A failure to stop life-threatening bleeding with an initial tourniquet application signals an immediate medical emergency requiring a rapid, systematic response. The priority remains the absolute cessation of blood flow to prevent the patient from progressing into hypovolemic shock. Losing a significant percentage of blood volume, which can occur rapidly with a major arterial injury, leads to the body’s systems failing due to inadequate oxygen delivery. A failed initial attempt requires focused, sequential troubleshooting before escalating to a second device.
Assessing the First Tourniquet Application
The most common reasons a professional-grade tourniquet fails are insufficient tightness or improper placement. Before applying a second device, quickly evaluate the first tourniquet to ensure it has been applied with maximum effort. The windlass mechanism must be twisted until the bleeding stops completely or until it can no longer be turned further. If the tourniquet is loose enough to allow a finger underneath the strap, it has not been adequately tightened.
Another frequent error is applying the device over bulky clothing or too close to a joint, which prevents necessary circumferential pressure. The tourniquet should be placed on bare skin or over a single layer of clothing, two to three inches above the wound, between the injury and the torso. If the wound location is unclear, the device should be placed as high on the limb as possible, near the armpit or groin (“high and tight”). If the initial device was placed incorrectly, such as over a joint, it must be adjusted or tightened to its maximum capability before applying a second one.
Proper Placement of a Second Tourniquet
If the first tourniquet has been checked for maximum tightness and correct placement, but massive bleeding continues, a second device must be applied immediately. A second tourniquet is necessary when the initial pressure is insufficient to overcome blood pressure in a large or muscular limb. This second tourniquet must be placed proximal to the first one, meaning closer to the patient’s torso or heart.
The second device should be placed directly adjacent to the first tourniquet, or two to three inches above it, creating a wider band of compression. This “stacking” technique ensures the cumulative pressure is high enough to completely occlude arterial blood flow. Both tourniquets must be tightened until the bleeding stops completely, which is the definitive sign of successful application. Neither device should be loosened or removed once bleeding is controlled, as this could restart the hemorrhage and must only be performed by a medical professional.
Ongoing Patient Care Until Medical Arrival
Once bleeding is completely controlled, the focus shifts to managing the patient while awaiting professional medical care. The most important information to record is the time of the tourniquet application. This time must be written clearly on the tourniquet strap, the patient’s forehead, or the limb itself, as it is critical data for hospital staff.
The patient must be continuously monitored for signs of hemorrhagic shock, including pale, cold, and clammy skin, a rapid pulse, or an altered mental state. Preventing hypothermia is a high priority because a drop in core body temperature interferes with the body’s ability to clot blood. Covering the patient with blankets or clothing helps maintain body heat and prevents the development of the lethal triad (hypothermia, acidosis, and coagulopathy). Continually reassess the wound site to ensure bleeding does not restart until the patient is handed over to emergency medical services.