In a survival situation you are going to have to make decisions quickly. This is particularly true when it comes to first aid treatment. A major cut to an artery or other major blood vessel can cause a life threatening bleed. You will need to react quickly and effectively to this situation in order to make a positive outcome more likely.
I’m sure that we all know what a tourniquet is, but do you know when to use one, and more importantly, when not to use one? Do you know how to apply one? A member of your family’s life may depend on you answering “yes” to all of those questions.
What Is A Tourniquet?
A tourniquet is a constricting device of some description (it could be a bandage, belt, shirt etc) that applies a large amount of indirect pressure to slow down and ultimately stop a massive bleed.
Surgical tourniquets are mechanical and usually involve compressed gas inflating a cuff which has been applied to the appropriate body part. During surgery, doctors sometimes use tourniquets to give themselves a blood-free view of the area of the body on which they are operating.
They do this by applying the tourniquet above the surgery site and stopping the blood flow to the affected area. This shows how effective tourniquets can be at stopping blood flow!
When To Use A Tourniquet
Tourniquets are considered a last resort first aid treatment. This is because of the potential adverse effects which they can cause if used incorrectly. You should only consider using a tourniquet to control a bleed in the following situations:
- You have applied direct pressure to the wound but the bleeding is not showing signs of slowing down. A high level of pressure is required for life threatening bleeds, so make sure you have put a lot of direct pressure on to the wound before deeming it ineffective
- You are unable to apply direct pressure due to body position (e.g. entrapment) or the wound is too big for this to be an option
- You have been told to do so by a medical professional who has instructed you on correct technique and location.
- The wound is on the person’s arm or leg (these are the only body parts where a tourniquet should be used)
- You have a suitable tourniquet on hand – a tourniquet needs to be wide enough so it does not cut into the skin or muscle when it is tightened. It also needs to be strong so it is less likely to break as it is tightened.
- If a limb has been completely amputated – there may not be bleeding immediately following an accidental amputation due to the body’s defence mechanism of constricting the blood vessels; however, it will eventually bleed, so direct pressure may or may not be effective.
When Not To Use A Tourniquet
Tourniquets can cause serious damage if used incorrectly. Tourniquets can cause nerve damage (temporary or permanent) due to the massive pressure placed on a relatively small area. Two hours of having a tourniquet applied is enough to cause irreversible nerve damage. Losing a limb is a very real possibility due to lack of blood circulation killing off tissue and muscle below the tourniquet. You should NEVER use a tourniquet in these situations:
- The wound is on the person’s head, torso, neck, etc. – tourniquets should only be applied to an arm or leg
- The bleed is not severe and life threatening
- A person is in shock or receiving CPR – their blood pressure will be low, but if they recover, their blood pressure will increase – meaning the tourniquet is no longer effective and they can still bleed to death
How To Use A Tourniquet (improvised tourniquet in an emergency situation)
- Prepare the material you will be using as the tourniquet. To prevent damage to skin and/or muscle tissue, this will need to be at least 2 inches wide
- Wrap the tourniquet around the injured limb – the tourniquet needs to be applied between the injury and the heart and should be 2 – 4 inches from the injury. A consideration to bear in mind is that a tourniquet should never be applied directly on top of a wound or a joint.
- Do several wraps around the limb ensuring the tourniquet stays flat as you do. This helps protect the skin from damage, which helps control pain
- Tie a half knot and place a stick or similar object over the half knot before tying a full knot over the top of the stick
- Twist the stick until the tourniquet is tight around the limb. Bright red blood should no longer be visible
- Once the tourniquet is in place, tie it down so the stick cannot unravel.
Once the tourniquet is applied – do not remove it! If you remove it too soon, the bleeding may start again and the casualty may go into shock.
Things To Remember About Tourniquets
- Do not cover the tourniquet up – keep it in clear view so medical staff will know immediately that one has been applied
- If a tourniquet is applied for longer than 2 hours – permanent nerve damage is likely
- If a tourniquet is applied for longer than 6 hours – muscle damage will have occurred, which will usually lead to amputation of the limb
- Loosening the tourniquet after application can cause death as a result of shock
- A correctly applied tourniquet is painful! Do not be worried about hurting someone to save their life
- A tourniquet applied too loosely can cause venous blood returning to the heart to be stopped but arterial blood from the heart can still flow, meaning heavy bleeding continues
Editor’s Note: One piece of equipment I have in every first aid kit I own includes an Israeli Bandage. These inexpensive and very effective bandages – which can be used as a tourniquet – have a very innovative design which allows anyone to apply one – even the injured individual themselves!