How and when to use a tourniquet: instructions for creating and using a tourniquet

By Cristiano Antonino On Jun 11, 2022

About tourniquet: Tourniquets are tight bands used to completely stop the blood flow to a wound

To control bleeding after an injury to a limb, tourniquets should ideally only be used by first responders trained in emergency first aid.

Knowing when (and when not) to use a tourniquet to control bleeding can be difficult to ascertain.

FIRST AID TRAINING? VISIT THE DMC DINAS MEDICAL CONSULTANTS BOOTH AT EMERGENCY EXPO

Tourniquet: When to Use

Even when used properly, complications from tourniquet can lead to severe tissue damage.

However, in the case of severe bleeding and life-or-death emergencies, properly using a tourniquet is an effective way to stop bleeding and keep an injured person stable until they can receive proper medical attention.1

Emergency scenarios that could require a civilian to use a tourniquet include car accidents, gunshot wounds, deep cuts, or a crushed limb related to a work injury.

Most people will never find themselves in a situation requiring the use of a commercial tourniquet.

Still, if you ever find yourself in one of these situations, knowing how to properly use a tourniquet could potentially save someone’s life.

THE RADIO OF THE WORLD’S RESCUERS? VISIT THE RADIO EMS BOOTH AT EMERGENCY EXPO

Materials for improvised tourniquets

If you are a first responder or emergency medical professional, you’ll likely have access to commercials tourniquets.

If you’re a civilian who has happened across an emergency scenario, however, you are not likely to have a tourniquet available and will need to improvise.

Research has shown that improvised tourniquets are effective up to 60% of the time.2

While that may not sound reassuring, as long as you have the required materials and knowledge to use an improvised tourniquet correctly in an emergency situation, any attempt to stop the bleeding will likely be better than doing nothing.

To assemble an improvised tourniquet, you will need two parts: a triangular bandage and something you can use as a windlass, such as a stick.

Other items you may have on hand that can be used include belts, shirts, or towels.

In an emergency situation, but especially those involving body fluids such as blood, be sure to practice universal precautions.

If personal protective equipment is available, don it before you begin providing first aid.

Procedure

Anyone can apply a tourniquet.

While you do not need any official or special medical certification or training, you do need to understand how to properly use one.

The first step you need to take in any emergency is calling Emergency Number to alert emergency services.

If someone else is with you, delegate the task of making the Emergency Number call to them while you attend to the injured person.

Using a tourniquet is only meant as a stop-gap measure to buy time while you wait for medical personnel to arrive.

If a person is bleeding profusely and help is not nearby, they may bleed out before first responders can arrive and provide necessary medical care.

By applying a tourniquet, your goal is to restrict blood flow to the injured limb to prevent life-threatening blood loss.

While constricting the limb to cut off its blood supply is a temporary measure, when done correctly it will slow or stop the bleeding enough to allow emergency responders time to arrive at the scene.

Find the Source

Before you apply tourniquets, you need to determine the source of the bleed.

In some cases, such as near or complete limb amputation, it may be obvious.

Other injuries may not be visible at first, especially if there is debris, wreckage, tattered clothing, or other objects obstructing your view.

If possible, have the injured person lay down so you can assess them from head to toe.

Try to stay calm and focused, as you will need to find the source of the bleeding as quickly as you can.

Apply Pressure

Once you have determined the source, start by applying direct pressure to the wound to control the bleeding.

If the bleeding fails to slow or stop when pressure is applied, you will need to find (or fasten) a tourniquet.

If the injured person is conscious and alert, tell them that you will be applying a tourniquet to their injury.

Unfortunately, the process of applying a tourniquet may be extremely painful, and the person is likely already in a great deal of pain.

Let the person know that applying the tourniquet will hurt but that it may save the limb, if not their life.

Next, cut, tear, or otherwise remove any clothing near the wound. The tourniquet needs to be applied to bare skin.

Position the Tourniquet

Position the cloth, towel, or other material to be used for the tourniquet on the limb several inches above the injury.

You will want to position the tourniquet at the part of the limb that is closest to the heart.

For example, if the injury is below the knee or elbow, you will need to tie the tourniquet above the joint.

Use a common square knot (like tying your shoelaces, but without making a bow) to tie the tourniquet around the limb.

Add a Windlass

You will need a stick or other item strong enough to act as a windlass.

A windlass is a lever that can be used to twist the tourniquet tighter.

Anything can be used as a windlass, as long as it is strong enough to hold the tourniquet and can be secured in place.

Consider using pens or pencils, sticks, or spoons.

Place your windlass on the knot you’ve made, then tie the loose ends of the tourniquet around it using another square knot.

Tighten

Begin twisting the windlass to increase the pressure.

Keep an eye on the bleeding and make note of when it begins to slow.

Continue turning the windlass until all the bleeding has stopped or is significantly reduced.

Once the bleeding has slowed or stopped, secure the windlass by tying one or both ends to the injured person’s arm or leg.

Time It

Tourniquets can only be applied for certain periods of time—no longer than two hours.4

Therefore, it will be very important for first responders and medical staff who treat the injury to know when you applied the tourniquet.

If possible, mark a “T” with the date and time you placed the tourniquet on the person’s forehead or another area highly visible to emergency personnel.

Tourniquet, Common Mistakes

Even if you know how to properly use tourniquets, it’s possible to make errors.

In an emergency, you may not have enough help or resources, and you will likely face many distractions.

The following are potential errors to be aware of when applying a tourniquet:

Waiting too long: You must address severe bleeding immediately for a tourniquet to be successful. When an injured person loses too much blood, they may go into shock.
Loose application: Loose tourniquets are not effective as they fail to sufficiently constrict arterial blood flow.
Not applying a second tourniquet: One tourniquet is usually enough to control severe bleeding, however, a person with large arms may require a second tourniquet.
Loosening: Constricting and loosening the tourniquet rather than continually constricting allows blood to reenter to the injury. If blood flows back to the injury, it can damage the blood vessels.
Leaving on too long: A tourniquet should not be left for longer than two hours. When applied for a longer time, tourniquets can cause permanent damage to muscles, nerves, and blood vessels.4
Using the wrong materials: Inappropriate materials, such as a cord, can cut into the skin. Not only does this render the tourniquet ineffective it can also cause more pain or result in further injury.

The best way to prevent mistakes is to be informed about how to use a tourniquet and practice the proper technique for applying one.

Tourniquets in First Aid Kits

A 2018 study, reported in the Journal of American College of Surgeons, confirmed that tourniquets can, and do, save lives—even when applied by civilians.

For the study, researchers sought to determine the effect civilian use of tourniquets had on mortality.5

When civilians performed prehospital tourniquet application, the risk for mortality was six times less in patients with peripheral vascular injuries (blunt trauma to the extremities).

While they do work in an emergency, commercial tourniquets are not available in first aid kits.

This is mainly because tourniquets should only be used in worst-case scenarios when there are no other options, as there are usually other ways to sufficiently control bleeding in most injuries.

However, in an emergency situation, a commercial tourniquet would be preferable to one that is improvised.

Commercial-use tourniquets are made from recommended materials and specifications, making them the most effective as well as easier to use.

Commercial tourniquets are also better suited to minimizing risk when using one.

You can add a tourniquet to your home first aid kit, as the items typically included in these kits may not be enough to help in the case of severe bleeding.

If you work with or care for those at the highest risk of a bleeding injury or complications from severe bleeding, such as young children and the elderly, you should have an available tourniquet and the knowledge to properly use one.

Whether you are a medical professional, first responder, student, or parent, knowing how to use a tourniquet can be a life-saving skill.