How to Use a Tourniquet

Tourniquets are tight bands used to control bleeding by completely stopping the blood flow to a wound. In the past, tourniquets had a bad rap in the field of emergency first aid. Complications of tourniquet use have, in many instances, led to severe tissue damage. However, tourniquets can stop bleeding quite well and are useful in cases of severe bleeding that cannot be stopped any other way.

As a members of the general public, most people will never use a commercial tourniquet. However, it is still a good idea to learn how to use one and understand how to improvise one. 

Common scenarios that may require the use of a tourniquet by a civilian include car accidents, gunshot wounds, deep cuts, or a crushed limb related to a work injury. And knowing how to use one could potentially save someone's life.

Materials Needed

You may have a commercial tourniquet available in a first aid kit but not every medical situation is going allow access to a commercial tourniquet. If you don’t have one available, you will need to improve.

Research shows improvised tourniquets are effective up to 60 percent of the time. While that doesn't seem good enough, it is better than nothing, especially in a emergency situation. Therefore, having sufficient knowledge of how to improvise a tourniquet can increase the effectiveness of an improved tourniquet. 

For an improvised tourniquet, will need a triangular bandage and something you can use as a windlass (such as a stick). You can also use other items to create a tourniquet, such as belt, shirt or towel. 

If you are not the victim, practice universal precautions and wear personal protective equipment if available.

Applying a Tourniquet

Tourniquets are for limb injuries and cannot be used for injuries to the head or torso. An injury to the head or torso requires application of pressure with a material that can absorb blood to slow or stop bleeding. 

Anyone can apply a tourniquet and doing so does not require any medical training. Before you do anything, however, you should call 911 and alert emergency services. If someone else is available to make the call, ask them so you can attend to the injured person.

The use of a tourniquet is to buy time for trained medical professionals to arrive and take over to provide the necessary medical care. It will constrict the arm or leg to control bleeding. This way the blood flow is cut off so that the injured person does not bleed out. 

Before you apply a tourniquet, you need to determine the source of the bleed. Have the bleeding person lay down and assess their injury as quickly as you can.  Once you have determined the source, apply direct pressure to the wound to control the bleeding. If doing so does not slow down or stop bleeding, a tourniquet should be used.

Since tourniquets are painful, you should let the injured person know what you are doing and warn the individual that there will be pain.

You will next need to cut or remove clothing so the tourniquet can be applied to bare skin. 

Position and Tie the Tourniquet Above the Wound

Tie the tourniquet around the injured arm or leg, several inches above the injury (the part of the limb closer to the heart). If the injury is below the elbow or knee, you may need to tie the tourniquet above the joint. The Red Cross recommends placing the tourniquet about two inches above the wound and not on a joint. Use a common square knot (like tying your shoes without the bow).

Add a Windlass

Place a stick or other item strong enough to act as a windlass (a lever that will twist the tourniquet tighter) on the knot and tie the loose ends of the tourniquet around it in another square knot.

Anything can be used as a windlass, as long as it is strong enough to hold the tourniquet and can be secured in place. Consider using pens or pencils, sticks, spoons, or even a piece of pipe.

Twist the Windlass to Stop Bleeding

Twist the windlass to increase the pressure until the bleeding stops. Continue turning the windlass until all the bleeding has stopped or is significantly reduced.  

Secure the windlass by tying one or both ends to the victim's arm or leg. If possible, mark the time the tourniquet was placed by putting a "T" on the victim's forehead with the time/day.

Common Tourniquet Mistakes

It is possible to make mistakes if you don’t know what you are doing or are distracted. The only way to make sure mistakes are not made is with practice and appropriate training. The following are potential errors that may be made when applying a tourniquet:

  • Waiting too long. It is important to address bleeding immediately for a tourniquet to be successful. A person who loses too much blood could go into shock.
  • Loose application. Loose tourniquets are not effective and don’t constrict arterial blood flow.
  • Not applying a second tourniquet. One tourniquet is usually enough to control severe bleeding, but a person with large arms may require a second tourniquet. 
  • Loosening. If you constrict and loosen the tourniquet rather than continually constricting, you are allowing blood to reenter to the injury. This can damage the blood vessels. A tourniquet should not be loosened or removed by anyone other than a doctor in the emergency department. Removal may lead to more severe bleeding.
  • Leaving on too long. A tourniquet should not be left for longer than two hours as anything longer can cause permanent damage to muscles, nerve and blood vessels.
  • Using the wrong materials. Inappropriate materials, such as a cord, can cut into the skin, making the tourniquet ineffective. This can also bring on more pain and injury. 

    Tourniquets in First Aid Kits

    The fact is tourniquets can save lifes and one 2017 study, reported in Journal of American College of Surgeons, confirms this. For the study, researchers sought to determine the effect civilian use of tourniquets had on mortality. What they found was when civilians performed prehospital tourniquet application, the risk for mortality was six times less in patients with peripheral vascular injuries (blunt trauma to the extremities). 

    Commercial use tourniquets are not available in first aid kits. One of the main reasons for this because they are only required in worse case scenarios and there generally are other ways to control bleeding. However, should an emergency situation occur, an improvised tourniquet isn’t as easy to pull together and use. A commercial one follows recommended materials and specifications. That makes it more effective and easier to use. Further, commercial tourniquets are more effective at minimizing risk if something goes wrong when using one.

    Everyone needs a tourniquet in their first aid kit because other items in the kit cannot help in situations with severe bleeding. It does not matter whether you are medical professional, a first responder, or a parent, having a tourniquet in your first aid kit should be a requirement. People of all ages benefit from them in situations of severe bleeding, especially small children and the elderly, who are a high risk, compared to other members of the public, for bleeding injuries. 

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