniquets, with many other cities following suit.
The Red Cross has issued new first aid guidelines on controlling bleeding, recommending that bystanders try to stop hemorrhage first by applying steady pressure, without or without a dressing, for at least five minutes. If the severe bleeding is on an extremity, responders should consider using a tourniquet if available, or, for wounds not on an extremity, a specialty hemostatic dressing that contains a clotting agent.
Two days after the Orlando shootings, the American Medical Association recommended greater training for police officers, first responders and the American public to be trained in use of tourniquets and hemostatic dressings.
Not all emergency medical experts believe that such measures will save as many lives as they have proven to on the battlefield.
A retrospective study of autopsy reports from 12 mass shootings in the U.S. between 1996 and 2012 showed that of 139 deaths, only 7 percent had potentially survivable wounds, and 90 percent of those individuals had chest wounds, which aren't treated with a tourniquet and can be challenging for surgeons in a well-stocked ER to treat.
"The overall and fatal wounding patterns are different from those resulting from combat operations … we discourage the current myopic focus on hemorrhage control for civilians," wrote Dr. Reed Smith, an emergency medical physician at George Washington University in D.C., and his colleagues on the Committee for Tactical Emergency Casualty Care.
Instead, they recommended a different management strategy geared specifically toward civilian crises.
"The overall wounding pattern and specific fatal wounds in civilian public mass shooting events are different than in military combat fatalities," they wrote.
Institute of Medicine researchers estimate that 30,000 lives could be saved in the U.S. each year if the country created a national trauma system and aggressively educated and supplied first responders on cutting edge trauma care techniques.
Holcomb said the report is a "call to arms" -- an effort to ensure that everyone who gets in an accident or is the victim of a crime has a fighting chance.
"We want to get rid of people saying ‘I didn’t know what to do,’" Holcomb said.
"There's been one death in the U.S. from Zika? ... It's not clear to me why the public is not jumping up and down about 1,000 preventable military deaths and 30,000 preventable civilian deaths a year. That qualifies as an epidemic."