Tourniquets are tight, wide bands placed around an arm or a leg to constrict blood vessels in order to stop blood flow to a wound.
Generally, tourniquets should only be considered if the venous or arterial bleeding incident is life-threatening and if EMS response will be delayed. Other reasons to consider using a tourniquet include:
- If bleeding cannot be controlled by direct pressure
- If the injury is in a location where direct pressure isn't possible
- If multiple people need help with life-threatening injuries and help is limited
- If the scene is unsafe or becoming unsafe
Warning: Tourniquets can be extremely painful. Therefore, it's best to warn the victim beforehand. And tell them why they'll be wearing a tourniquet.
How to Provide Care
If you have a commercial tourniquet, great. If not, anything that you can wrap around an injured limb will work – a piece of rope, an insulated wire. Tie that into a knot and then insert a screwdriver, stick, or pen and begin twisting to tighten.
Your goal in using a tourniquet is to control bleeding before hypovolemic shock sets in due to blood loss.
Pro Tip 1: What may seem like a wound that won't stop bleeding, may just be due to pressure that's not being applied directly over the wound. Bandages can slip. Victims could be in shock and not applying as much pressure as it appears. Make certain that direct pressure truly fails before considering a tourniquet.
We will assume that you've already made sure the scene is safe, and you're wearing latex-free gloves or have thoroughly washed your hands and have determined that the victim is currently not in shock.
- Apply the tourniquet over the extremity where the injury as occurred and a couple inches above the wound to limit tissue damage. Avoid wrapping around joints and follow the manufacturer's instructions.
- Secure the tourniquet as tightly in place as possible.
- Slowly tighten the tourniquet handle until bleeding stops.
- Fasten the handle to the tourniquet.
- Test the victim's toenail or fingernail to make sure you get a delayed capillary response, so you know the tourniquet is working as it should.
- Write down on the victim's dressing what time the tourniquet was applied and give that information to EMS.
The ABCs of Bleeding
Regardless of the bleeding incident, it's important to understand these simplified steps to trauma care response:
A – Alert! Call 911.
B – Bleeding. Find the bleeding injury.
C – Compress. Apply pressure and stop the bleeding by:
- Applying direct pressure with a clean cloth or dressing pads.
- Using a tourniquet.
- Packing or stuffing the wound and then applying pressure.
A Word About Perfusion
Perfusion is how your body's circulatory system delivers oxygen and nutrients to your organs, all of which require varying amounts of perfusion. Your heart, for instance, requires constant perfusion to continue working.
Your brain can last four-to-six minutes without perfusion, before damage begins to set in. Your kidneys can last 45 minutes and your skeletal system about two hours.
What does this have to do with tourniquets?
Pro Tip 2: It's important to keep in mind that limiting perfusion is a bad thing. But when we apply a tourniquet to a victim, that's exactly what we're doing. We're voluntarily cutting off the supply of oxygen and nutrients to a part of someone's body. So, it bears repeating:
Tourniquets should only be considered if the venous or arterial bleeding incident is life-threatening and if EMS response will be delayed.