How To Apply A Tourniquet Correctly: Because Death Is Not An Option

Tourniquets save lives. Disregard what you read or learned in the 90s from that community first-aid course as the global war on terror threw out all the old misinformation about tourniquet use. The old belief was that tourniquet use would lead to limb loss. Now, surgeons can restore limb use hours after a tourniquet has been applied. For around $30, you can equip yourself with a tourniquet that can be self-applied or used on a loved one. Having a tourniquet is not enough. Knowing how to apply it is the other part of the equation.

CAT 7 and SOF-T Wide

​The two most common tourniquets you’ll find in training classes are the North American Rescue C.A.T. 7 and the Tactical Medical Solutions SOF-T Wide. Both of these tourniquets function similarly with a buckle that tensions and a band that is tightened with the twisting of a windlass. They stop massive bleeding by occluding blood flow through arteries in the arms and legs. While stopping the bleeding with direct hand pressure is possible, a good tourniquet will hold long after a rescuer’s hands fatigue. Both of these tourniquets are available in a variety of colors, but the most visible or contrasting color is the best choice for easy identification.

How To Apply A Tourniquet Correctly

Staging

​With any tourniquet, ensure it is staged in a way that allows easy access and deployment. Do not leave it in the plastic packaging from the factory. Set up your tourniquet to have a large enough loop to pass an arm or leg through and fold it in a way that the flick of one hand will prepare it for placing it on the extremity. Where you carry your tourniquet will also factor into your survival.

They can be placed in a vehicle on the “oh damn” grab handles and daily on your person in an EDC bag near the very top. You don’t want to waste precious time searching for it in the bottom of your bag. Make sure you don’t carry your tourniquet in a manner that would damage it or get it dirty to the point it will not function properly. Also, before you go to apply a tourniquet, make sure you initiate a call for advanced medical care. Task an onlooker by calling 9-1-1 and start the process of getting help to you.

Two-Hand vs. One-Hand Application

​Before you put your faith in a tourniquet, learn to apply it and practice over and over with it. There are dedicated blue training tourniquets for the C.A.T. 7, and the SOF-T wide can be used over and over to practice placement. If you use the C.A.T. 7, stretch the band out before storing it. Pull the loose end of the strap toward your heart when you place either tourniquet over your arm or leg.

You will generate more force closer to your centerline than you will pulling to the outside of your body. That initial pull is incredibly important. Learn to use your tourniquet on your leg by either unthreading or unclipping the loop, placing it around the leg, and then reattaching it before tensioning. There may be a scenario where a foot is pinned, so looping a tourniquet around the lower leg and up into position is impossible. Opening the band may be the only way. Train for as many possibilities as you can imagine.

High And Tight

​The general guideline for placing a tourniquet is “high and tight.” You want to get the tourniquet high up on the arm or the thigh. This does not mean on top of the shoulder but just below the deltoid on the arm. Keep in mind that there is a chance the artery you are trying to constrict may be retracted into the body and not where you see the bleeding. Also, if you want to put pressure on the brachial artery, your upper arm has one bone (humerus) while the forearm has two (radius and ulna).

The same is true of the leg, as the upper thigh has the large single femur and the lower leg has the tibia and fibula. Don’t apply the TQ over elbows, wrists, knees, or ankles. There is no need to remove clothing as the tourniquet will work over the top. On the flip side, remember that heavy clothing can hide bleeding, and thick jackets can absorb a lot of blood. Make sure you check your patient with a thorough assessment.

Tighten and Secure

​Continue tightening the turnbuckle using the windlass until the bleeding stops. If your patient is conscious, they may comment on the pain or discomfort you are causing them. Tourniquet pressure hurts, but it won’t kill someone. You can practice on yourself and test for a pulse to get an idea of how much pressure it takes. Don’t leave the tourniquet on yourself for more than a minute if you train this way.

Once you achieve the correct amount of pressure, make sure you secure the windlass using the gate, velcro, and triangular ring provided. If you have a lot of excess strap, you can figure 8 the strap around the windlass before securing it in place with the secondary measures. If you must move a patient, monitor the tension on the tourniquet and prevent it from bumping into any objects that could loosen it. Reassess the tourniquet during and after movement. Recheck it often, don’t loosen it due to the distal end of the leg reducing in size because of the blood being stopped.

Don’t Loosen

​After your tourniquet is in place, mark the time it was administered. Whatever you do, do not loosen the tourniquet. The idea of opening and closing it over time is dated advice. The only person who should remove that tourniquet is someone with more training than you and an “M.D.” suffix after their name. Once the tourniquet is in place, be prepared to relay information to the first responders that can help them address the patient’s needs. If you need to move the patient or yourself to help, consider tasking others as support to carry or assist in the transport. Continue to monitor and assess the patient until you are relieved of your responsibility. Learning how to apply a tourniquet correctly can be the difference between life and death.