A tourniquet is a device designed to apply pressure to a limb, stopping severe blood loss from an injury. Its primary purpose is to control life-threatening hemorrhage, especially in emergency situations where immediate medical help may not be available.
When to Use a Tourniquet
A tourniquet is reserved for situations involving severe, uncontrollable bleeding from an arm or leg. This includes instances where direct pressure, the initial method for bleeding control, fails to stop the blood flow after several minutes. Scenarios such as traumatic amputations, where a limb is partially or completely severed, or arterial bleeding, characterized by spurting or pulsating blood, warrant immediate consideration of a tourniquet. It helps buy time until professional medical care arrives. However, it should only be used on limb injuries and not for wounds on the head or torso.
Applying a Tourniquet Step-by-Step
When applying a commercial tourniquet, first ensure the injured person is lying down if possible and clear any clothing from around the wound to expose the skin. Position the tourniquet two to three inches above the bleeding site, between the wound and the heart. Avoid placing it directly over a joint, such as an elbow or knee, as this can cause nerve or blood vessel damage and reduce effectiveness.
Thread the strap through the buckle and pull it as tightly as possible around the limb. For many commercial tourniquets, this involves pulling the self-adhering band until it is snug. Next, twist the windlass rod until the bleeding stops completely or is significantly reduced. You should not be able to feel a pulse below the tourniquet once it is adequately tightened.
Once the bleeding has stopped, secure the windlass rod in its clip or locking mechanism to prevent it from unwinding. Some tourniquets also have a strap to further secure the rod. While applying, inform the injured person that the process will be painful, as this is expected and necessary for the tourniquet to function properly.
After Tourniquet Application
Once the tourniquet is successfully applied and bleeding has stopped, it is important to immediately note the time of application. This information is crucial for medical professionals, as it helps them assess how long the limb has been without adequate blood flow. You can write the time directly on the tourniquet itself or on the injured person’s forehead with a permanent marker.
After marking the time, promptly call emergency services (such as 911 or your local equivalent) to ensure professional medical help is en route. It is important not to loosen or remove the tourniquet once it has been applied. Only trained medical professionals should remove it in a controlled environment, as premature removal can lead to a dangerous surge of blood back into the injured area or release toxins into the bloodstream. While waiting for help, continue to monitor the injured person and ensure the tourniquet remains effective.
Mistakes to Avoid
A common mistake is not tightening the tourniquet enough, which can prevent it from effectively stopping arterial blood flow and may even worsen bleeding by obstructing venous return. Tourniquets should be placed on bare skin if possible, as applying them over thick clothing might prevent proper compression.
Using improvised materials that are too narrow, like rope or shoelaces, can also be problematic. Such materials may cut into the skin and cause nerve damage without effectively stopping the bleed. Hesitation in applying a tourniquet when faced with severe, life-threatening bleeding is a significant mistake, as rapid blood loss can quickly lead to shock.