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How to apply a tourniquet

By Tom Rader

When it comes to stopping the bleed, tourniquets are one of the most important tools in the medical toolbox.  Emergency situations run the gamut from car accidents to gun violence to industrial injuries. But how do you use a tourniquet correctly? Here’s a quick guide.

Managing life-threatening bleeding

There are several places on the body that can produce life-threatening bleeding.  Since this post is about tourniquets, we will focus on unwanted blood flow from an extremity. 

You do not have to be a “medical professional” to stop rapid blood loss.  We will discuss how most people should apply a tourniquet to someone who is bleeding profusely from an injured limb.  We will only apply a tourniquet to an arm or leg; the head is not considered an extremity for our purposes here–as much as you might like to put a tourniquet around someone’s neck… 

We will not go deep into more advanced concepts, like discontinuing a tourniquet or using a tourniquet for other applications.  Think of this tutorial more at the American Red Cross level and not at the 18-D level.

When should I apply a tourniquet?

If you see blood pouring out of a person’s injured limb, like in an 80’s slasher movie, that is an easy decision.  However, if we know the person just received a significant traumatic injury, and we can see some bleeding from an open wound, we might consider a tourniquet.

We are not talking about a patch of road rash that has beads of blood, we are talking about a bleed that is continuously flowing.  Certainly, if we see bleeding “spurting” in time with the person’s heartbeat, we should apply a tourniquet.

There are very few dangerous complications with tourniquet application.  Old school thought was that the second you applied a tourniquet, you doomed that person to further injury, including loss of the limb–which was acceptable over death.  Unless you have been living under a rock, you know this is no longer true. 

We are concerned with tissue and nerve damage and tissue breakdown from crushing the muscle around the artery.  But you aren’t going to see those in the short term, and that can be managed once the injured person gets medical attention.

Don't forget about applying direct pressure

If you are not EDC’ing a tourniquet (and why are you not using something like our Tourniquet Holder?), hopefully you have one in a pack or something close at hand.  If you have to run back to a vehicle for a first aid kit or find a “Stop the Bleed” cabinet, that bleeding injury will continue bleeding.  And all bleeding stops eventually–when we stop it or when the patient dies.

If you have a tourniquet within arm’s reach, but it will take a little time to access it, don’t neglect the injured person.  You can apply direct pressure to the inside of the arm or top of the groin by kneeling on it or using the palm of your hand (though using your hand precludes using it to help access the tourniquet).  The only caveat is if you suspect the person has a broken pelvis (an injury you might see in conjunction with a bad car accident)–you could make things worse (you can still apply pressure to the arm).

How do I know when I have put the tourniquet on correctly?

The bleeding has stopped (and the patient is still alive).  Seriously.  The point of using a tourniquet is to prevent the loss of more blood.

What tourniquet should I have?

The long answer will be addressed in another article.  The short answer is “anything currently approved by the Committee on Tactical Combat Casualty Care (CoTCCC).” 

You should purchase your tourniquet from approved vendors–Amazon is not a good source for life-saving devices.  Avoid gimmicky products that have limited research and unproven track records.

What should I look for in a tourniquet?

Besides being a CoTCCC-approved tourniquet, you should select from a smaller subset of what they recommend.  They list a few models, which work fine, but take a little more training to use and are harder to find.

A proper tourniquet needs to generate mechanical advantage, which generally means a windlass (rigid object) to tighten the material and be wide enough to compress the blood vessels against the bone in the limb.  Research tells us this needs to be at least 1.5-inches wide.  Elastic bands, bungee cords, shoe laces, and 550 cord are inappropriate.

Look for CAT, SOF-TQ, and SAM-XT.

Can I use an improvised tourniquet?

Improvising should never be the first plan.  Commercial CoTCCC-approved tourniquets are affordable and accessible.  It is not recommended unless you have practiced a bunch and have the materials. 

Research shows that the most effective improvised tourniquets mimic the commercial ones.  They must be at least 1.5-inches wide and use a windlass device to generate the appropriate forces.

Steps for shutting down unwanted blood flow

Our focus here is to stop bleeding and save someone’s life.  This is an emergency situation and we must act quickly to preserve as much of the blood supply as possible.

When applying a tourniquet, always err on the side of tighter rather than looser – it’s better to cause pain than to allow continued bleeding.

And once a tourniquet is in place, don’t remove it! Doing so can cause further damage and potentially lead to death.

If we can get down to bare skin, that is preferable, but don’t let the inability to remove clothing and get to bare skin stop you from applying the tourniquet.

For application on others:

  1. Access your tourniquet and unfold it.
  2. If the tourniquet is stored threaded through a buckle, un-thread it (it is very challenging to get TQ placement by feeding up a limb, especially a leg).
  3. Feed the tourniquet between the affected limb (arm or leg) and the body with the buckle and strap facing OUTWARD, at the highest point on the limb.
  4. Thread the strap through the buckle.
  5. Anchor the tourniquet and pull that strap as tight as you can (you should not be able to shove a finger under the strap circling the limb).
  6. If the tourniquet uses hook and loop (CAT, SAM-XT, etc.), adhere as much hook and loop as you can around the limb.
  7. Turn the windlass (either direction) until the bleeding stops, or you cannot turn it anymore. This very likely will be painful for the individual but it is a necessity to ensure the blood flow has stopped. 
  8. Secure the windlass in the retaining clips.
  9. If the tourniquet uses hook and loop, you must bring the remaining strap around the secured windlass (if there is enough strap left).
  10. Secure the windlass (and additional strap) using the retaining device (on the CAT and SAM-XT this is a hook and loop tab; on the SOF-TQ you will lock the end of the windlass in the “triangle”)
  11. Confirm bleeding has stopped

If bleeding has not stopped, confirm that the tourniquet is applied correctly.  If it is applied correctly and the person is still bleeding, consider using a second tourniquet.

You do not need to write the time of application on the patient’s forehead or on the tourniquet itself.  That is an older practice left over from the days when we thought a couple of hours made a difference.  It doesn’t.

For self-application:

Self-application works as it does on another person, with two notable exceptions.  You will face the buckle in the other direction since you want to pull across your own body (as opposed to away from your body).  And you need to practice one-handed self-application if one of your arms is injured, meaning feeding the tourniquet up the affected limb while it is still looped–it is very hard to rethread the buckle with one hand.

The CAT and SAM-XT excel at one-handed self-application–the hardest thing is getting the “first pull” tight enough and then effectively managing the windlass.

Second tourniquet?

In some cases, especially on larger limbs, you might need to use a second tourniquet.  If you applied the first tourniquet “high and tight, ” place the second one directly below the first. Not a few inches below. Directly below. You never want to leave any space in between two tourniquets.

To conclude

If you’re ever in a situation where someone is bleeding heavily and you need to stop the bleed, remember: a tourniquet is your best friend. You can save a life by controlling bleeding and getting the injured person to necessary medical care.

We recommend that you take some training and don’t rely on YouTube to learn how to save lives.  If you have time, seek out something like Wilderness First Responder, where you will learn additional skills like how to discontinue a tourniquet within two hours, how to use the tourniquet to numb a limb with a wound you may have to debride, or how to do alternate placements for a tourniquet (lower on the limb, though never over a joint).

In all cases, you should be able to treat a life-threatening bleed and not have to wait for first responders.  Carry a tourniquet with you whenever you are out and about–they don’t take up much space and can save a life.

About Tom Rader

Tom is a former Navy Corpsman that spent some time bumbling around the deserts of Iraq with a Marine Recon unit, kicking in tent flaps and harassing sheep. Before that, he was a paramedic somewhere in DFW, also doing some Executive Protection work between shifts. Now that those exciting days are behind him, he has embraced his inner “Warrior Hippie,” and assaults 14ers in his sandals, and engages in rucking adventure challenges while consuming copious water. To fund these adventures, he writes all manner of content (having also held editor positions at several publications) and teaches wilderness medicine and off-road skills. He hopes that his posts will help you find the gear that will survive whatever you can throw at it (and the training to use it). Learn from his mistakes–he is known (in certain circles) for his curse…ahem, ability…to find the breaking point of anything. You can follow him at https://linktr.ee/docrader.

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