Unfortunately, many people have been applying tourniquets wrong without realizing it. Below, we shed some light on this topic and discuss several things everyone should know.
The tourniquet isn't overly complex. However, it's easy to get things wrong if you don't train.
The Definition of a Tourniquet
The dictionary definition of a tourniquet is a device that checks bleeding or blood flow by compressing blood vessels.
Tourniquets are designed to stop all blood flow to a limb. They work by compressing an artery. An interesting way to think about this is to imagine a garden hose. If a car rolls onto the hose, the water stops. The same thing happens with a tourniquet - you compress the blood vessels until blood flow to a limb is cut off.
When major arterial bleeding is suspected, tourniquets can be applied to the arms and legs. The tourniquet may be one of the most well-known pieces of medical gear. With that said, there are still a lot of misconceptions about how to use a tourniquet.
Seven Things Often Missed about Tourniquets
Let's look at several things you should know about the tourniquet. This is a life-saving tool. Unfortunately, if you get this wrong, it could be the difference between life and death.
Here are several things to know:
- Not all tourniquets are equal
- Belts are not usually good tourniquets
- Tourniquets don't automatically equal amputation
- Tourniquets don't cure all bleeds
- You can use two tourniquets
- You must combine Tourniquets with other bleeding control methods
- Don't be afraid to use a tourniquet fast.
Now, let's look at each of these in more depth. Also, at the end of this section, we will answer some commonly asked questions about tourniquets.
1. Not all Tourniquets are Equal in Quality
If you've ever shopped for tourniquets on the internet, you may think that just about any tourniquet will work. However, this often gets people into trouble. Non-recommended tourniquets can break or fail to stop blood circulation.
There's an organization called CoTCCC, or committee on Tactical Combat Casualty Care that recommends tourniquets.
The CoTCCC will review new tourniquets on the market from time to time. So, the list of recommended tourniquets could change.
Here are several CoTCCC recommended tourniquets:
The SWAT-T is a tourniquet that isn't currently CoTCCC recommended, but most professionals still regard it as useful in the field, as you can also use it as a pressure dressing or a sling.
Beware: Any tourniquet that doesn't use a windlass or some mechanical ratcheting method should be carefully evaluated. Do your research. Realize this: out of any piece of medical gear, you don't want to skimp on the tourniquet. Watch out for counterfeit tourniquets!
2. Belts Don't Make Great Tourniquets
Believe it or not, many people still think everyday belts make good tourniquets. Unfortunately, this leads to some people thinking that tourniquets aren't that important because they can "just use their belt."
Here's the problem: Even for a strong person, it's very difficult to get the needed pressure without a windlass (something to twist, creating pressure). It's better to either learn to make an effective improvised tourniquet or buy a real CoTCCC recommended tourniquet.
3. Tourniquets Don't Mean Amputation
In the past, people thought that cutting the blood flow to your limbs meant the limb would instantly "die." This isn't the case. Unlike your brain, which can only last about six minutes without oxygen, your limbs can handle a tourniquet for up to two hours.
So, don't let fear of amputation stop you from applying a good tourniquet. Even if a tourniquet did equal amputation (which it doesn't), it's more important to save a life than save a limb.
4. Tourniquets Don't Cure All Bleeds
Some people may believe that carrying a tourniquet around in their pocket makes them superhuman, healing all they desire. Unfortunately, tourniquets don't cure all bleeds.
Here are several instances where you'll need a different way to control bleeding:
- Bleeding to the neck and head. We obviously don't place tourniquets on the neck, so anything from the neck up to the head will require a different bleeding control method.
- Armpits and groin. These body areas are also called junctions, areas where the limbs join the torso. There are some fancy junctional tourniquets (expensive, and work different than traditional tourniquets), most of the time, you'll need to wound pack these areas with a hemostatic dressing (if you have it)
- Internal bleeds. If someone is bleeding internally, you need to treat them for shock (keep warm, comfortable, no movement) and take them quickly to a trauma center.
- Chest wounds. A tourniquet isn't much use if a patient has been stabbed in the chest or back. For these injuries, you'll need to apply a chest seal. If you're curious, you can read our article all about chest seals.
Get trained in all methods of bleeding control.
5. You Can Use Two Tourniquets
Large muscle areas under high pressure, like the upper thigh, might require two tourniquets. Also, most people advise that if the first tourniquet doesn't stop the bleeding, it's better to apply another tourniquet above (closer to the torso) the first tourniquet than take off the first tourniquet and readjust.
Also, I'll take a moment to note here: As one responder applies a tourniquet, someone should still be holding direct pressure. The pressure will act as a temporizing measure while the tourniquet is applied. You should not allow a person to bleed out while applying a tourniquet.
6. You Must Combine the Tourniquet with Other Bleeding Control Methods
In recent years, there's been a positive trend toward going right for the tourniquet. This method contrasts with the traditional method of using a tourniquet as a last resort. In the old days, you started with direct pressure, then limb elevation, then pressure points, then finally a tourniquet.
The old method allowed people to bleed out long before the tourniquet was applied (which stopped bleeding right away).
Here's the only caveat: Yes, responders should go directly for the tourniquet if they see a lot of blood. With that said, they should also try to maintain direct pressure in a short time while they are preparing and tightening the tourniquet.
Read the article on bleeding control to learn about common errors.
7. Don't be Afraid to Use a Tourniquet
These days, if you think you might need a tourniquet, you probably need a tourniquet. Hemorrhage is one of the leading causes of death. Responders and bystanders must be aggressive with bleeding control.
If you're curious, check out our article on the tourniquet vs. the trauma dressing.
Want to know the best way to reduce fear around using a tourniquet? Get trained. Though Hollywood likes to portray tourniquets as a simple solution, as you'll see (hopefully through this article), there's a lot that can go wrong. So, take some time to learn everything you can.
Now, let's answer some frequently asked questions about the tourniquet.
How Painful is a Tourniquet?
A tourniquet is painful. I've had tourniquets applied to my arm during class (real tourniquets that easily cut off my circulation), and it wasn't pleasant. I'm sure that having an actual injury would increase the pain.
With that said, your arm or leg will go numb quickly after the blood flow is cut – whether this affects the pain will depend on the injury and the person. Expect pain, and don't let pain deter you from using a tourniquet if needed.
Does a Tourniquet Go Above or Below the Wound?
Above and below are the wrong terms to use for tourniquet application. In medical terminology, we say proximal and distal—proximal means closer to the torso, and distal means further from the torso. Here's a good rule of thumb: place the tourniquet between the wound and the heart.
Note: Don't place tourniquets directly over joints, like knees, ankles, and elbows.
Can a Tourniquet Cause a Blood Clot?
A tourniquet could cause a blood clot. However, there are several things to consider here. First, a life-threatening arterial bleed comes before everything - everything. In fact, it's the only injury that you should treat before the airway and breathing.
A patient with a severe bleed can die in seconds. However, a blood clot is not a guaranteed death sentence, it's a possibility, but it is not certain. Also, it's not certain that a tourniquet would cause a blood clot in the first place.
So, if a patient needs a tourniquet, use the tourniquet.
Final Words on Tourniquets
It's important to practice and get hands-on experience. I would also direct you to several videos on the tourniquet application. These will help certain concepts make more sense.
Get your hands on a good tourniquet. They even make training tourniquets, so you can practice with them (on manikins).
Note: Nothing in this article is meant to supersede your local laws or medical guidelines. Medicine is often changing. There will likely be more information about using a tourniquet in the future. Keep studying!