Are you curious about the difference between a tourniquet and a trauma dressing?

Do you know which to use?

You're in the right place. 

In a nutshell...

Tourniquets have a specific job: stop arterial bleeds.

Trauma dressings serve many purposes, including stopping minor bleeds, acting as pressure bandages, and providing wound protection.  

When you learn to use the tourniquet and trauma dressing, you’re gaining a skill that could save someone's life.

However, misusing these tools will cause harm. In this article, we dive into guidelines about when, where, and how to use a tourniquet and trauma dressing.

What’s the Difference Between a Tourniquet and a Trauma Dressing?

Let's begin with a brief list of differences between the tourniquet and the trauma dressing. 

Here they are: 

• Tourniquets stop arterial bleeds (bright red, pulsing blood) 
• Most tourniquets use a windlass to tighten (The RevMedTX being an exception)
• Trauma dressings hold pressure over a wound 
• Trauma dressings come in many forms (a simple bandage and gauze, or something like the OLAES modular trauma dressing) 
• The tourniquet and trauma dressing are not interchangeable 
• Both require training! 

Now, let's look a little closer at each tool. We start with the tourniquet.

What is a Tourniquet? 

A tourniquet is a bleeding control device used to stop serious arterial bleeds.

Here are the major components of most tourniquets: 

• Strap: Most tourniquets use a durable nylon strap. However, some tourniquets, like the SWAT-T, use an elastic band.
• Windlass: The windlass gives you a mechanical advantage when tightening a tourniquet
• Buckle: Holds the strap tightly in place - this is one of the more variable components; the CAT, SOFTT-W, and SAM tourniquet all use a slightly different design.
• Velcro: Helps hold the strap down on some tourniquets.
• Timestamp: Area to mark the time of application. 
• Ratchet: The RevMed tourniquet is an exception to the windlass rule. Instead of a windlass, this tourniquet uses a ratchet action. 

Those are the basic components. Below, we explore four of the most common tourniquets and their features. 

Four common tourniquets: 

• SOF Tourniquet: This tourniquet uses a traditional windlass design. The SOF folds small for easy carry and uses an intuitive buckle for fast application. CoTCCC approved
• CAT: Tradition windlass design. The CAT is larger than the SOF, but it is still lightweight. CoTCCC approved
• SAM XT: Windlass design. The SAM’s claim to fame is the intuitive strap and buckle. As you tighten the strap, the SAM “clicks” into place, indicating it’s time to turn the windlass. CoTCCC approved
• SWAT-T: A long and wide elastic tourniquet. They are used similar to a pressure dressing – a good choice for pets and children. Not endorsed by CoTCCC, but still proven for their purpose. 

Alright, now let’s discuss when to use a Tourniquet. 

Note: CoTCCC approved indicates that the Committee on Tactical Combat Casualty Care has reviewed and recommends using a tourniquet. 

When Should I Use a Tourniquet? 

Use a tourniquet any time there is an obvious or suspected arterial bleed. 

Unfortunately, many first responders are still afraid to apply a tourniquet. While you should not be flippant about tourniquet application, you should quickly apply them when necessary. Seconds matter during bleeding control. 

To keep things simple, using the "oh my gosh, that's a lot of blood" principle is appropriate. Basically, if you approach a patient and say, "that's a lot of blood," your mind should think tourniquet. 

Guidelines for tourniquet application:  

• Arterial bleeds: spurting, pulsing, bright red blood. 
• Stab wounds to arms and legs 
• Amputations to arms or legs 
• Gun show wounds (GSW) to arms and legs 

Now, here are several times to avoid a tourniquet: 

• Junctional wound 
• Veinous bleeds (Non-spurting, dark red blood)

As you become familiar with emergency medicine, you'll find that "rules" are rather grey. Use your best judgment and follow local protocols. 

Note: Times have changed. If you see bright red spurting blood, grab the tourniquet and apply it. Gone are the days of the “step-wise approach”: starting with direct pressure, then elevation, then pressure points, then more gauze. . . then finally the tourniquet - by this time, the patient doesn’t have any more blood. If they need it, use it!

How Do I Use a Tourniquet? 

Using a tourniquet is a skill, just like shooting a basketball, hitting a baseball, or throwing a football. You must practice applying a tourniquet. 

If you strike out, your coach is disappointed. If you fumble with bleeding control, people can die. 

First phase to applying a tourniquet (SOF, CAT, SAM, and TMT models):  

1. PPE: If you have time, apply hand and eye protection. 
2. Assess: Confirm the bleed is significant and confirm its location. You don't have to be perfect here; you just need to know where the blood is coming from. 
3. Direct pressure: Even if you know you need a tourniquet, begin applying direct pressure (Push hard! Don't just hide the blood with your hand, actually compress the tissue - think about how hard a tourniquet squeezes, and try to apply a similar amount of pressure).
4. Prepare Tourniquet: As you hold pressure with one hand, prepare your tourniquet with the other. Also, consider applying pressure with your knee, freeing both hands for the tourniquet. 

Second phase to applying a tourniquet: 

1. Strap tourniquet into place: Try to strap the tourniquet into place without removing pressure. You may need to unclip the buckle and weave the strap around the limb (this is where the SOF tourniquet comes in handy) 
2. Pull the strap tight: There should be no slack, and you shouldn't be able to slip a finger under the strap easily. The SOF and the SAM have indicators telling you when you're tight enough.
3. Tighten windlass: Spin until bleeding stops. You can confirm by checking that distal pulses (below the tourniquet) are absent. 
4. Hook windlass into place: Slide the windlass into the provided C-clips. 
5. Mark the time: Always mark the time you applied the tourniquet. Tourniquets can stay in place safely for two hours before tissue damage begins; however, eventually, they need to be removed. 
6. Visible: Never cover a tourniquet; everyone should be aware that a tourniquet is in place. 
7. Immobilize: If you have time, it's a good idea to provide support/immobilization of the extremity. 

If you're feeling a bit squeamish about using a tourniquet, or you believe the patient will lose their arm from lack of blood flow, check out this video on the top misconceptions about tourniquets. 

Now, let's tackle trauma dressings. 

What is a Trauma Dressing? 

A trauma dressing controls minor to moderate bleeding, protects wounds from contamination, and provides padding for injured tissue. 

A trauma dressing has two main parts: the gauze pad (which directly contacts the wound) and the bandage (which forms a pressure wrap over the gauze). 

Here are several types of trauma dressings and how they work:  

• Standard Trauma pad and Pressure bandage: These tools will serve you well and can be placed after wound packing or direct pressure.
• NAR Trauma Dressing: This comes in several sizes. Also, some come packaged thin for easy carry. NAR dressings usually have a lock rod at the end of the bandage for securing the dressing.
• Israeli Bandage: One of the most popular multi-purpose trauma dressings. It is equipped with a pressure-point bar and a sleeve for one-handed application. 
• OLAES: The OLAES has built-in gauze that you can remove for wound packing. The OLAES also has a pressure cup, an occlusive dressing, and an eye shield. This is the Swiss army knife of trauma dressings.

Now that we know the different kinds of trauma dressings let's discuss when to use them. 

When Should I Use a Trauma Dressing? 

The trauma dressing is easy to misunderstand. Some trauma dressings are quite large, and many people instinctively think of these big, towel-like bandages when they see a lot of blood. However, you must remember: Don’t hide the bleed, STOP the bleed.  

Here's an example scenario: an EMT friend tells you they helped someone who was stabbed in the leg. "The guy bled through five trauma pads!" they yell. 

What's wrong with this? 

Well, instead of combining good direct pressure, wound packing, and tourniquets, the EMT just kept applying more trauma pads. This is bad. 

Hiding the blood doesn't make it stop. Here's a video showing why many people perform basic bleeding control wrong. 

How Do I Use a Trauma Dressing? 

Similar to a tourniquet, there are two phases to applying a trauma dressing. 

First phase of applying trauma dressing:

1. PPE: if you have time, wear gloves and eye protection. 
2. Direct pressure: If you see major bleeding, immediately apply (firm) direct pressure. 
3. Consider wound packing: If the wound is in the junctions (groin, shoulders, neck), break out the gauze and begin packing the wound. Wound packing ensures direct pressure is applied at the bleeding site - this is a separate skill that you must practice!

The second phase to applying a trauma dressing: 

1. Apply gauze pad: This gauze pad protects the wound. It also helps the bandage apply direct pressure. 
2. Apply bandage: The bandage holds the gauze pad in place. With premade trauma dressings, the bandage is attached to the gauze pad. Wrap around the wound, applying a good amount of pressure as you go (If you're wrapping near the chest or neck, be sure you don't compromise the airway!). 
3. Secure the bandage: Some people just tuck the end of the bandage into itself. While tucking is okay for minor injuries, a true pressure dressing should be adequately secured. Safety needles, tape, or a good knot are appropriate options. 
4. Check pulses: A good pressure dressing should slow the bleed but avoid cutting off all blood flow. Your patient should still have pulses in their hands and feet. 

Here's a video on several types of trauma dressings and how to use them.

Note: Hemostatic agents like QuickClot and Celox are great to use in conjunction with wound packing. 

Final Word on Tourniquets vs. Trauma Dressings

Tourniquets and trauma dressings are both effective tools when applied correctly. If you can, find a local course on first aid. There's nothing like hands-on experience. 

Also, the opinions in this article are not meant to supersede your local protocols and regulations. Learn your local laws.