A tourniquet is a medical device designed to halt massive hemorrhage from an extremity, and an improvised version is strictly a measure of last resort. This technique is only appropriate when a commercial tourniquet is unavailable and the bleeding is life-threatening and uncontrollable by direct pressure alone. Since rapid blood loss can lead to death within minutes, application is paramount, despite the potential for tissue and nerve damage associated with any tourniquet use.
Recognizing the Need and Proper Placement
The decision to apply a tourniquet is reserved for situations involving profuse, uncontrollable bleeding from a limb, often characterized by blood spurting or rapidly soaking through bandages and clothing. If direct pressure has failed to stop the hemorrhage, or if blood loss indicates a major arterial injury, applying a tourniquet is the correct choice to preserve life. The device works by applying circumferential pressure to the limb, compressing the arteries and temporarily stopping blood flow beyond that point.
Correct placement is a defining factor in the success of the intervention. The tourniquet must be applied high on the limb, positioned at least two to three inches above the wound and closer to the torso. Placing the device over a major joint, such as the elbow or knee, should be avoided because the underlying anatomy protects the blood vessels from compression, rendering the tourniquet ineffective. Ideally, the tourniquet is applied directly to the skin, but in an emergency, it can be placed over clothing.
Selecting and Preparing Improvised Materials
An improvised tourniquet requires two functional components: a constricting band and a windlass mechanism. The band must be a non-elastic material, such as a sturdy strip of cloth, a scarf, or a folded triangular bandage, and it should be at least one-and-a-half to two inches wide. Using a band that is too narrow, like a cord or wire, concentrates pressure on a small area, which can lead to severe nerve and tissue damage without effectively stopping arterial flow.
The windlass is the rigid object used to twist the band and apply the necessary constricting force. Suitable options include a strong stick, a closed pocket knife, or a stout metal rod, all of which must be sturdy enough not to break under the immense pressure required. Thin items like pencils or weak twigs are not recommended because they are likely to snap before achieving adequate tension.
Step-by-Step Application for Severe Bleeding Control
The first step involves tying the constricting band tightly around the limb, positioning it two to three inches above the bleeding site. After the initial wrap, tie a half-knot, place the rigid windlass object directly on top of it, and then tie a second half-knot over the windlass to secure it against the band.
With the windlass secured, the operator begins twisting the rigid object in one direction, rapidly increasing the circumferential pressure on the limb. This twisting action must continue until the hemorrhage completely stops, confirming the pressure is sufficient to occlude the underlying artery. This necessary level of tightness will cause significant pain, but it is required to save the patient’s life.
Once the bleeding is controlled, the windlass must be prevented from unwinding, which would immediately release the pressure. Secure the windlass in place, typically by tying the remaining ends of the cloth band or using a separate piece of material or tape to lock the windlass against the limb. The effectiveness of the improvised device hinges entirely on this windlass mechanism.
Immediate Actions After Application
Following the successful application of the improvised tourniquet, two immediate actions are required. First, the exact time of application must be recorded. This time is vital data for medical professionals to assess the duration of restricted blood flow and manage the risk of tissue damage.
The time should be clearly marked with a permanent marker directly onto the patient’s skin, often on the forehead or the limb itself, or conspicuously on the tourniquet. Second, the patient must be transported for professional medical care without delay. Under no circumstances should the tourniquet be loosened or removed by a non-professional, even if the bleeding has stopped, as this could cause severe reperfusion injury or a catastrophic re-bleed.