In life-threatening situations where severe bleeding occurs, the proper use of a tourniquet makes the difference between life and death. When blood loss cannot be controlled through direct pressure or other methods, applying a tourniquet is one of the most effective ways to stop bleeding until professional medical help arrives.

This comprehensive guide will teach you how to use a tourniquet effectively, focusing on when it's appropriate, how to avoid common mistakes, and understanding the potential risks involved. Whether you're a trained first responder or someone preparing for general first aid, mastering this skill is essential for handling emergencies with confidence.

What is a Tourniquet?

A tourniquet is a medical device used to apply controlled pressure to a limb (arm or leg) to stop severe, life-threatening bleeding. It is designed to restrict the flow of blood to the affected area, usually following an injury that causes major bleeding, such as a cut or puncture to a major artery. Different types of tourniquets are available, each with its own mechanism to stop bleeding effectively:

• Windlass Tourniquet: The most common type, this tourniquet uses a stick (windlass) that twists to tighten the band around the limb. It is often found in military and tactical environments, as well as in emergency medical kits.
• Elastic Tourniquet: These are stretchy bands often used in medical settings, typically for procedures like drawing blood. However, they are also used in emergencies but require extra effort to ensure proper blood flow restriction.
• Pneumatic Tourniquet: These use air pressure to restrict blood flow and are more common in surgical settings. They are rarely used outside of hospitals but may be found in some specialized first-aid kits.

When to Use a Tourniquet?

A tourniquet should be used only when direct pressure, elevation, and wound packing have failed or when bleeding is so severe that rapid intervention is required to prevent shock or death. Knowing the right time to use a tourniquet make the difference between life and death in emergencies. Here are the situations when a Tourniquet is needed:

• Severe arterial bleeding: Uncontrollable bleeding from a damaged artery, often resulting in spurting blood and rapid blood loss.
• Traumatic injuries to limbs: Severe trauma to arms or legs, such as amputations, crush injuries, or deep lacerations.
• Prolonged rescue or delayed medical care: When emergency medical help will take time to arrive, and controlling blood loss is essential to prevent further complications.

Misusing a tourniquet lead to serious consequences. If applied incorrectly or left on for too long, it cause permanent tissue damage due to the restricted blood flow, leading to muscle death. There is a risk of nerve damage, which result in loss of sensation or movement in the affected area.

In severe cases, prolonged use of a tourniquet lead to the loss of the limb, as tissues deprived of oxygen and nutrients for too long may become irreversibly damaged, requiring amputation. Proper training is essential to avoid these risks.

How to Apply a Tourniquet

Applying a tourniquet correctly save a life in severe bleeding situations. However, it must be done carefully to avoid complications. Follow these steps to ensure the tourniquet is applied safely and effectively:

1. Select the Tourniquet: Choose a commercially available tourniquet, or in emergencies, improvise with a strong, non-stretchy material like a belt.
2. Position the Tourniquet: Place the tourniquet about 2-3 inches above the wound, but avoid placing it directly over a joint like the knee or elbow. If the injury is near a joint, position the tourniquet above the joint.
3. Tighten the Tourniquet: Pull the strap of the tourniquet tight, ensuring it is snug around the limb. Use the windlass (a rod or stick) to twist the tourniquet, tightening it until the bleeding stops. Secure the windlass to maintain pressure.
4. Monitor for Effectiveness: Ensure that the tourniquet is tight enough to stop the bleeding but not so tight that it causes unnecessary damage. The bleeding should slow significantly or stop altogether. Check for no pulse below the tourniquet site, which indicates that blood flow to the area has been restricted.
5. Record the Time: It's crucial to note the time the tourniquet was applied. This information will help medical professionals know how long the blood supply to the limb has been cut off, as prolonged use of a tourniquet lead to tissue damage.
6. Monitor the Patient: Keep an eye on the patient for signs of shock and seek professional medical help immediately.

1. Select the Tourniquet

Choosing the right tourniquet is critical for effectively stopping severe bleeding. Commercially available tourniquets, such as the Combat Application Tourniquet (CAT) or SOF Tactical Tourniquet (SOFTT), are designed for safe and efficient use. These are ideal because they are durable, adjustable, and specifically engineered for hemorrhage control. However, in emergencies where a commercial tourniquet is unavailable, improvise using a strong, non-elastic material like a belt, scarf, or strip of cloth. It is important that the material be wide and sturdy to apply adequate pressure without cutting into the skin or causing additional injury.

2. Position the Tourniquet

You should position the tourniquet about 2-3 inches above the wound, ensuring it's placed on intact skin. Avoid placing it directly over joints like the knee or elbow, as bones in these areas prevent the tourniquet from applying sufficient pressure to stop the bleeding. If the injury is near a joint, position the tourniquet further up the limb, above the joint, to ensure proper blood flow restriction. Always make sure the area where the tourniquet is applied is free of obstructions like clothing or debris, as these interfere with its effectiveness.

3. Tighten the Tourniquet

Once the tourniquet is in place, it needs to be tightened to the point that it effectively stops the bleeding. Begin by pulling the strap as tight as possible, ensuring it is snug against the limb. Next, use the windlass (a rod or stick attached to the tourniquet) to twist and tighten the strap further. Continue twisting the windlass until the bleeding stops, which require pressure. Once the windlass is tight, secure it in place to maintain the pressure. It’s crucial that the tourniquet is tight enough to cut off circulation but not so tight that it causes extreme pain or additional injury.

4. Monitor for Effectiveness

After tightening the tourniquet, closely monitor the effectiveness of your application. Check to see if the bleeding has slowed or stopped entirely; if it continues, further tighten the tourniquet. One key indicator that the tourniquet is working is the absence of a pulse below the application site, which shows that blood flow has been restricted. Be aware that applying a tourniquet is painful, but it is necessary to prevent blood loss. If bleeding resumes or continues, reassess the positioning and tightness of the tourniquet.

5. Record the Time

It is vital to record the exact time the tourniquet was applied. Tourniquets restrict blood flow to the area, and leaving them on for extended periods causes irreversible tissue damage or even the loss of a limb. Most medical guidelines recommend not exceeding two hours of tourniquet application. Noting the time will help medical professionals assess the risk of damage and determine when the tourniquet needs to be removed or adjusted in a controlled environment.

6. Monitor the Patient

After applying the tourniquet, closely monitor the patient for signs of shock, which occur due to excessive blood loss. Symptoms of shock include pale or clammy skin, rapid or shallow breathing, weakness, confusion, and a weak pulse. Keep the patient calm and still, as movement exacerbates their condition. If possible, elevate their legs to improve blood circulation and prevent further shock. Continuously reassess their condition while awaiting medical help, and ensure that the tourniquet remains in place and effective. 

When to Seek Medical Help?

It’s important to seek professional medical help immediately in the following situations:

• Severe Bleeding: If the bleeding is uncontrollable with direct pressure or other methods and requires the application of a tourniquet, medical intervention is critical to prevent shock and further complications.
• Signs of Shock: If the patient shows symptoms such as pale or clammy skin, weakness, confusion, rapid breathing, or a weak pulse, they may be in shock and need urgent medical care.
• Injuries to Limbs: For traumatic injuries, such as amputations, deep lacerations, or crush injuries, prompt medical attention is necessary to prevent long-term damage or loss of the limb.
• Prolonged Tourniquet Use: If a tourniquet has been applied, professional help should be sought as quickly as possible to remove it safely, as leaving it on too long lead to permanent tissue or nerve damage.
• Infection Risk: For deep wounds, there is always a risk of infection. Seek medical help to ensure proper wound cleaning and to receive antibiotics or other treatments if necessary.

In any serious injury or life-threatening situation, contacting emergency services immediately is essential.

Common Mistakes to Avoid When Using a Tourniquet

Proper tourniquet application is critical in controlling severe bleeding. However, mistakes during the process lead to ineffective results or even cause additional harm. To ensure the tourniquet is used safely and effectively, it’s important to be aware of and avoid these common errors:

• Applying the Tourniquet Too Loosely: A loosely applied tourniquet will not effectively stop the bleeding and cause increased blood loss. Ensure the tourniquet is tightened enough to completely restrict blood flow to the injured area, as insufficient pressure lead to serious complications.
• Placing the Tourniquet Over a Joint: Never place the tourniquet directly over a joint, such as the knee or elbow, as it will not properly restrict blood flow. Always position it 2-3 inches above the injury, on a flat part of the limb, to ensure the bleeding is controlled.
• Leaving the Tourniquet on for Too Long: Prolonged use of a tourniquet result in permanent tissue and nerve damage, potentially leading to amputation. Record the time of application and seek immediate medical attention to minimize the risk of serious complications.

How long is it safe to leave a tourniquet on?

A tourniquet is safe for up to 1.5 to 2 hours before the risk of permanent tissue damage increases. After 2 hours, the chances of nerve, muscle, and blood vessel damage rise significantly, which could lead to amputation. Seek medical help as quickly as possible since even 90 minutes of continuous use cause tissue death, making immediate intervention essential.

What if I don't have a professional tourniquet?

If you don't have  a professional tourniquet, use a strong, non-elastic material like a belt, scarf, or cloth. The material should be at least 1.5 inches wide to prevent injury to the skin and tissues. While improvised tourniquets stop bleeding in emergencies, professional tourniquets provide better and safer control by maintaining consistent pressure and reducing complications.

Can a tourniquet be used for any type of bleeding? 

No, A tourniquet is only suitable for severe limb bleeding, especially from arteries, where other methods like direct pressure fail. Avoid using a tourniquet for bleeding on the head, neck, or torso, as these areas cannot be compressed safely. Tourniquets work best for life-threatening limb hemorrhage, such as traumatic injuries or amputations.

What is the correct sequence of actions when both CPR and a tourniquet are needed?

When both CPR and a tourniquet are necessary, begin CPR by performing chest compressions at a rate of 100-120 compressions per minute. Provide 30 compressions followed by 2 rescue breaths, using the appropriate technique based on whether the individual is an adult, child, or infant. If you notice severe bleeding during CPR, briefly pause compressions to apply a tourniquet. Position the tourniquet 2-3 inches above the wound, tightening it until the bleeding stops, and then return to CPR while ensuring the tourniquet remains effective.

How does First Aid training prepare individuals to handle situations requiring a tourniquet?

First Aid training equips individuals with the essential knowledge and skills to respond effectively in emergencies where a tourniquet might be needed. The courses emphasize the specific circumstances under which a tourniquet should be applied, focusing on its vital role in controlling severe bleeding when direct pressure is inadequate. Participants learn to recognize the signs of life-threatening hemorrhage and understand the risks associated with improper application. 

By enrolling in our First Aid training, you gain the confidence and skills needed to respond to emergencies effectively and make a real difference when it matters most.

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References:

• American Red Cross. (n.d.). First Aid/CPR/AED Online Training. Retrieved from American Red Cross
• Centers for Disease Control and Prevention (CDC). (2021). Stop the Bleed: A National Awareness Campaign. Retrieved from CDC
• National Safety Council. (n.d.). First Aid Basics. Retrieved from National Safety Council
• American Heart Association. (2020). High-Quality CPR: The Critical Importance of Effective Chest Compressions. Retrieved from American Heart Association
• U.S. Department of Defense. (2018). Tactical Combat Casualty Care (TCCC) Guidelines. Retrieved from TCCC
• Mayo Clinic. (2022). First Aid: Controlling Bleeding. Retrieved from Mayo Clinic
• World Health Organization (WHO). (2016). First Aid in the Workplace. Retrieved from WHO