Tourniquets and Where to Use Them

Tourniquets can only be used on arms or legs. With other parts of the body, you would have to use direct pressure and haemostatic dressings. They are used to control excessive bleeding that you cannot control with direct pressure and pressure dressings. These types of bleeds are classified as catastrophic bleeds. They include amputations, stab wounds, gunshot wounds or other serious injuries.

A person can lose a potentially fatal amount of blood when they lose about 40 percent of their blood. Their body can no longer compensate for the blood loss by increasing the heart rate and dilating the blood vessels. You can lose 40 percent of your blood in just 3 to 4 minutes with a femoral artery bleed. In other parts of the body, this will be more. This shows that we must stop blood loss as fast as possible and we do not have a lot of time to think.

When bleeding is very severe, and if the person needs CPR, there is little point in delivering chest compressions if the blood is all forced out of the wound.  In this case,  we can add a “C” to the DRABC cycle and this “C” is Catastrophic Bleeding. Catastrophic bleeding needs to be stopped before we commence CPR. Time is crucial and we need to apply a tourniquet quickly so we can then treat other life-threatening conditions like cardiac arrest.

When we apply a tourniquet,  the aim is to block the arteries and the veins. The arteries are found deeper in the limb and the veins nearer the surface so we need to apply the tourniquet tight enough to block the deeper arteries and not just the veins. Applying the tourniquet too loosely would be life-threatening for the patient.

When you apply a tourniquet, it will be painful to the patient and hard work for you physically and emotionally but it is vital it is done quickly.

The tourniquet needs to be applied directly to the skin ideally, although it can be applied over clothing. Make sure there are no other injuries above the application site that could be hidden by clothing.

Tourniquets were advised to be applied to a single bone like the upper arm or thigh bone but 2017 guidelines updated this to say that tourniquets should be applied above the wound but not over a joint.

Apply the tourniquet at least 5cm above the joint of the knee or elbow to avoid damaging the joint when it is tightened.

Tourniquets can be applied to yourself one-handed if you need to. This is done very effectively in military settings across the world.

Tourniquets are only removed in a hospital by a Doctor and never by a first aider even if the patient complains of the pain of the tourniquet. This pain should reduce as the area goes numb.