A tourniquet is a device designed to stop blood flow completely to an arm or leg, making it a powerful tool in emergency medicine. This intervention is reserved strictly for catastrophic, life-threatening hemorrhage from an extremity that cannot be controlled by direct pressure. Improvised methods, such as using a belt, are significantly less reliable than purpose-built commercial tourniquets. However, they can be a necessary measure of last resort to prevent death from exsanguination.
Identifying the Need and Proper Anatomical Placement
The decision to apply a tourniquet must be based on a clear and immediate danger to life, such as massive external bleeding that is spurting or pooling rapidly. A tourniquet is indicated only when firm direct pressure fails to stop the blood loss. It is also necessary if the injury, such as a traumatic amputation, makes direct pressure impossible to sustain. In mass casualty scenarios, a tourniquet allows a single rescuer to quickly control one patient’s bleeding to move on to others.
The placement of the constricting band is critical for effectiveness and minimizing potential tissue damage. The guideline for rapid application is “high and tight,” meaning the tourniquet is placed as high as possible on the limb, close to the torso. If time permits and the wound is visible, a more precise placement is two to three inches above the wound site, positioned between the injury and the patient’s heart.
Crucially, the tourniquet must never be placed directly over a joint, such as the elbow or the knee. The underlying bone structure prevents the necessary compression of the major arteries in these areas. The primary goal is to achieve total arterial occlusion, stopping the high-pressure flow of blood from the heart to the limb. If the device is not tight enough, it may only stop the lower-pressure venous return, which worsens bleeding by trapping blood below the application site.
Step-by-Step Guide to Improvised Tourniquet Application
To create an improvised tourniquet using a belt, you require two components: a sturdy leather or nylon belt for the constricting band and a rigid object to serve as the windlass. The windlass can be a strong stick, a metal rod, or a substantial closed folding knife. It must be robust enough to withstand significant twisting force without breaking. Because a standard belt is rigid, the mechanical advantage of the windlass is necessary to create sufficient pressure.
First, unbuckle the belt entirely and thread it around the injured limb at the selected placement site. This site should be either high on the limb or two to three inches above the wound. Secure the belt as tightly as possible by pulling the free end through the buckle, but do not use the buckle to achieve final pressure. Next, tie a simple overhand knot, or a half-knot, and lay the rigid windlass object directly over the knot.
A second knot is then tied over the windlass object to secure it against the belt material. This process creates a loop connecting the windlass to the constricting band. The windlass is then twisted firmly in one direction, rapidly increasing the circumferential pressure on the limb.
Continue twisting until the bright red arterial bleeding stops completely, which may require multiple full rotations. This twisting action will be noticeably painful, which is an expected consequence of achieving full arterial occlusion. To prevent the windlass from unwinding and releasing pressure, secure it immediately. This can be done by tucking one end of the stick beneath the belt or by using a secondary piece of material, such as tape, to bind the windlass to the belt.
Critical Post-Application Management and Transfer of Care
After the improvised tourniquet is successfully applied, verify its effectiveness by confirming the bleeding has ceased. A secondary check involves attempting to feel for a pulse in the limb below the tourniquet; if successful, this distal pulse should be absent. If bleeding continues, apply a second improvised tourniquet immediately above the first one, and tighten the windlass until the flow stops.
A time-stamp is vital information for medical professionals. Use a permanent marker to write the exact time of application directly onto the belt or visibly onto the patient’s skin, such as the forehead. This time informs subsequent medical staff how long the tissue has been deprived of oxygen. This information influences decisions regarding limb salvage and treatment for potential reperfusion injury.
The absolute rule of post-application management is to never loosen or remove the tourniquet once bleeding is controlled. Loosening the device, even briefly, can lead to dangerous blood loss or the sudden release of built-up toxins into the bloodstream. The improvised tourniquet is a temporary, life-saving measure that causes tissue damage over time. It should only be removed or converted to another form of hemorrhage control by trained medical personnel in a controlled environment. Immediate contact with emergency services is mandatory to ensure the patient receives advanced care quickly.