A tourniquet is a tight band or strap that is applied to a limb such as an arm or leg, to stop the flow of blood temporarily. The tourniquet is a simple yet critical medical device used to control severe bleeding in emergency situations.
Injuries and tragedy can strike at any time, in everyday life or extreme and unlikely situations. It could be a car crash or a particularly nasty fall. In other circumstances, the heat of the moment in combat underscores the importance of swift life-saving actions. A tourniquet (TQ) is an essential life-saving tool that can, and has been the difference between life and death on the battlefield and in everyday life.
This article seeks to shed light on tourniquets, delineating their purpose, utility, various components, and maintenance to equip readers with essential knowledge on this device.
What Does a Tourniquet Do?
At its core, a tourniquet serves as a life-saving tool. It operates as a compression device specifically designed to halt blood flow to a wounded extremity, like an arm or leg. By doing so, it plays a vital role in preventing excessive blood loss, which if left unchecked could be fatal.
To grasp its significance, you need not rely on imagination alone; media coverage of events like shootings or explosions often showcases immediate aftermath scenes, where victims suffer from severe bleeding. In these critical moments, the rapid application of a tourniquet can be the decisive factor between life and death, effectively stemming blood loss.
To put things in perspective, an average person typically has between 4,500 to 6,000 mL of blood, depending on their size. Losing just 50% of this volume is generally considered fatal. The Brachial artery, governing blood flow down the arm, can lead to death within a mere 5 to 60 minutes if uncontrolled bleeding occurs. Similarly, the Femoral artery in the leg poses the same life-threatening risk and times.
Beyond combat situations Combat Application Tourniquets (CATs) are a popular choice due to their proven efficiency and ease of application. tourniquets hold equal significance in various emergency medical scenarios. Whether it’s accidents resulting in traumatic injuries or surgical procedures requiring precise control over blood flow, tourniquets stand as indispensable tools, capable of preserving lives when every second counts.
Parts of a Tourniquet
As simple and straightforward as modern tourniquets may seem there are many specifications for each individual piece of the whole.
The Strap
The strap is a semi-flexible band made from durable and non-stretchy material that wraps around the injured limb. It serves as the primary medium to exert pressure on the limb, restricting blood flow. These bands are made with an excess of material to fit on the leg of any individual.
Windlass
The windlass is a rod-like structure that plays the primary role in tightening the strap around the limb. As it’s twisted the strap’s pressure on the limb intensifies, effectively halting or reducing blood flow. Once blood flow is stopped by the pressure, the windlass is secured to prevent unwinding.
C-Clip
Also known as the windlass clip, the C-Clip acts as a locking mechanism. After the windlass has been turned to achieve the necessary pressure, it is secured in place with the C-Clip, ensuring the tourniquet remains tight and effective.
Time Tag
A crucial yet sometimes overlooked component of a TQ is the time tag. This is a small, writable area on the tourniquet. Once applied, the time of application should be noted here. This is critical information for medical personnel, as leaving a tourniquet on for prolonged periods of time can cause additional complications or harm. Knowing how long the device has been in place helps medical staff better treat the wound with minimal complications.
Where to Apply a Tourniquet
Choosing the right spot to apply a tourniquet heavily correlates with effectiveness. Tourniquets are applied on limbs, given that these are the most common sources of treatable life-threatening hemorrhages in trauma situations. The upper arms and above the knees are the primary areas, as they are the broadest parts and can most effectively restrict blood flow. Quick access to, and prompt application of, a tourniquet can literally be the difference between life and death. This is especially important in situations where every second counts, such as in arterial bleeding.
Proper Tourniquet Application
The right technique in tourniquet application is vital. An improper application might not only be ineffective but could also exacerbate the injury. Here’s a basic guideline to ensure it’s done right:
**We are not medical professionals or trained physicians, the following information is not medical advise, it is what we have been taught through trainings and courses.**
Find the Bleeding Source
Identify the source of major bleeding. In cases of trauma where multiple injuries are present, it’s even more important to determine which wounds are life-threatening and prioritize those. Search for the location of arterial bleeding, evident by spurting blood or bright red blood.
Apply Pressure
Using a hand or a hemostatic dressing, apply direct pressure to the wound. This can help control the bleeding temporarily, especially while you prepare the tourniquet for application. If the victim is conscious instruct them to do so, leaving your hands free to provide aid and prep the TQ.
Positioning
At minimum place the tourniquet 2-3 inches above the injury, but not on top of a joint (e.g., avoid the knee or elbow). If the exact location of the injury is unknown, or if there are multiple injuries, position the tourniquet as high as safely and securely possible on the limb.
Apply and Tighten
Apply the tourniquet to the limb. It is recommended to stage a tourniquet so that it can be slipped around a limb and tightened, saving precious time. Once in place tighten the strap as tight as you can, and secure the strap so it will not move.
Windlass
Once the tourniquet strap is in place, twist the windlass until the flow of blood stops. This requires a fair amount of strength and can be very painful to the victim.
Secure the Windlass
After the windlass is twisted to a stop, secure it in place using the C-Clip or other locking mechanism. It’s important to double-check that bleeding has indeed stopped post-tightening. If not, you will need to use a second tourniquet before removing or adjusting the original.
Time It
Always note the time of application on the time tag or elsewhere if one isn’t available. This information is vital for medical professionals. Generally, a tourniquet should not be left in place for more than two hours, but the situation will dictate whether this is necessary. Leaving the tourniquet in place for longer than two hours increases the likelihood of long-term damage, however this is preferable to bleeding out.
History of Tourniquets
Tourniquets have been a part of medical practice and battlefield triage for centuries. Their origin traces back to the Roman Empire when they were rudimentarily used to control bleeding, especially during amputations. During the Renaissance, the tourniquet was refined by French surgeon Ambroise Paré, who used a stick and a band to prevent excessive bleeding during surgeries.
As warfare evolved, so did the necessity for efficient battlefield medical interventions. The tourniquets used in the 18th and 19th centuries were often simple belt-like devices, tightened with a twist mechanism. Their usage was widely documented in major conflicts like the American Civil War and World War I.
It wasn’t until more recent conflicts, such as the wars in Iraq and Afghanistan that the importance of rapid and effective tourniquet application became more widely recognized. Modern tourniquets, made from durable materials with more efficient designs, are now standard issue for many military units and are also commonly found in civilian trauma kits. With time virtually all medical gear has become both more effective and more accessible to anyone seeking it.
Tourniquets Myths
Tourniquets come with their share of myths and misconceptions like many medical tools. One of the most persistent myths is that applying a tourniquet will inevitably lead to amputation of the affected limb. While tourniquets do stop blood flow which can be damaging if left for extended periods, the risk of amputation is far less than the risk of uncontrolled hemorrhage leading to death.
Modern training and guidelines emphasize the use of tourniquets in life-threatening bleeding situations, as they save lives when used properly. The key is timely application and ensuring that they’re removed as soon as possible by medical professionals, usually within two hours.
Another misconception is that tourniquets are only for “last-resort” situations. However, in many trauma scenarios, especially those involving arterial bleeding, they should be among the first interventions. Early intervention saves lives by preventing the victim from bleeding out, but also heavily delaying other symptoms of blood loss such as shock. A person is able to lose roughly 30% of their blood volume before their resting heart rate and blood pressure become affected.
Maintenance
Tourniquet maintenance is really simple and will keep the TQ functioning effectively as long as it is well maintained. Here are some maintenance tips and proper care advice for tourniquets:
- Regular Inspection: Check the tourniquet for wear and tear periodically. Ensure that all components, including the windlass, strap, and locking mechanism, are in good working condition.
- Cleanliness: After use, throw the tourniquet away. They are cheap and can be purchased again. If there is blood on the tourniquet it should not be used on another person. Many bloodborne pathogens die relatively quickly, but not all. After use a tourniquet will have been stretched, and the strain on the band means it may not be effective on a consecutive use.
- Avoid Excessive Sunlight: While many modern tourniquets are made from UV-resistant materials, it’s still a good idea to store them away from direct sunlight to prevent degradation. Excessive UV radiation could lead to parts becoming brittle, and resulting in the band/windlass snapping when put under tension.
- Replace When Needed: Like all tools, tourniquets can wear out. If the strap shows signs of fraying or if any component becomes loose or dysfunctional, replace it immediately.
- It is a Tool: Tourniquests are a tool, and should be treated as such. Don’t play with it, mess with it, or use it for practice if you will be using it for an emergency. Training tourniquets can be purchased, but it is important to use a fresh tourniquet that is in top condition for real application.
Frequently Asked Tourniquet Questions
Tourniquets are used to control severe bleeding from an extremity, such as an arm or leg.
At minimum 2-3 inches above the injury on a limb, higher if possible.
Everyone can benefit from having a tourniquet, remember they are a first line tool to stop bleeds. Tourniquets will be found as standard issues in the military, and among first responders.
Tourniquets are typically made from materials like nylon, Velcro, or other sturdy, flexible materials.
No, using a tourniquet does not necessarily mean amputation. When used correctly and for a limited duration, tourniquets can be lifesaving without causing the need for amputation.
Yes, when used correctly and for a limited duration, tourniquets are generally safe and can save lives in situations of severe bleeding. However, they should only be applied by individuals trained in their proper use, and their use should be temporary to prevent complications.
Tourniquets should be stored somewhere they can be accessed easily such as in a tourniquet holder affixed to a plate carrier or belt. This keeps them accessible to yourself or others in the event you need help treating an injury.
Final Thoughts
The importance of tourniquets in emergency scenarios cannot be overstated. Their ability to halt life-threatening hemorrhages has made them an indispensable tool in medical kits of professionals and civilians alike. With the ever-increasing awareness about emergency preparedness, having knowledge about tourniquets and their application is crucial.
However, while articles like this can provide foundational understanding, there’s no substitute for hands-on training. Applying a tourniquet correctly under stress demands both knowledge and practice. Those who might find themselves in situations where a tourniquet is required should seek out proper training and regularly refresh their skills.
Moreover, the quality and accessibility of the tourniquet itself equip anyone with the capability to save a life. It’s not just about having one but having one that’s reliable and within quick reach when seconds count. Companies like Tacticon recognize this and have developed options for tourniquet holders, ensuring rapid accessibility in these situations. A tourniquet soft holder or a TQ soft pouch can be added to any of our plate carriers or battle belts in keep tourniquets out of the way and easily accessible.
While the world of tourniquets might seem straightforward, there are depths to explore, from the nuances of their application to the myths surrounding their use. Embracing the journey of learning and preparedness can not only be personally enriching but can truly make a difference in a life-or-death situation. Always prioritize safety, continuous learning, and ensuring that you have the right equipment at hand.
For training check Stop the Bleed for courses offered near you, they are generally fairly inexpensive to attend.
The opinions expressed in this post are those of the author and do not necessarily reflect the views and opinions of Tacticon Armament.
