Tourniquet Training – How and When to Use a Tourniquet

How do you use a tourniquet? When do you use a tourniquet? Does a makeshift tourniquet work as well as a commercial tourniquet? Are you ‘allowed’ to use tourniquets in workplace first aid?

These are all questions we get asked a lot. So, in this blog post we will clear up any confusion you might have over the use of tourniquets.

Please note – this blog post is not intended to be used as tourniquet training, if you need to update your first aid skills, please take a first aid at work training course.

What is a tourniquet?

First, let’s start from the beginning and explain what a tourniquet is used for.

A tourniquet is a tight band used to control bleeding. It can only be used on limbs and not on the torso or head.

A band is placed between the wound and the heart, above a joint with a double bone (such as a knee or an elbow).

The tourniquet is then wrapped tightly enough to stop the blood flowing from the heart, but does not stop the blood flowing towards the heart.

Makeshift vs Commercial Tourniquets

There seems to be a lot of confusion between the use of makeshift tourniquets (the sort of shirt ripping, stick twisting, blood gushing stuff of action movies), and the use of commercial tourniquets (found in emergency first aid kits).

A commercially made tourniquet should be your go to choice. Not only are they fit for purpose and far better at controlling blood flow, they also leave less chance of causing further injury by using unsuitable makeshift tourniquet materials.

This should be included in any emergency first aid kit. But, what happens if you need to help a casualty and don’t have access to a commercial tourniquet?

You can make a tourniquet yourself with a strip of non-stretchy fabric and a windlass (a rod used to twist the fabric tighter).

Good examples of fabric are: a triangular bandage, terry cloths, towels, shirts, etc. The fabric should be at least 1 and a half inches wide. Any thinner and it could do more damage and would be ineffective in stopping blood flow.

Good examples of a windlass are: scissors, stick, metal rod, dinner knife, etc. These can also be easily secured in place.

When should you use a tourniquet?

Is it a last resort? Does someone have to be bleeding out and about to die before you can use one?

The short answer is no. You should of course use less extreme methods of bleeding control first, e.g. applying pressure directly to the wound, or using dressings to causing the blood to clot and stop flowing.

But if other methods of bleeding control don’t work you should use a tourniquet.

If there is uncontrolled or catastrophic bleeding, and there is a potentially life threatening amount of bleeding, using a tourniquet and saving a life is well worth any potential side effects.

Should you use a tourniquet or not?

Tourniquets have had a bad rep over the last few years. This was due to concerns over tourniquets leading to potential Toxic Shock Syndrome (TSS), muscle and nerve damage and tissue necrosis, leading to potential limb amputation.

Let’s clear this up right away. If the need arises First Aiders should use a tourniquet. As mentioned before, it’s far better to save a life than let a person bleed out, even if that means the potential of sacrificing a limb to do so.

Catastrophic bleeding and tourniquet training have been reinstated into emergency first aid at work training courses since October 2017. If you need to add catastrophic bleeding and tourniquet training to your first aid skills, take a look at our available open courses.

tourniquet training and catastrophic bleeding is now included in QualSafe Emergency First Aid At Work Courses

How to use a tourniquet

As mentioned above, the step by step process below is for illustrative purposes only, please make sure you know what you’re doing and have gained permission from the casualty (if possible) before using a tourniquet.

1. Hygiene

Infection control is important. If you’re in a life or death situation with no first aid kit, then you do what you can to keep the wound clean. If you are able, you should wash hands and/or wear gloves (nitrile powder free). Care should be taken to clean the wound as much as possible.

2. Assess and dress the wound

If you have assessed that a tourniquet is needed you should apply pressure to the wound with a haemostatic dressing. The dressing is used to encourage blood to clot, (which happens when blood stops flowing).

Once applied, do not remove this first dressing layer as blood will continue to flow again. If needed, add extra layers on top of the first dressing.

3. Apply the tourniquet

Position your tourniquet around the injured limb between the heart and the wound. It should be placed above a double boned joint, e.g. elbow and positioned at least several inches above the wound. Tie the tourniquet tight. Do not place directly on top of the wound.

4. Tighten the tourniquet

If using a make-shift tourniquet:

Use a windlass (rod/stick) to tighten the tourniquet and stop blood flowing to the wound.
First tie a half knot, add the rod, and fasten the knot above the rod. Twist the rod until the tourniquet is tight and the bleeding stops.
Secure the windlass in place so it doesn’t unravel. You could do this by securing it with another strip of fabric.

Many how-to tourniquet guides tell you to write a “T” and the time of day on the patient’s forehead. Firstly, your patient might not like this! Secondly, a commercial tourniquet has a space to write on the time. If using a makeshift tourniquet, we would recommend just passing on the information directly to the emergency services instead of writing on the casualty!

5. Observe patient

As blood loss can cause shock and its associated symptoms, keep the patient warm and calm until emergency services arrive.

Don’t leave the tourniquet on too long!

Everyone is different, so side effect times for leaving on tourniquets differ from person to person. The longest recorded tourniquet being applied with no issue was 6 hours.

After two hours muscle tissue damage occurs, leading to permanent loss of normal muscle function.
If left on too long, necrosis can set in (death of tissue). If necrosis occurs, the limb may need to be amputated.
The tourniquet should be removed by medical professionals.

Get tourniquet training

If you have not had catastrophic bleeding or tourniquet training on your last First Aid at Work or Emergency First Aid at Work course, take a look at our available courses by clicking on the image below.