A life-threatening hemorrhage from a limb requires immediate action, and a professionally manufactured tourniquet is the standard tool for this intervention. The purpose of the tourniquet is to completely occlude arterial blood flow to the injured extremity. If the severe bleeding persists after applying the first tourniquet, you must use a rapid, systematic approach to correct the application failure. Recognizing that the initial attempt has failed is the first step toward achieving total hemorrhage control.
Primary Correction: Inspecting and Retightening
The most common reasons a tourniquet fails are insufficient tightening or improper placement on the limb. Your first response must be a quick, focused assessment of the existing application. Check the placement to ensure the tourniquet is not positioned directly over a joint, such as the elbow or knee, which prevents effective compression. Also, ensure the device is not applied over bulky objects in clothing, like a wallet or a thick seam, which can distribute pressure unevenly.
If the tourniquet was applied over clothing, it is recommended to move it directly onto the skin two to three inches above the wound. If the injury is high on the limb, the tourniquet must be placed as high up as possible on the arm or leg, near the armpit or groin. Once placement is confirmed, the immediate priority is correcting the tightness. You must immediately twist the windlass or continue to pull the strap until the bleeding stops completely.
The necessary tightening is intense and will cause considerable pain for the injured person. This pain is a direct indication that you are achieving the pressure required to overcome the patient’s systolic blood pressure. Continue tightening until the flow of blood ceases entirely, regardless of the patient’s reaction to the pain. Confirmation of a successful application is the complete cessation of all bleeding and the absence of a pulse below the tourniquet. If bleeding is reduced but not stopped, or if you can still feel a pulse, the application is failing, and you must move to the next corrective step.
Secondary Correction: Applying a Second Tourniquet
If you have inspected and retightened the first tourniquet as much as possible, and the life-threatening bleeding still has not stopped, immediately apply a second tourniquet. This step is necessary because some limbs, particularly those with significant soft tissue or larger circumference, require more pressure than a single device can deliver. The second tourniquet should be applied proximal to the first one, closer to the torso.
Position the second device directly next to the first one, ensuring there is no large gap between them. This tandem application increases the total circumferential pressure on the underlying artery. Once positioned, tighten the second tourniquet fully, using the same criteria as the first: continue tightening until the bleeding is entirely controlled.
Do not remove the first tourniquet, even if you believe it caused the failure. The second tourniquet is applied as an adjunct, working with the first to achieve complete arterial occlusion. The goal remains no bleeding and no distal pulse, confirming that the combined pressure is sufficient to save the person’s life.
Post-Control Care and Waiting for Help
Once the hemorrhage is completely controlled, your focus shifts to patient care and preparation for professional medical assistance. The most time-sensitive information required by responding medical teams is the exact time the tourniquet was applied. Use a permanent marker to write the time of application directly onto the tourniquet strap, the device itself, or the patient’s forehead.
After controlling the bleed, work to prevent the patient from developing hypothermia, which is a common and dangerous complication in trauma. Keep the patient covered with blankets or clothing to maintain their body temperature. Continuously monitor the patient’s condition, watching their level of consciousness and periodically checking the wound to ensure bleeding does not resume.
The applied tourniquet must remain in place until the patient is transferred to definitive medical care. You must never loosen or remove a successfully applied tourniquet in a pre-hospital setting. This action can cause a sudden, catastrophic return of bleeding and potentially lead to fatal blood loss.