Indications
Even when used properly, complications of tourniquets can lead to serious tissue damage. However, in severe bleeding and life-or-death emergencies, the proper use of a tourniquet is an effective way to stop the bleeding and keep the injured person stabilized until they receive proper medical care.
Emergencies that require the use of a tourniquet include car accidents, gunshot wounds, deep cuts, or crushed extremities associated with work-related injuries.?
If you find yourself in one of these situations, knowing how to properly apply a tourniquet could save someone's life.
Materials Needed
If you are a first responder or emergency medical professional, you may be able to use a snap-on tourniquet. However, if you are a regular person experiencing an emergency, you may not have a tourniquet and will need to make one on the spot.
Remember - the most important priority is your own safety. Before administering first aid, make sure it is safe for you to do so.
Studies have shown that temporary tourniquets are up to 60% effective. While this may not sound reassuring, as long as you have the materials and knowledge needed to properly apply a temporary tourniquet in an emergency, any attempt to stop the bleeding is likely to be better than doing nothing at all.
To assemble a temporary tourniquet, you'll need two parts: a triangular bandage and something that can be used as a noose, such as a stick. Other items you can use on hand include a belt, shirt, or towel.
Always take universal precautions in emergencies, especially those involving body fluids such as blood. If personal protective equipment (PPE) is available, put it on before you start providing first aid.
Ways to apply a tourniquet
Anyone can apply a tourniquet. While you don't need any official or special medical certification or training, you do need to know how to use it properly.
The first step you need to take in any emergency is to call the emergency services.
Tourniquets are intended for use on extremity injuries, not head or torso injuries. Head or torso injuries require pressure with a material that can absorb blood to slow or stop the bleeding.?
The use of a tourniquet is only a stopgap measure to buy time while you wait for medical personnel to arrive.
By using a tourniquet, your goal is to restrict the flow of blood to the injured limb to prevent life-threatening blood loss. While constricting the limb to cut off its blood supply is a temporary measure, if done correctly, it will slow or stop the bleeding enough to save lives.
Finding the bleeding point
Before applying a tourniquet, you need to identify the source of the bleeding. In some cases, such as a proximal or complete amputation, it may be obvious. Other injuries may not be visible at first, especially if there is debris, wreckage, torn clothing or other objects blocking your view.
If possible, have the injured person lie down so you can assess them from head to toe. Try to remain calm and focused, as you need to find the source of the bleeding as soon as possible.
Applying pressure
Once you have identified the source, start by applying direct pressure to the wound to control the bleeding. If the bleeding does not slow or stop when pressure is applied, you will need to find (or tighten) a tourniquet.
If the person is conscious and alert, tell them that you will apply a tourniquet to their wound. Unfortunately, the process of applying a tourniquet can be very painful, and the person is likely already in a lot of pain. Let the patient know that using a tourniquet will hurt, but if it doesn't save their life, it may save the limb.
Next, cut, tear, or otherwise remove any clothing near the wound. The tourniquet needs to be applied to the exposed skin.
Placing the tourniquet
Place the cloth, towel, or other material used for the tourniquet on the limb 5 cm above the injured area. You need to place the tourniquet on the limb closest to the heart. For example, if the injury is below the knee or elbow, you will need to tie the tourniquet above the joint.
Tie the tourniquet around the limb using a common square knot (such as tying a shoelace, but not a bow).
Using a stringer
You will need a stick or other object strong enough to act as a stringer. A winch is a lever that can be used to twist the tourniquet tighter. Anything can be used as a winch as long as it is strong enough to hold the tourniquet in place and can be secured in place. Consider using a pen or pencil, stick, or spoon.
Place your winch bar over the knot you've tied, then tie the loose end of the tourniquet around it with another square knot.
Tighten
Begin twisting the noose to increase pressure. Watch the bleeding closely and note when it starts to slow down. Continue turning the anchor hoist until all bleeding stops or is significantly reduced.?
Once the bleeding has slowed or stopped, secure the winch bar by tying one or both ends to the injured person's arm or leg.
Marking time
A tourniquet should only be used for a specific period of time - no more than two hours. For this reason, it is important for first responders and medical staff treating injuries to know when you are using a tourniquet.
If possible, mark the date and time you placed the tourniquet on the person's forehead or other area highly visible to emergency personnel with a "time".
Moving
The tourniquet should not be loosened or removed by anyone except a physician in the emergency department.
Common tourniquet mistakes
Even if you know how to use a tourniquet properly, things can go wrong. In an emergency, you may not have enough help or resources and you may face many distractions.
Here are potential mistakes to watch out for when using a tourniquet:
Waiting too long: You have to address a serious bleeding problem immediately for a tourniquet to be successful. When an injured person loses too much blood, they may go into shock.
Loose application: loose tourniquets are ineffective because they do not adequately constrict arterial blood flow.
No second tourniquet: one tourniquet is usually sufficient to control severe bleeding, but people with thick arms may need a second tourniquet.?
Loosening: Contracting and loosening a tourniquet rather than continually contracting it allows blood to re-enter the wound. If blood flows back into the injury, it may damage the blood vessels.?
Leaving it on too long: a tourniquet should not be left on for more than two hours. Prolonged use of a tourniquet can cause permanent damage to muscles, nerves and blood vessels.
Using the wrong material: Inappropriate materials, such as cords, can cut into the skin. Not only will this render the tourniquet ineffective, it can lead to more pain or further injury.
The best way to prevent mistakes is to understand how to use a tourniquet and to practice the proper technique for applying it.
Tourniquets in the First Aid Kit
A 2018 study published in the Journal of the American College of Surgeons confirms that tourniquets can and do save lives - even when used by civilians. In this study, researchers sought to determine the impact of civilian tourniquet use on mortality. When civilians used tourniquets prehospital, the risk of death in patients with peripheral vascular injuries (blunt force trauma to the extremities) was reduced by a factor of 6.?
Although they do work in emergencies, snap-on tourniquets are not available in first aid kits. This is largely because tourniquets should only be used in worst-case scenarios where there are no other options, as there are usually other ways to adequately control bleeding from most injuries.
However, a commercial tourniquet is preferable to a temporary tourniquet in an emergency. Commercial tourniquets are made from recommended materials and specifications, making them most effective and easier to use. Commercial tourniquets are also better suited to minimize risk when used.
You can add tourniquets to your home first aid kit, as the items typically included in these kits may not be sufficient to help in cases of severe bleeding. If you work with or care for people who are most at risk for bleeding injuries or serious bleeding complications, such as young children and the elderly, you should be prepared with available tourniquets and the knowledge to use them properly.
Whether you are a medical professional, first responder, student, or parent, knowing how to use a tourniquet can be a life-saving skill.