11/27/2025
👉When to use a tourniquet:
Use it for life-threatening limb bleeding (spurting blood, bleeding that soaks through dressings quickly, loss of pulses distally, major amputations). Try direct, firm pressure first; if bleeding continues or you cannot maintain pressure, apply a tourniquet immediately.
👉Equipment (best to have):
A commercially made tourniquet (Combat Application Tourniquet/CAT, SOF, SWAT-T or similar) is preferred.
If none available and bleeding is life-threatening, an improvised device (wide, strong material + something rigid to twist) can be considered only as a last resort — but commercial ones are much more reliable.
👉Step-by-step — Applying a commercial windlass/ratchet tourniquet:
▪️Tell the person what you’re doing (it will hurt) and call/ensure EMS is on the way.
▪️Expose the limb enough to see the wound if you can safely do so (you may place the tourniquet over clothing if necessary).
▪️Place the tourniquet 2–3 inches (≈5–7 cm) above the wound, between the wound and the heart. If the wound crosses a joint, place the tourniquet proximal to the joint (above it). Do not put the device directly over the wound.
▪️Apply the band around the limb and secure it (buckle/strap) so it will not slip.
▪️Tighten the tourniquet by pulling the strap and then twisting the windlass (or using the ratchet mechanism) until the bleeding substantially decreases or stops and you can no longer feel distal pulses (if you can safely check). Keep twisting until bleeding stops — it must be tight enough to stop arterial flow.
▪️Secure the windlass/rod so it cannot unwind (clip, strap, Velcro as designed).
▪️Write or mark the time the tourniquet was applied on the person’s forehead, on a piece of tape on the tourniquet, or tell EMS immediately. This time is critical for hospital staff.
▪️Do NOT loosen or remove the tourniquet once applied — only trained medical professionals in a controlled setting should do that. If bleeding resumes after tightening, you may need a second tourniquet placed above the first.
👉If you must improvise (last resort):
Use a wide, strong material (≥2–3 inches wide if possible). Narrow items (thin cord, wire) increase tissue damage and are not recommended. Use something rigid (stick, pen) as a windlass if you can and secure it so it cannot unwind. Improvise only if commercial tourniquet is unavailable and bleeding is uncontrolled.
👉After application — what to do next:
▪️Call/maintain 911/EMS contact and tell them: “Tourniquet applied at HH:MM, location: left/right arm/leg.”
▪️Keep the person warm and still. Monitor for shock (pale, clammy, confused).
▪️Do not give the person anything by mouth if shock is suspected.
▪️Don’t remove or loosen the tourniquet. Hand over care and the time info to EMS/hospital staff on arrival.
👉Important safety notes & complications:
▪️Modern guidelines favor early tourniquet use for life-threatening limb hemorrhage because uncontrolled bleeding can be fatal; the risk of losing a limb from tourniquet use is much lower than the risk of death from exsanguination.
▪️Tourniquets can cause pain, nerve injury, ischemia and (with prolonged application) increase risk of tissue damage — that’s why timing and rapid definitive care are essential.
▪️Do not use a tourniquet for minor bleeding, on the neck/torso/head, or as a substitute for direct pressure when the bleeding is controllable.
👉Common mistakes to avoid:
▪️Placing it too close to the wound (put it 2–3 in. above) or over a joint.
Using very narrow materials (rope, wire) that cut into tissue.
Loosening/removing it before trained clinicians can evaluate the limb.
Waiting too long to use it when bleeding is life-threatening.
👉Training recommendations:
▪️Practicing Stop the Bleed / first-aid courses from Red Cross, AHA or local EMS will teach hands-on skills and reduce hesitation in emergencies. If you carry a tourniquet, learn correct application beforehand.
