Medical emergenciesin the wake of natural disasters, vehicular collisions, or even a violent shooting are tricky to treat. You shouldn’t move the injured until their condition is stabilized. While waiting for trained medical personnel to arrive, assistance from average citizens significantly improves a patient’s chances of survival. Knowledge of basic first aid and other useful emergency treatments are indispensable in such situations.
Traumatic injuries from accidents or acts of violence may lead to rapid and fatal blood loss. In fact, physical trauma or injuries are the leading cause of death among Americans younger than 46 years old. Locating and controlling bleeding, therefore, is paramount for patient survival when administering emergency care.
In severe cases, a tourniquet may be what saves a patient from bleeding to death.
The Basics of a Tourniquet
What is a Tourniquet?
A tourniquet is a cuff-like device designed to quickly and effectively stop bleeding. It features a strap that wraps around the injured limb and a windlass or rod to tighten the strap and prevent blood flow.
The earliest versions were first used in surgeries and military combat. Soldiers these days are trained to use tourniquets for immediate medical treatment in combat situations. The US military, for instance, uses theCombat Application Tourniquet.
When should a Tourniquet be Applied?
Emergency respondents are trained to apply a tourniquet on a patient before they lose more than 20 percent of their total blood content. Patients whoexperience sudden blood loss and low blood pressure soon go into hemorrhagic or hypovolemic shock. Early application of tourniquets not only prevents this but also stems the bleeding before it causes the patient to slip into a coma or die.
Life-threatening blood loss often stems from a cut arterial vein. This is characterized by pulsating or spurting blood with a bright red color. Potentially life-threatening cases of bleeding, on the other hand, have a slow and steady flow, as well as dark red-colored blood.
Tourniquet as a First Aid Treatment
The use of tourniquets was traditionally only meant as a last resort, due to misconceptions about it that could lead to more serious injuries in a patient — tourniquets have historically and inaccuratelybeen associated with the process of immediate limb amputation. Modern emergency medical services providers and authorities emphasize the opposite. Thanks to military combat casualty data, a tourniquet is now considered an aspect of first aid.
Tourniquets as first aid prove especially important in cases of traumatic injuries that involvesevere bleeding. It’s also recommended for patients who havemoderate bleeding but face prolonged extrication or can’t be immediately taken to a medical center.
Dedicated Tourniquet vs. Makeshift Tourniquet
Dedicated or commercially available tourniquets are widely preferred over makeshift or improvised ones. Commercially available tourniquets follow the recommended specifications and materials. This makes them easier to apply and generally more effective than improvised ones.Moreover, they are more effective at minimizing the risks of something going wrong during the application.
When are Makeshift Tourniquets Acceptable?
Not every emergency situation affords you the luxury of access to commercially produced tourniquets. So, although improvised tourniquets are found to be ineffective in 40% of applications, it’s still better than nothing. Adequate knowledge on how to improvise a tourniquet and apply one improves its effectiveness.
Guidelines for Improvising a Tourniquet
Tourniquets only have three parts: 
- The band or strap that winds around the injured person’s arm or leg
- The windlass or rod that pulls the tourniquet tighter and closes the blood vessels
- A securing mechanism to keep the windlass in place
When making an improvised tourniquet, consider its materials carefully. Materials that are too rigid won’t be twisted and tightened properly. Use a durable and flexible fabric for the strap. Experts recommend using asoft, wide piece of cloth to prevent the tourniquet’s edges from digging into the skin and potentially causing another injury. The cloth should ideally be at least two inches or five centimeters wide when twisted or tightened.
Some materials to avoid when making improvised tourniquet bands are:
- Leather belts
- String or shoelaces
- Ropes
- Wires
- Neckties
Your makeshift windlass needs to be strong enough not to break when used to tighten the tourniquet band. A cylindrical object, such as a branch or sturdy pen, or a flat one, like a knife or scissors, are good options.Meanwhile, the improvised securing mechanism can simply be a hair tie, rubber band, handkerchief, or the ends of the cloth used for the tourniquet band.
How to Properly Apply a Tourniquet
The proper application of a makeshift tourniquet minimizes the risk for complications. Regardless of whether the tourniquet used is a commercial or improvised one, civilians are advised to call emergency professionals before applying a tourniquet. It’s also important to talk with the injured person. Make sure they understand the situation and the reason for the tourniquet.
Step One. Apply pressure either directly over the injury or above it. Remove or cut away the clothes around the injured area. Applying the tourniquet on bare skinis necessary to prevent it from slipping.
Step Two. Place the tourniquet band around two to three inches above the injury site. Take note not to place it on a joint, though.
Step Three. Pull the tourniquet tightly and secure it. While commercial tourniquets can simply be slid on or buckled into place, improvised tourniquets should be wrapped around the limb and tied securely with a knot.
Step Four.Place the makeshift windlass over the knot and tie two more knots over it to keep it in place.
Step Five. Twist the makeshift windlass to tighten the tourniquet. Continue twisting several times until the bleeding stops.
Step Six. If the bleeding doesn’t stop or restarts no matter how tight the tourniquet is, don’t remove it. Apply more pressure using your hand or make another tourniquet instead. Place it close to the first one (about an inch or two above it).
Step Seven. Secure the object using another piece of cloth or elastic object to keep the blood vessels constricted.
Step Eight. Write the exact time the tourniquet was applied. Make sure medical professionals willeasily see it.
Common Mistakes When Applying Tourniquets
Civilians (and even emergency respondents) can make mistakes when unsure of their actions or distracted. Consistent training and regular practice are necessary to ensure the correct application of tourniquets. The following are some of the common errors by the unskilled and unpracticed.
Waiting Too Long to Apply. For years, emergency respondents, medical professionals, and civilians were taught that tourniquets were onlya last resort (even for cases of severe bleeding) out of fear it would lead to amputation. While tourniquets are now recommended as a first line of treatment for severe bleeding emergencies, people may still wait too long before usingone. This leads to patients going into shock, reducing the effectiveness of tourniquets when it’s finally applied.
Applying It Loosely. Tourniquets that aren’t tight enoughoften only constrict venous blood outflow and not the arterial inflow. Doing so defeats a tourniquet’s purpose and raises the patient’s risk of developing muscle complications.
Not Using a Second Tourniquet. While one tourniquet is usually enough to control severe bleeding, some cases (e.g., injured patients who are obese or have large limbs) require another tourniquet. Failure to use a second tourniquet leads to the same consequences as applying one loosely.
Periodic Loosening.Periodically loosening and constricting a tourniquet used to be an accepted practice to allow blood to re-enter the injured limb. However, this only increases the patient’s likelihood of dying from gradual exsanguination. It can also damage the constricted blood vessels. Current recommendations state that once a tourniquet is applied it should only be removed if there are other ways to stabilize the bleeding.
Leaving It on for Too Long.Tourniquets are safe to leave on for up to two hours. Any longer than that increases the likelihood of permanent muscle, blood vessel, and nerve damage.
Making a Tourniquet with Unsuitable Materials. Inappropriate materials like leather or cords cut into the skin when pulled tightly and may even lessen the tourniquet’s effectiveness. It alsobrings the patient more pain and adds trauma.
Dangers of Improper Tourniquet Application
Stopping the patient’s blood from flowing into their injured limb may save their life but the improper or prolonged use of tourniquets causes health complications, such as tissue or muscle damage and circulatory problems.
Extended tourniquet time periods can cause ischemic injuries. Ischemia happens due to an insufficient blood supply. This, in turn, leads to a lack of oxygen and nutrients in the ischemic organs or limbs. Ischemia often causes organ malfunction, while severe or protracted cases may lead to complete organ failure.
Compartment syndrome is another possible health issue that arises from improper tourniquet application. The condition happens when an increase in pressure cuts off the oxygen supply to the muscle compartment and damages the nerves. A loose-fitting tourniquet and singular but insufficient one are two possible causes of compartment syndrome.
Although tourniquet use is tied to some health complications, its life-saving capabilities still far outweigh these risks. To avoid the adverse health conditions associated with improper tourniquet application, experts recommend individuals get proper training and practice regularly. Moreover, providing more first aid training opportunities, including tourniquet use,for emergency responders, law enforcement officers, and civilians would improve first response and survival rates in emergency situations.
