Some common misuses of the tourniquet include: • • • •
Placing the tourniquet in the wrong location Using a tourniquet in the wrong situation Applying the tourniquet's band too loosely Breaking the windlass
• Loosening the tourniquet after the bleeding is controlled
The big fear with tourniquets is that limiting blood supply to the limb can result in amputation. This does not appear to be the case in most civilian tourniquet applications. Having a tourniquet in place for up to 2 hours should not have any ill effects beyond those caused by the injury requiring the tourniquet. It typically takes at least 4 to 6 hours for tourniquets to cause harm.
For correct tourniquet use, one must decide if: • The bleeding is life-threatening • The location is suitable for tourniquet use •
Improvised tourniquets
If your medial kit does not have a modern commercial tourniquet, you may have to improvise. Using a belt or necktie is better than nothing, but a 2017 Prehospital Disaster Medicine study showed improvised tourniquets failed 6 out of 7 times.
"An improvised tourniquet is better than nothing, but you need to understand the proper placement and application to make it work properly.
How to be prepared to use a tourniquet correctly
Tourniquet use requires training. Correct use isn't necessarily intuitive. It's not uncommon for lay providers to be taught how to use them and then forget how to do so a couple of months later. This is especially true given that the tourniquet is almost always used under stress and we have difficulty processing under extreme stress.
"Tourniquet application is not as easy as you may think. It looks like a simple device, but in order to work effectively you must position it properly, tighten it appropriately, secure it properly and then check for distal bleeding and pulses.
Proper use includes: •
Placing a wide constrictive band (commercial grade tourniquet is best) 2-3 inches above the injusy site.
• Apply the strap so your fingers will not slide underneath it.
Another bleeding control method, such as direct pressure alone, would better fit the situation
•
Tighten the tourniquet using its windlass until the bleeding stops
• Secure it in place and note the time.
Knowing when and how to use a tourniquet can make a big difference in patient outcome. Proper training will give you the confidence to use a tourniquet properly
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