Tourniquets-The when, why, and how

Tourniquets have been used in the medical profession for hundreds of years. The Roman Empire is said to have used tourniquets in conjunction with amputation. The tourniquet has seen a significant increase in use during the last 17 years with the War on Terror. With the increased use there is a better understanding of how effective they are and why they are now more accepted than before.

Tourniquets are used to stop life threatening arterial bleeding of the limbs. Tourniquets are best used when there is spurting blood, a large pool of blood, the scene is considered to be unsafe, there are multiple traumatic injuries, multiple people with life-threatening injuries, and/or the wound is inaccessible due to being trapped.

Tourniquets should not be removed except when the patient has arrived at emergency department and only then when the doctor is prepared to deal with the injury. Tourniquets can be left on a patient for upwards of 2 hours with little to no damage to the limb.

What kind of incidents can create such trauma? Cycling accidents, falls from ledges, motor vehicle collisions, crushing incidents, and gunshots to name a few.

Most tourniquets are of similar design. They consist of a band/strap and tensioner. Two of the most used are the Tactical Medical Solutions SOF Tourniquet and the Combat Application Tourniquet (C.A.T.).

Some are elastic like the SWAT-T Tourniquet. This has a unique design so that as you stretch to appropriate tightness, the oval designs become circles. Once you get to the end of the SWAT-T, you tuck the tail under a previously wrapped layer.

There is also ratcheting tourniquets such as the Ratcheting Medical Tourniquet. They have two designs based on approximate weight. One for below 120 lbs and one for over 120 lbs. 

Tourniquets can also be improvised with belts, straps, etc..

To use the SOF Tourniquet you can slip the tourniquet over the wounded limb or you may disconnect the strap and feed it under and around the limb. Then re-secure the strap to the buckle. Pull the strap tight. Make sure to remove as much slack as possible.

Turn the windlass until the blood stops flowing. Secure the windlass with the clip and then tuck into the triangular lock.

Mark the time on the tag the tourniquet was applied.

To use the C.A.T. you can slip the tourniquet over the wounded limb or you may undue the strap from the single routing buckle. You can then feed it under and around the limb. Pull the strap tight. Make sure to remove as much slack as possible. Secure the strap with the Velcro.

Turn the windlass until the blood stops flowing. Secure the windlass with the clip.

Mark the time on the tag the tourniquet was applied.

To improvise a tourniquet you will need a material pliable enough to wrap around the limb and allow there to be exsanguination. Leather belts can be difficult at times to be flexible enough to stop blood. You can use shirts, pants, tent material, camping hammocks, rope (last resort), etc.. The suggested width is 2-4” wide. 

You will need a windlass to tighten the material. Many items can be used as a windlass. Carabiners, hearty sticks (not rotten & brittle), and tools (screw drivers, wrenches, etc).

You will also need to find a way to secure the windlass from unraveling. Tape (duct, electrical, and medical), rope, clothing material, hair ties, rubber bands, etc all can work to keep the windlass from coming undone.

To use the improvised tourniquet you can slip the material over and around the wounded limb. Make a knot to secure the material encircling the limb. Insert improvised windlass. Turn the windlass until the blood stops flowing. Secure windlass.

Mark the time on the tourniquet or patient when tourniquet was applied.

Closing points. 

• Remember to never cover a tourniquet by tape or bandage. By doing so you could keep the tourniquet from easily being recognized and appropriate care provided.
• Don’t be afraid to use a second tourniquet if you have tightened the first and you have not stopped the hemorrhaging. This can happen with people who have a lower limb injury to the leg and they have larger thighs. 
• Don’t let the victim’s pain dictate the tourniquets application. 
• Tourniquets should be placed 2-3 inches above the wound or above the nearest joint. In some circumstances high and tight to the groin or into the armpit is best. 
• If you are treating for a traumatic injury with significant blood loss do not forget to begin to watch for shock and loss of body heat. Cover the victim with blankets and attempt to place something between them and the ground to keep them from losing heat. 
• If treating a victim in the wilderness with this significant of trauma, your next steps is to begin planning an evacuation. 
• Practice putting a tourniquet on a friend. DO NOT TIGHTEN FULLY AS IT MAY CAUSE INJURY. Have them move around a bit. Putting a tourniquet on may not be to a lifeless body. If they are alert and in severe pain they will not sit still while you are attempting to provide aid. 
• Practice applying the tourniquet to yourself on a leg and arm. DO NOT TIGHTEN FULLY AS MAY CAUSE INJURY.

Tourniquets are life saving devices.  You should keep one with you when venturing into the wilderness. Due to the world we live in I keep one in my vehicle and with my person all times. If you are in need of a tourniquet please visit our store and place an order. 

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