Emergency First Aid: When and How to Apply a Tourniquet?

The tourniquet is a powerful, valuable, and yet dangerous medical tool. With one right decision you can use a tourniquet to save a man from bleeding to death, but with a wrong one you can irrevocably destroy parts of another man’s body. It is important to know how to use it properly so that it can save lives, but it is equally important to know when to use a tourniquet so that it does not cause unnecessary harm.

What Makes a Good Tourniquet?

A tourniquet is meant to be used for one purpose and one purpose only, which is to stop the flow of blood to a limb. Typically this comes into play when someone has a wound to the arm or leg that is too large or persistent to be stopped by a bandage and applied pressure. Although there are several military styles such as the C.A.T. tourniquet that are used by soldiers in the field, they can be somewhat expensive for the budget-conscious prepper. When it comes time to improvise, then, what makes a good tourniquet?

It must apply pressure over a fairly wide area. Shoelaces and cord are terrible tourniquet materials because they squeeze a tiny area very tightly, which causes damage to blood vessels. Within reason, the wider a tourniquet is the better. If in doubt, make sure that the improvised material is at least 2 inches wide.

apply tourniquet

It must soft without being “mushy”. It has to pull tightly and apply enough pressure to cut off blood flow, but if it is too hard it can be painful for the patient and may not wrap completely around the contours of the arm or leg, making an imperfect seal.

It needs to be strong and durable. When improvising tourniquets from rags and clothing, the problem of ripping and tearing as the patient is carried, moved, or generally jostled about. Once you’ve applied a tourniquet it should only be removed under controlled conditions, so a rag that suddenly snaps in two is actually worse than letting the patient bleed without a tourniquet at all in some cases.

It needs something to tighten it. Just tying a knot is usually not enough, and you’ll need a pen, stick or other object to twist the tourniquet until it is properly tight. Military tourniquets come pre-equipped with their own rods.

It needs to be easily seen. This is actually more important than you may think. A tourniquet is not a minor bandage to be applied and then forgotten: you will need to pay attention to it and inspect it frequently. If you have multiple bandages wrapped around the person, you’ll need a special color or mark on the tourniquet to identify it so that it is not carelessly damaged or removed.

Now that you have some idea of how to improvise a tourniquet, let’s look into when you should use one.

When to Apply a Tourniquet?

A tourniquet should not be used unless it is strictly necessary, but it is not a “last ditch” resort. There are huge arguments over this very issue in the medical field, with anecdotal evidence giving testament to both the life-saving and life-destroying power of a simple strip of cloth. I therefore make the best recommendation I can, but you should do additional research periodically to see what new developments have surfaced.

Notice how the blood is welling out of the bandage even after pressure is applied: if there is enough coming out to kill the person, it is time for a tourniquet.

Tourniquets should be applied when a life-threatening injury on an arm or leg cannot be stopped by direct pressure and bandage application. That sounds incredibly simple, but the truth is that it can be hard to tell when that is. A mangled leg from a bear attack might cause the victim to bleed out, or it might not. An otherwise small wound to the thigh could cut a major artery, and immediate action may be needed to save a life. You will have to use your best judgement, make the call, and then live with the consequences either way.

In general you should apply a tourniquet if the bandage has been saturated with blood and more is still seeping around the edges, clear evidence of further bleeding.

How to Use a Tourniquet?

The wound should be identified and inspected, rapidly if necessary, to determine the best place to apply the tourniquet. This is particularly important in the event of multiple wounds or if the blood obscures the exact location of the bleeding site. You want to apply the tourniquet just above the wound that is bleeding, so figure out which one is your “leaker” and move on to the next step.

If you have them, apply sterile gloves. Human blood is nasty stuff, and it carries a lot of diseases out of the body to you, and back into the body of the patient. Keeping a clean barrier between you and the patient could be vital for both of you. Furthermore, it allows you to shuck the gloves off and put on another pair if they become too slippery.

Choose the site and wrap a soft separating piece of fabric flat around the arm or leg. This can be a sleeve or pant leg, or a rag or other cloth. It is not the tourniquet: rather you are providing a barrier between the tourniquet and the skin to keep it from tearing into the skin and causing additional bleeding or pain.

Wrap the tourniquet around the separator, taking care to keep the surface as flat as possible, Your site should be about 2 inches above the wound, or if you cannot find the specific bleeder than on the upper arm or thigh. If there is a joint 2 inches above, move a little higher. Joints prevent you from putting pressure on the blood vessels below, and you want to maintain that 2 inch minimum. Keeping the fabric flat prevents the tourniquet from digging into the skin and causing more pain.

Tying the tourniquet on top of the limb with an overhand knot, place your stick or other implement in the knot. This knot is easily removed but also strong, and has a convenient loop for you to insert the stick into. This will give you leverage to twist the tourniquet tightly.
Begin twisting the stick in order to tighten the tourniquet until the bleeding stops. This may cause pain for your patient, but the need to save their live is much more important here.

Secure the stick in place to maintain the tension. Use another cloth to tightly tie it to the patient’s leg or arm. It is vital that the tourniquet not come undone at this point.

Inspect the tourniquet regularly, as your situation allows. If you were patrolling away from the retreat with only a few people, that is obviously different from caring for multiple people at the retreat after a battle or accident. Tissue and blood vessel damage typically occurs within 2 hours of tourniquet application, but some tourniquets have been removed after almost a full day of use and no damage resulted. You want to make sure that no more blood is seeping out and that the tension stays consistent. Your patient will be useless in monitoring their own health, as severe blood loss is incredibly draining on a person physically and mentally.

Treat the wound as best you are able, but if no other solution is available you will be amputating. The simple fact of the matter is that a limb without blood will die and turn gangrenous. If you do not run into someone with sufficient medical knowhow to fix the previously unstoppable blood flow, then the limb will have to be removed at some point very soon.

Never remove the tourniquet unless you know no medical help will be available. Time and again it has been shown that removing a tourniquet to temporarily allow blood to flow into the damage limb actually causes more harm to blood vessels than a single application. If there is nothing else that can be done and the patient is going to be able to lie still and rest for awhile, loosen the tourniquet at least 1 hour (2 is better) after the bleeding is completely stopped by the tourniquet. If no more blood flows (or if renewed flow can be halted by renewed efforts with a bandage/pressure) then start treating the wound and do not apply the tourniquet again. If not, put the tourniquet back on and do not remove it again.

This diagram gives you a simple description for using a tourniquet on an arm wound, though it lacks the addition of a protective cloth under the tourniquet.

A tourniquet is a fabulous tool for saving lives in an emergency, and it’s fairly easy to improvise one out of common materials. But common sense when using one is a little harder to come by, so be sure you know how and when to use one.

Special Disclaimer

I never claim to be an infallible expert in anything on this site, medical advice especially, and a tourniquet is a very dangerous tool in the wrong hands. I strongly advise getting training in the use of a tourniquet, from the Red Cross or other certified entity.

Also be aware that using one of these in our modern world can carry serious liability concerns, particularly since even the right decision can be ruined by an improperly applied tourniquet. I hate that our litigious culture would make us hesitate to protect human life, but a second to consider the implications of your actions both for the victim and for yourself is wise.

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