When a person is experiencing massive, life-threatening bleeding from an arm or leg, a tourniquet is a life-saving tool used to stop the hemorrhage. The goal is to completely cut off blood flow to the injured limb until professional medical care can be reached. If bright red, pulsing, or continuous bleeding persists after applying the first tourniquet, it signifies the device has failed to achieve complete arterial occlusion. Immediate action is required to prevent the injured person from losing a fatal amount of blood.
Re-evaluating the Initial Application
If bleeding continues, the first step is to re-evaluate the initial application for correct placement and maximum tightness. A common error is not placing the tourniquet “high and tight” enough, meaning two to three inches closer to the torso than the actual wound. Applying it over bunched clothing can also prevent the necessary compressive force from reaching the deeper arteries.
Check the tightening mechanism, such as a windlass rod, to ensure it has been twisted until it cannot be twisted any further. The tourniquet is only effective when bright red bleeding has completely stopped and no pulse is detectable below the device. If bleeding is reduced but not stopped, the device may only be compressing veins, which can increase blood loss by trapping blood in the limb. If the device is correctly positioned but bleeding continues, immediately move to the next stage of treatment.
Applying a Second Tourniquet
If re-tightening the first tourniquet to its maximum capacity does not stop the hemorrhage, immediately apply a second tourniquet. This is the definitive next step, as the first device has failed to generate enough pressure to stop the flow of blood through the main artery. Do not remove the first tourniquet, even if you suspect it is ineffective, as it may still be providing some measure of control.
The second tourniquet should be placed directly adjacent to the first one, or slightly closer to the torso (proximal placement). Position the second device two to three inches above the first tourniquet on the limb. This strategy doubles the width and compressive force, creating a wider pressure wave more likely to collapse the deep arterial vessels.
Both tourniquets must be tightened fully until all signs of bleeding have ceased and you can no longer feel a pulse below the injury site. Achieving complete cessation of blood flow may be extremely painful for the injured person, but it is necessary to save their life. Utilizing two devices significantly increases the chances of achieving the complete arterial occlusion required to control the massive hemorrhage.
Documentation and Ongoing Patient Care
Once bleeding is controlled, the focus shifts to stabilization and communication for arriving medical professionals. A time-stamped record is important for the patient’s eventual medical treatment. Document the exact time the first tourniquet was applied, often by writing the time directly onto the device or the injured person’s forehead using a permanent marker.
The patient should be continuously monitored for signs of shock, such as paleness, confusion, or a rapid, weak pulse, as significant blood loss may have already occurred. Once the tourniquet is applied and effective, it must not be loosened or removed by untrained personnel, as this can cause a fatal re-bleed.
Keep the tourniquet uncovered so its effectiveness can be easily monitored until professional medical help arrives. When transferring care, clearly communicate to the medical team the number of tourniquets applied, their location, and the recorded time of application. This information is a major factor in subsequent medical decisions concerning the limb and the patient’s overall resuscitation.