The Tourniquet (how to apply)

[Caution Graphic Images Within]

As a First-Aid instructor, I’m often plagued with the decision of whether I should teach about tourniquets or not. The Red Cross certainly doesn’t advocate it in their basic First-Aid course, but it is okay in their Wilderness First-Aid course. Lets examine why. The reality is, tourniquets have made a comeback with a vengeance, due to their overwhelming success at saving lives in Iraq and Afghanistan, and most recently during the Boston marathon bombing.

Here’s what Dr. David Mooney, trauma Chief at Boston Children’s Hospital said in an interview:


 “My first thought was, ‘He’s really hurt. This isn’t just some EMS overcall,’” Mooney said. “Someone at the scene put on a big tourniquet. He had singed hair, singed eyebrows, soot all over his face.”

The 9-year-old girl also was in bad shape and singed. “Whoever got to her first saved her life” by putting on a tourniquet, Mooney said. “If they hadn’t done that, she would have died.”

read the whole interview here…


The fact is tourniquets work–

The Tourniquet

In Basic First-Aid, it is assumed professional help is a few minutes away. In Wilderness First-Aid, it is assumed help is not near-by; moreover, it is better to lose a limb than lose a life.

Quite frankly, I feel it should be part of the basic first-aid class, but with the proper understanding of when and how to use it. In fact, the basic first aid-course should be expanded in many areas, because it seems to me it leads to a false sense of confidence under certain situations.

During a major disaster, ie earthquake, hurricane, flooding, battle, terrorist attack, etc., EMS services are going to be taxed and help will be a long ways away, hours, if not days. I have been told by one of our local fire departments, very emphatically, I might add, “If a major disaster hits, we’re not coming for you, so you better be prepared.” Lines will be down, or overloaded so phone calls will be pointless. For this reason, and others, it is important folks have better life saving skills than the standard first aid provides.

Tourniquets are so effective at saving lives, they have become standard issue in military IFAKs (improved first aid kits)

When to use a tourniquet

In case of an amputation, a tourniquet should be applied immediately. Initially, there may be no bleeding, because of the veins and arteries constricting, but they will relax and bleeding out will begin.

If there is no amputation, but arterial hemorrhaging has occurred, every attempt to use direct pressure should be used. If that doesn’t work, a tourniquet should be used.

NEVER use a tourniquet on a neck, around the abdomen, chest, or head. Tourniquets are only used to control bleeding at the extremities.

How to use the tourniquet

  1. A tourniquet should be, at minimum, two inches wide. The use of anything smaller can result in further tissue damage at the tourniquet site.
  2. The tourniquet should be placed 3-4 inches above the wound site, never directly over the wound, and never directly over a joint, such as an elbow or knee. If the elbow or knee is 3-4 inches above the wound site, apply the tourniquet above the joint.
  3. The tourniquet must be tightened until distal pulse and bleeding stops.
  4. In case of an amputation, leave the tourniquet in place, DO NOT REMOVE! If there is a tourniquet on a non-amputation, release slowly after a few minutes to see whether or not bleeding can be controlled via direct pressure and dressing. If not, reapply the tourniquet and leave in place.
  5. On the patients forehead, write the letter “T” and the time the tourniquet was applied.
  6. Make no attempt to remove a tourniquet, if it has been in place for 6 or more hours. Let the MTF (Medical Treatment Facility) do that.
The Tourniquet how to apply

In the image above, this soldier’s life was saved, because of the proper use of tourniquets. Notice how the Tourniquets were placed proximal to the amputation, above the knee.  Also, take note of the width of the tourniquets.

There is some confusion on how long a tourniquet can be in place before a loss of limb will occur. Some say forty-five minutes and CLS (Combat Life Saver) manual says two hours without major complications. Tourniquets are often used in hospitals during surgery on limbs and left in place for longer than 4 hours, at times, without significant damage. That is not our call to make, however. Let the hospital make that decision. Bottom line, the loss of a limb is nothing compared to the loss of a life.

The use of a tourniquet is in no way a substitute for getting help. It is used as a means to extend life, while getting the casualty to an MTF.