How to Use a Tourniquet

A tourniquet is a device that encompasses the arm of the wounded and compresses it to stop blood flow, usually via constricting an artery or vein.
A tourniquet should only be used when there is severe bleeding and immediate medical attention cannot be provided by other means. A well-applied tourniquet can save lives in certain situations, but if not done properly will cause more harm than good, such as loss of limb.

Note from the editor: This is a guest post by Bruce A. West. Mr. West was a doctor in the Army during the Iraq war. In a program called Combat Lifesaver, he taught over 500 troops how to save lives, and he’ll be sharing his experience here on AoM in a series on vital first aid/first responder skills that every guy should have.

When a mountain lion jumps out of the woods, leaps upon your pal, and sinks its fangs into his thigh, you’re strolling down a path with your partner. You take out your pocket knife and stab the cat, which causes it to flee. Your friend’s leg is a mangled mess that’s dripping blood. Do you know what to do when you’re miles away from civilization?

Basic emergency medical skills are essential for surviving the dangers you may face in the wild–or even in your own garden. There are several schools that teach first aid, but few are as good at keeping it SIMPLE as the Combat Medic. Sure, contemporary physicians have sophisticated equipment in their packs, and they utilize it–but what they can do in the absence of these instruments is what a man should know for survival.

You won’t have significant trauma equipment in the woods, beside a road, or in the aftermath of a natural or man-made tragedy. You’ll have little more than a first-aid kit, the clothes on your back, and whatever else is accessible in the surroundings. But if you know how to improvise, you’ll have everything you need. These methods aren’t taught in school. They do not adhere to all of the guidelines. They’re the battle-tested survival tactics that line medics have handed down through the centuries. They’re quick. They’re straightforward. They also save lives.

One of these abilities is the ability to regulate substantial blood loss without the need of specialized equipment. And it’s something that every male, military or citizen, should be aware of. Today, I’ll give you a crash course in this life-saving skill.

Your Blood Loss Containment Strategy

If you’re with anybody else than the victim, have them phone 911. If it’s only you and the victim, put a halt to the victim’s bleeding before calling 911. Follow these methods to stop the bleeding:

Step 1: Make sure your surroundings are safe, and wear gloves to protect yourself.

Put on some rubber gloves to protect yourself against immunodeficiency disorders (and any other infections). Because of the possibility of allergies, I would recommend investing a few dollars extra on powder-free, latex-free gloves for your vehicle or first-aid box. Nitrile gloves are the most prevalent gloves used in today’s EMS. They’re inexpensive, and they’ll fit well in your car’s…glove box (at long last, it’ll live up to its name!). Gloves aren’t likely to enrage the individuals you’re helping, so use them for ALL victims.

Step 2: Make the open wound visible.

 

“A cheerful trauma patient is a naked trauma patient,” we say in emergency care. If you can’t see what’s wrong with them, you’ll never know.

Remove any clothes that is covering the injury. It’s simple: rip the trouser leg or shirt sleeve out of the way. If their garments are too tough to tear by hand, use your knife to begin the cut.

Step 3: Press firmly and directly on the wound.

If gauze is available, apply it to the wound during this stage. If you don’t have any gauze, try a towel, washcloth, or a rag ripped from a shirt instead. Unless you’re in an emergency circumstance, such as the patient is bleeding profusely or you’re far from civilization, try to avoid using this homemade treatment. Non-sterile bandages may spread illness further–but bear in mind that if you’re five miles from anybody, it’s better to confine the wound with a few bacteria than to leave it open to all germs.

You will need to apply a tourniquet if the pressure does not stop the bleeding and the dressing gets wet with blood.

Wait! Is it safe to use tourniquets?

Before we go on to the next phase, I believe it’s important to talk about tourniquet safety, since a lot of what you think you know about bleeding control is probably obsolete. For decades, traditional emergency medical services (EMS) used a six-step process to stop bleeding. The tourniquet was considered the “nuclear option,” and it was only used as a last resort to halt bleeding. The tourniquet was disliked because it was thought that by totally restricting blood flow to a limb, tissue surrounding the limb would die, forcing the patient to have their leg amputated. Unfortunately, many lost more blood, and even their lives, than was required by following standard bleeding control techniques and leaving tourniquets as a last option.

How to apply tourniquet illustration.

In contrast to civilian EMS, military medicine has long advocated for the use of tourniquets considerably sooner in the management of blood loss. According to recent study conducted in military hospitals in Iraq and Afghanistan, applying a tourniquet does not ensure limb amputation or even nerve damage, contrary to common assumption. In reality, researchers discovered that just 0.4 percent of patients who had a tourniquet placed to a leg before arriving at the hospital had their limb amputated, and that the cause for the amputation was largely unrelated to the tourniquet. On the subject of nerve injury, just 1.5 percent of tourniquetted patients had any form of persistent nerve damage. Many civilian EMS trainers and practitioners are beginning to promote tourniquet usage much earlier as a result of this emerging understanding.

Muscle tissue necrosis does not occur until 2 hours without blood flow, and it may persist up to 5-8 hours without causing amputation; thus, you can leave the tourniquet on for a while–but you should get the victim aid as quickly as possible.

 

Let’s go on to selecting and applying the tourniquet now that you’ve gotten that FYI out of the way.

Step 4: Pick a tourniquet to use.

All troops in today’s military are supplied tourniquets in addition to their armor and weaponry, and every soldier is trained and adept at putting his tourniquet–even on his own arm–one-handed. The Combat Action Tourniquet (CAT tourniquet) is a single-handed tourniquet used by the army; it costs roughly $30 and isn’t practicable for a civilian to carry around in his pocket every day.

Fortunately, saving a life does not need the use of a specialized tourniquet. Look about you; tourniquets are strewn throughout. Do you have a belt on? Tourniquet! Do your shoes have laces? Tourniquet! A female observer’s brassiere, a long sleeve shirt, a bicycle inner tube, a backpack strap, or a long sleeve shirt? Tourniquets, tourniquets, tourniquets! This lifesaving gadget can be made out of whatever your imagination can conjure up as a tourniquet. (If you have rope or a survival bracelet on hand, you may want to start there.)

You’ll also need a torsion device to tighten your tourniquet. Anything long and stick-like would suffice. I suggest using a stick if you’re in the woods. If there are no sticks or stick-like things in the area, seal your knife’s blade or cover it with a sheet and donate it to a worthy cause. It’s now up to you to use the torsion device.

Step 5: Place the tourniquet around your neck.

To begin, let’s make sure we’re all on the same page: Only limbs are subjected to tourniquets! Never on a person’s neck! (You wouldn’t be the first to do this.) Major bleeding control techniques in locations not accessible by tourniquets (such as the stomach and back) will be discussed in more detail at a later date. Now that that’s out of the way, here’s how to apply a tourniquet:

How to apply tourniquet wrap limb with rope belt illustration.

Wrap a rope/belt/bra around the limb that is at least two inches closer to the body than the wound. Applying a tourniquet across a joint will never exert pressure on the arteries since the blood passages are protected in joints. It should be placed nearer to the body than the joint. Then, using an overhand knot, secure the tourniquet in place.

How to apply tourniquet overhand illustration.

On top of the overhand knot, place your appropriate torsion device. To bind the torsion device onto the tourniquet, tie another overhand knot, then another (or a square knot if you’re a knot expert).

Twisting the torsion device in one direction until bleeding stops illustration.

To halt bleeding, twist the torsion device in one way.

Securing the tourniquet on knee illustration.

Place the tourniquet in its proper position. This is frequently performed by tying one end of the torsion device to the tightened tourniquet or to the limb using the loose ends from your previous knot.

Step 6: Check for signs of shock.

So you’ve used a tourniquet to keep this individual from bleeding to death. They haven’t returned home yet. Check to see whether they are still breathing. It may seem self-evident, yet failing to do so will result in the waste of a tourniquet. Look, listen, and feel is an aphorism you’ve undoubtedly heard before. Place your ear near their lips and listen for and feel for breathing while checking their chest for rises and falls. Make it if it doesn’t exist. This is where CPR is performed. But that’s a topic for another time.

 

Check for indications of shock once you’ve confirmed that your patient is still breathing. If you put a tourniquet on the patient, they’ll almost certainly go into hypovolemic shock. Don’t be alarmed; it’s a large term that really means “too little volume.” They’ve just given up a significant amount of blood volume, so it’s a given–though not a certainty. Hypovolemic shock may be identified by the following symptoms:

  • Skin that is cold and clammy (moist, cool, and pale skin)
  • Cyanosis is a condition that affects people (big word, but it means blue skin)
  • Weakness
  • Confusion
  • Breathing quickly
  • Unconsciousness

First, lie the patient flat on his back to treat shock. You may have learnt to raise their feet in the past–forget about it! According to research, this may result in blood collecting in the organs and brain, as well as other complications. Next, keep the victim warm by covering them with blankets, jackets, and garments, or anything else you have on hand–just keep them warm! (The ancient hypothermia trick of huddling for warmth may also be used here.)

Step 7: Call 911 right now if you haven’t already.

If rescue personnel are unable to reach you or there is no phone service, never leave the victim alone to seek assistance–grab them and flee. Prepare to do a fireman’s carry.

Congratulations! You’ve just learned how to save a life! Go forth into the world with the knowledge that you can contribute to making it a safer place.

Disclaimer: While this lecture is instructive, it does not replace the important experience of completing a first-aid course with the American Red Cross. It is highly advised that you schedule a class with your local Red Cross representative to get certified. Take CPR as well while you’re at it! When you’ve had the chance to put your lifesaving skills to use, you’ll seldom regret it.