In light of recent terror attacks across the world, being able to provide first aid and an improvised tourniquet has become essential.
The trauma and devastation caused by explosions can be horrific and in the aftermath of such an attack being able to apply an improvised tourniquet could save someones life.
One of the most common questions I get when teaching is “Are you going to show us how to make a tourniquet?” I’m not sure if this stems from watching old westerns with cowboys twisting handkerchiefs around a stick, but apparently this is something that people know to ask about, but not how to do properly. This post is designed to teach you how to fashion an effective improvised tourniquet.
But before we begin, it’s absolutely essential that we start with one caveat.
** Improvised tourniquets are poor substitutions for commercial tourniquets. **
Improvised / makeshift tourniquets should be converted to a commercial tourniquet as soon as possible.
Fill in the Blanks below :
A tourniquet should only be used as a _______ __________ .
If you said Last Resort you need to keep reading. Tourniquets have been around since the middle ages and they have saved countless lives. However, there is A LOT of confusion surrounding them. The intent of this post is to clear up some of the confusion and teach you how to make a tourniquet if someone is bleeding to death and you do not have a commercial tourniquet.
Here is a short list of what we’d love for you to take away from this post:
- A mindset shift that Tourniquets are safe & effective
- An understanding that Tourniquet application is NOT likely to lead to amputation of a limb
- Tourniquets should be considered a First Resort (not a last resort) for life threatening extremity bleeds
- Improvised Tourniquets are rarely effective at stopping arterial blood flow and far less effective then commercial ones
- Commercial Tourniquets are affordable and widely available and you should have them on hand in the event of an accident
- Stopping a Bleed in an arm or leg is a manageable task, and NO ONE should ever bleed to death from an extremity wound
Anyone can save a life, and you don’t need years of training to do it. We offer online training for tourniquets and haemostatic dressings – use this code for a discout UK-HPBNJO
When is a Tourniquet needed ?
- whenever you have uncontrollable bleeding from an Arm or Leg
- whenever their is an amputated or partially amputated limb
- when you have multiple injuries or multiple victims to address
- if other attempts to control a bleeding extremity have failed (direct pressure,bandages)
- when your description of the bleeding limb begins with an expletive “Oh S#*%, that’s a lot of blood!”
STEP 1: Apply Pressure
- Stopping bleeding requires pressure – apply firm and aggressive manual pressure
- Its possible that direct pressure over the wound site may not be the most effective means of controlling a bleed
- Pressure above the wound on the artery should slow down or even stop blood flow to the injured portion below
- Applying pressure above the bleeding area is a stop gap fix that will buy you time to locate a commercial tourniquet or the materials needed to improvise one
Step 2 : Apply a Commercial Tourniquet
OK it’s a blog post on improvising a Tourniquet but I wanted to stress how much more successful the outcome can be if you have the right tool for the job.
Step 3 : Improvise a Tourniquet
To make an effective Tourniquet you will need 3 things:
Material – a band of some sort to wrap around the extremity
Windlass – rigid object to twist the material (hand tightening is ineffective)
Securing mechanism – something to keep the windlass from unwinding
Material should be at least one and a half inches in width, but no one is going to take time to measure. Utilizing material thinner then one and a half inches is less likely to stop arterial blood flow and more likely to cause nerve damage. Tourniquets that are not wide enough are more dangerous and less likely to be effective. Remember, your largest artery is approximately the thickness of your thumb, so compressing/standing on/kneeling on that limb is a far better option then bleeding out.
Good options for material:
- Neck Tie
- Neckerchiefs, scarves, bandanas
- Fabric long enough to wrap around limb
- Nylon webbing
- Triangular bandage folded into a strip
Poor Options for Material:
- Belt – seems to be the number one thing people suggest using, however it’s a poor choice for an improvised tourniquet. Under stress people will try to tighten a belt around a limb the same way it’s tightened around a waist and that will never be tight enough to stop arterial flow. Option two is to use an object as a windlass to gain a mechanical advantage. A windlass is a crucial step in fashioning an improvised tourniquet but is unable to to create enough torque or pressure due to the belts rigidity.
- Zip Tie – likely to be very painful and cause tissue and or nerve damage
Good windlass options:
- Carabiner – these make a great windlass provided they are sturdy enough.
- Stick – a good old fashioned stick, sturdy enough to not break with pressure.
- Jack handle – trauma is often the result of a motor vehicle crash and most vehicles are equipped with a jack.
- Broom handle – may need to be cut down but should be sturdy enough.
Poor Windlass Options:
- Pens / Pencils – another item that is frequently on hand but very likely to break
- Hands – trying to rely on your hands and brute strength is a bad idea and likely to result in an ineffective tourniquet.
Adding a windlass to an improvised tourniquet is a crucial step in the process and should not be skipped. Studies show a 32% failure rate with use of a windlass compared to a 99% failure rate when no windlass is used.
The picture shows an improvised tourniquet using a pair of tough cut scissors.
Steps 4 – 7
- 4th Step – Once the tourniquet is complete the next step is to reassess the wound and confirm that the bleeding has stopped or slowed down to an inconsequential amount. *Bonus Tip – if possible check for a pulse in the injured limb, a pulse should not be present below the tourniquet.
- 5th Step – complete a thorough hands on evaluation of the victim to assure they have no other life threatening bleeds
- 6th Step – Note the time of tourniquet application – if possible write the letter T and the time the tourniquet is applied on the patients forehead
- 7th Step – Evacuate the victim for urgent medical attention
Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma John F. Kragh, Jr., MD, Thomas J. Walters, PhD, David G. Baer, PhD, Charles J. Fox, MD,
Charles E. Wade, PhD, Jose Salinas, PhD, and COL John B. Holcomb, MC
Tourniquet use at the Boston Marathon bombing: Lost in translation King, David Richard MD; Larentzakis, Andreas MD; Ramly, Elie P. MD; The Boston Trauma Collaborative
Role of the Windlass in Improvised Tourniquet Use on a Manikin Hemorrhage Model. Altamirano MP, Kragh JF Jr, Aden JK 3rd, Dubick MA.
This article has been written with the kind permission of and information from https://firstcareprovider.org/blog/tk-how-to