Apply A Tourniquet
 

Posted Friday, October 7, 2005

A tourniquet is a constricting band placed around an arm or leg to control bleeding. A soldier whose arm or leg has been completely amputated may not be bleeding when first discovered, but a tourniquet should be applied anyway. This absence of bleeding is due to the body's normal defenses (contraction of blood vessels) as a result of the amputation, but after a period of time bleeding will start as the blood vessels relax. Bleeding from a major artery of the thigh, lower leg, or arm and bleeding from multiple arteries (which occurs in a traumatic amputation) may prove to be beyond control by manual pressure. If the pressure dressing under firm hand pressure becomes soaked with blood and the wound continues to bleed, apply a tourniquet.

WARNING: Casualty should be continually monitored for development of conditions which may require the performance of necessary basic life-saving measures, such as: clearing the airway, performing mouth-to-mouth resuscitation, preventing shock, and/or bleeding
control. All open (or penetrating) wounds should be checked for a point of entry or exit and treated accordingly.

*The tourniquet should not be used unless a pressure dressing has failed to stop the bleeding or an arm or leg has been cut off. On occasion, tourniquets have injured blood vessels and nerves. If left in place too long, a tourniquet can cause loss of an arm or leg. Once applied, it must stay in place, and the casualty must be taken to the nearest medical treatment facility as soon as possible. DO NOT loosen or release a tourniquet after it has been applied and the bleeding has stopped.

a. Improvising a Tourniquet. In the absence of a specially designed tourniquet, a tourniquet may be made from a strong, pliable material, such as gauze or muslin bandages, clothing, or kerchiefs. An improvised tourniquet is used with a rigid stick-like object. To minimize skin damage, ensure that the improvised tourniquet is at least 2 inches wide.

WARNING: The tourniquet must be easily identified or easily seen.

WARNING: DO NOT use wire or shoestring for a tourniquet band.

WARNING: A tourniquet is only used on arm(s) or leg(s) where there is danger of loss of casualty's life.

b. Placing the Improvised Tourniquet.

(1) Place the tourniquet around the limb, between the wound and the body trunk (or between the wound and the heart). Place the tourniquet 2 to 4 inches from the edge of the wound site. Never place it directly over a wound or fracture or directly on a joint (wrist, elbow, or knee). For wounds just below a joint, place the tourniquet just above and as close to the joint as possible.

(2) The tourniquet should have padding underneath. If possible, place the tourniquet over the smoothed sleeve or trouser leg to prevent the skin from being pinched or twisted. If the tourniquet is long enough, wrap it around the limb several times, keeping the material as flat as possible. Damaging the skin may deprive the surgeon of skin required to cover an amputation. Protection of the skin also reduces pain.

c. Applying the Tourniquet.

(1) Tie a half-knot. (A half-knot is the same as the first part of tying a shoe lace.)

(2) Place a stick (or similar rigid object) on top of the half-knot.

(3) Tie a full knot over the stick.

(4) Twist the stick until the tourniquet is tight around the limb and/or the bright red bleeding has stopped. In the case of amputation, dark oozing blood may continue for a short time. This is the blood trapped in the area between the wound and tourniquet.

(5) Fasten the tourniquet to the limb by looping the free ends of the tourniquet over the ends of the stick. Then bring the ends around the limb to prevent the stick from loosening. Tie them together under the limb.

NOTE: Other methods of securing the stick may be used as long as the stick does not unwind and no further injury results.

NOTE: If possible, save and transport any severed (amputated) limbs or body parts with (but out of sight of) the casualty.

(6) DO NOT cover the tourniquet--you should leave it in full view. If the limb is missing (total amputation), apply a dressing to the stump.

(7) Mark the casualty's forehead, if possible, with a "T" to indicate a tourniquet has been applied. If necessary, use the casualty's blood to make this mark.

(8) Check and treat for shock.

(9) Seek medical aid.

CAUTION: DO NOT LOOSEN OR RELEASE THE TOURNIQUET ONCE IT HAS BEEN APPLIED BECAUSE IT COULD ENHANCE THE PROBABILITY OF SHOCK.