Tourniquet

A tourniquet is a medical device that puts enough pressure on a body part to stop blood from flowing past it, cutting off circulation. Tourniquets are often a part of routine care in medical settings like surgeries. But outside of medical settings, tourniquets can be a lifesaving treatment for severe blood loss.

Severe blood loss (hemorrhage) is a life-threatening medical emergency. If you lose too much blood, you can go into shock. The first option to stop bleeding is to put direct pressure on the wound until bleeding stops. But sometimes, that isn’t possible. Some examples of that include if:

• The bleeding is too severe (it won’t stop under direct pressure, or it’s coming from multiple places)
• The injury is in a place you can’t press on
• The bleeding is from an amputation (where a limb or body part is almost or totally removed)

First responders may also use tourniquets in mass casualty events, where quick action is necessary to save as many lives as possible. And in some cases, they may also use a tourniquet as a temporary measure to buy time while they do CPR or other critical lifesaving treatments.

How do you place a tourniquet?

WARNING: Only use a tourniquet as a last option or in extreme situations. Before using a tourniquet, you should try the following:

1. Place a wound dressing or bandage right on the wound. Elevate the affected limb and press down on the wound directly. Don’t hesitate to press hard, especially with heavy bleeding, even if it’s painful.
2. Pack the wound. Push bandage material into the wound and press down on it.
3. Spanish windlass technique. Tie a bandage around the limb with the knot directly over the wound. Then, insert a sturdy object like a stick or rod under the knotted bandage. Turn that object so the looped bandage presses directly on the wound.
4. Use a tourniquet. It needs to go above the wound to be effective (see below for details).

How and where to place a tourniquet

Many tourniquets come with instructions on how to use them. It’s best to use them only if you have training, like a first aid class. But in a life-or-death situation, you can improvise a tourniquet using a nonelastic piece of fabric or cloth. This is known as an improvised or Russian tourniquet. You should start with placement, remembering the following:

• The tourniquet needs to go directly on the skin (move or remove any clothing that could get in the way).
• The tourniquet goes as close to, but at least 2 inches (5 centimeters) above, the injury.
• Tourniquets are painful to the person getting them, but that’s necessary for the tourniquet to work properly.

Once you have the placement right, use the Spanish windlass technique to tighten the bandage until the bleeding stops. Once the bleeding stops, tie another knot over the cinching object to hold it in place.

Make sure to note the time you tie the final knot. Medical professionals will need to know that time when they take over treatment. And be absolutely certain they know about the tourniquet. Don’t automatically expect them to see and recognize it.

Once you’re sure you’ve stopped the bleeding, call 911 (or your local emergency services number) if someone hasn’t done so already. The faster a person with a tourniquet gets professional medical care, the more likely a positive outcome.

Materials and items that work as tourniquets

Manufactured tourniquets, made for exactly that purpose, are best when available. If you have to improvise, remember the following

• The best improvised material is half-inch diameter medical latex tubing.
• In a pinch, stockings/hosiery will also work.
• Don’t use belts, wires, cables, etc. They aren’t likely to work.

What are the potential benefits and risks of tourniquets?

Tourniquets save lives when used properly. The downside of a tourniquet is that it cuts off circulation to parts of the limb below it. While that stops dangerous bleeding, it can also lead to damage from lack of blood flow (ischemia). And if ischemia lasts too long, the affected limb might need amputation.

Tourniquets can remain in place without permanent damage for up to two hours under ordinary conditions. But tourniquets should be as temporary as possible, so emergency medical care for them is always critical.

Is it safe to practice using a tourniquet while training?

Yes, but only with professional supervision. Many first aid classes led by trained, certified instructors can teach you how to use them. Local nonprofit groups, healthcare organizations and first responder departments often host them.