A tourniquet is a medical device designed to compress a limb to halt blood flow completely in cases of severe trauma. This strap or band is used exclusively on arms or legs to control massive bleeding that other methods cannot stop. Its purpose is to achieve total occlusion of arterial blood flow. Applying a tourniquet is an emergency measure, considered a last-resort intervention when direct pressure is ineffective or impractical to sustain. This action is taken when blood loss is so rapid that waiting for professional medical help would be fatal.
Recognizing the Need for a Tourniquet
The decision to apply a tourniquet rests on identifying signs of a true life-threatening hemorrhage from a limb. A primary indicator is blood that is spurting or pulsing from the wound, often bright red, suggesting an arterial injury with significant pressure. Another clear sign is bleeding that continues profusely despite the sustained application of direct pressure. This uncontrolled flow means the body is losing blood too quickly to wait.
A tourniquet is appropriate when the injury involves a partial or complete traumatic amputation of the arm, as this level of damage almost always results in catastrophic bleeding. Remember that this device is for use only on a limb and cannot be used for injuries to the head or torso. The goal is to stop the flow of blood to the limb entirely to prevent the patient from progressing into hypovolemic shock.
Step-by-Step Application on the Upper Arm
Once the need is established, the tourniquet must be applied to the upper arm. Position the tourniquet on the bare skin, if possible, by pushing or cutting away any clothing. Place the device high up on the arm, approximately two to three inches above the wound, ensuring it is positioned between the injury and the torso. Avoid placing the tourniquet directly over a joint, such as the elbow, as this placement may not provide the necessary pressure to occlude the artery.
Route the tourniquet strap around the limb and pass the end through the buckle, pulling the strap as tightly as you can to remove all slack. The strap should be so snug that you cannot fit your fingertips underneath it. Secure the strap back on itself using the Velcro or fastening mechanism. This initial tightening provides a foundation for the next step.
The next action involves using the windlass rod, which is the rotating mechanism on commercial tourniquets. Twist the rod in one direction, which will cinch the band down on the arm, increasing the pressure. Continue twisting the windlass until the bright red, life-threatening bleeding completely stops. You may also check for a pulse farther down the arm, which should be eliminated when the tourniquet is properly applied.
After the bleeding has stopped, the windlass rod must be secured immediately to prevent it from unwinding and releasing the pressure. Lock the rod into the designated clip or holder on the device to maintain the necessary tension. Finally, secure the rod and the clip with the strap or time-writing band, ensuring the entire mechanism remains locked in place.
Critical Post-Application Steps
Immediately after securing the tourniquet, perform a check to confirm that the hemorrhage is fully controlled and that no bright red blood is escaping the wound. If the bleeding continues, a second tourniquet should be applied directly above the first one and tightened until the flow stops. Once the bleeding has completely stopped, the next step is to document the time of application.
Use a permanent marker to write the exact time the tourniquet was applied directly onto the device itself, or on the patient’s forehead if the device does not have a designated writing strap. This time stamp is important because medical professionals need to know how long the blood flow has been restricted. The tourniquet should never be covered, as it must remain clearly visible to all responding medical personnel.
Do not loosen or remove the tourniquet once it has been applied and bleeding is controlled, even if the patient is experiencing pain. Only a trained healthcare professional in a medical setting should make the decision to remove or adjust the device. The patient requires immediate transport to a hospital, as extended application carries a risk of tissue damage.