Save Lives Like a Combat Medic: How to Use a Tourniquet to Control Major Bleeding

by A Manly Guest Contributor on March 21, 2012 · 60 comments

in Manly Skills, Survival

Editor’s note: This is a guest post from Bruce A. West. Mr. West served as an Army medic in the Iraq war. He taught over 500 soldiers how to save lives in a class called Combat Lifesaver, and will be sharing his knowledge here on AoM in a series on important first aid/first responder skills every man should have.

You’re hiking along a trail with your buddy when a mountain lion darts out from the bushes, leaps onto your friend, and sinks its teeth into his leg. You grab your pocket knife and stab the cat with it, causing the animal to run off. Your buddy’s leg is a chewed up mess, and it’s bleeding profusely. You’re miles from civilization…do you know what to do?

Basic emergency medical skills are a must-have to survive the perils you encounter in the wilderness–or even in your own backyard. There are many schools of teaching in first aid, but few know how to keep it SIMPLE quite like the Combat Medic. Sure, modern medics carry bags full of fancy gear, and they use it too–but what they can do in lieu of these tools is what a man should know for survival.

In the woods, along a road, or in the aftermath of a natural or man-made disaster, you won’t have major trauma equipment. At most you’ll have a first aid kit, the clothes on your back, and whatever is available in the environment around you. But when you know how to improvise, these are all the tools you need. These techniques aren’t in textbooks. They don’t follow all the rules. They’re the battle-tested survival skills that have been passed down through generations of line medics. They’re fast. They’re simple. And they save lives.

One of those skills is knowing how to control major blood loss without dedicated gear. And it’s something every man—whether soldier or civilian–should be well-versed in. Today I’ll be providing a primer on this lifesaving piece of knowhow.

Your Blood Loss Control Battle Plan

If there’s someone else with you besides the victim, have them call 911. If it’s just you and the victim, stop the victim’s blood loss first, and then call 911. To stop the blood loss, follow these steps:

Step 1: Make sure your surroundings are safe, and keep yourself safe by wearing gloves.

Protect yourself from immunodeficiency diseases (and all other diseases) by putting on some rubber gloves. Because of people’s potential allergies, I would suggest spending a couple dollars more and investing in powder-free, latex-free gloves for your car or first aid kit. The common gloves used in today’s EMS are made of nitrile. They’re cheap, and they fit nicely in your car’s…glove box (finally it will live up to its name!). Your use of gloves doesn’t commonly anger people you’re saving, so do it for ALL victims.

Step 2: Expose the open wound.

We have a saying in emergency medicine: “A happy trauma patient is a naked trauma patient.” You just don’t know what’s wrong with them if you can’t see it.

Remove the clothing over the injury. Nothing fancy to it: tear the pant leg or shirtsleeve out of your way. If their clothes are too tough to rip by hand, carefully start the cut with your knife.

Step 3: Apply firm, direct pressure to the wound site.

Use gauze on the wound during this step if it’s available. If there is no gauze, use a towel or washcloth or a rag torn from a shirt. Try to avoid having to use this homemade dressing unless it’s an emergency situation, i.e., the patient is bleeding excessively, or you are far from civilization. Non-sterile bandages can cause further unnecessary infection–but keep in mind that if you’re five miles from nowhere it is better to contain the wound with only a few germs than leave it exposed to all germs.

If the pressure does not stop the bleeding, and the dressing becomes soaked with blood, you will need to apply a tourniquet.

Wait! Are tourniquets safe?

Before we move on to the next step, I think a word about the safety of tourniquets is necessary, as much of what you think you know about bleeding control is probably based on outdated knowledge. For decades, standard emergency medical services (EMS) controlled bleeding using a series of six tedious steps. The tourniquet was seen as the nuclear option and was used only in a last ditch effort to stop bleeding. The aversion to the tourniquet was based on the belief that by completely stopping blood flow to a limb, tissue around the limb would start to die, which would result in the patient having to undergo amputation.  Unfortunately, by following traditional bleeding control steps and leaving tourniquets as a procedure of last resort, people lost more blood than they needed to.

Unlike civilian EMS, military medicine practices have long called for tourniquet application much earlier in the treatment for blood loss. Recent research in military hospitals in Iraq and Afghanistan has shown that, contrary to popular belief, using a tourniquet doesn’t guarantee limb amputation or even nerve loss. In fact, researchers found that among patients who had a tourniquet applied to a limb before arriving to the hospital, only 0.4% of them underwent an amputation and usually the reason they got an amputation had nothing to do with the tourniquet. On the nerve damage front, only 1.5% of tourniquetted patients suffered any kind of permanent nerve damage. Based on this newfound knowledge, many civilian EMS teachers and practitioners are starting to encourage tourniquet use much sooner.

Necrosis of muscle tissue doesn’t onset until after 2 hours without blood flow, and can even last 5-8 hours without consequences resulting in amputation; so you can keep the tourniquet on for awhile–but you want to get the victim help as soon as possible.

Now with that FYI under your belt, let’s move on to choosing and applying that tourniquet.

Step 4: Choose a tourniquet.

In today’s military, all soldiers are issued tourniquets to accompany their armor and weapons, and every soldier is trained and proficient at applying his tourniquet–even one-handed on his own arm. The common tourniquet used by the army, the Combat Action Tourniquet (CAT tourniquet), is made for single-handed application; they run around $30 and aren’t practical for a civilian to carry around in his pocket every day.

Luckily you don’t need a dedicated tourniquet to save a life. Look around you; there are tourniquets everywhere. Are you wearing a belt? Tourniquet! Have laces on your shoes? Tourniquet! Long sleeve shirt, bicycle inner tube, backpack strap, or a female observer’s brassiere? All tourniquets! You can fashion this lifesaving device out of anything your mind can conceive as a tourniquet. (You might consider rope or a survival bracelet first if you have them handy.)

In order to tighten your tourniquet, you’ll also need a torsion device. This can be anything long and stick-like. If you’re in the woods I recommend using, well, a stick. If there are absolutely no sticks or stick-like objects around you, then close your knife’s blade, or put the sheet on it, and give it up for a good cause. It’s now your torsion device.

Step 5:  Apply the tourniquet.

First, so we’re all on the same page: Tourniquets are ONLY applied on limbs! Never on a neck! (If you did this, you wouldn’t be the first.) Major bleeding control practices in areas not accessible by tourniquets (like the stomach and back) will be covered further at another time.  With that out of the way, here are the steps of applying a tourniquet:

Wrap the limb with a rope/belt/bra at least two inches closer to the body than the wound. Do not apply a tourniquet over a joint--blood passageways are protected in joints, and you’ll never put pressure on the arteries. Place it closer to the body than the joint. Then tie the tourniquet in place once using an overhand knot.

Place your desired torsion device on top of the overhand knot. Tie another overhand knot, then another (or tie a square knot if you’re knot savvy) to secure the torsion device onto the tourniquet.

Twist the torsion device in one direction until bleeding stops.

Secure the tourniquet in place. This can often be accomplished by using the loose ends from your last knot to tie one end of the torsion device to the tightened tourniquet, or to the limb.

Step 6: Assess for shock.

So you’ve saved this person from bleeding out with a handy-dandy tourniquet. They’re not home free yet. Make sure they’re still breathing. Seems obvious, but if you fail to do so you’ve wasted a tourniquet. You’ve probably heard the adage: Look, listen, and feel! Put your ear near their mouth and listen and feel for breathing while looking at their chest to make sure it rises and falls. If it doesn’t, make it. Here is where you apply CPR. But that’s another lesson for another day.

After you’ve made sure your patient is indeed still breathing, check for signs of shock. If you’ve placed a tourniquet on the patient, it’s very likely they’ll suffer hypovolemic shock. Don’t freak out–it’s a big sounding word, but it basically means: “too little volume.” They’ve just given up a lot of blood volume, so it’s kind of a given–though not a guarantee.  Signs of hypovolemic shock include:

  • Cool, clammy skin (moist, cool, and pale skin)
  • Cyanosis (big word, but it means blue skin)
  • Weakness
  • Confusion
  • Rapid breathing
  • Unconsciousness

To treat shock, first lay the patient down flat on his back. You may have once learned to elevate their feet–dismiss this practice! Research has shown this can cause pooling of blood in the organs and brain and other damage. Next cover the person to keep them warm: employ blankets, coats, and clothes, whatever you can offer–just keep them warm! (That old hypothermia technique of huddling for heat can come in handy here too.)

Step 7: If 911 has not been called yet, do so now.

If rescue workers cannot get to you where you are, or there is no phone service, never leave the victim alone to look for help–grab them and go. Be prepared to do the fireman’s carry.

Congratulations! You now know how to save a life! Go out unto the world knowing you can help make it a safer place.

Disclaimer:  This lesson, while informative, far from replaces the invaluable experience of taking an American Red Cross first aid course. It is strongly recommended you contact your local Red Cross representative to set up a class and become certified. While you’re at it, take CPR as well! You’ll rarely regret your decision to be educated in lifesaving when you’ve had the opportunity to apply it.

{ 60 comments… read them below or add one }

1 William L. Allen March 21, 2012 at 7:18 pm

As a TC3 instructor I found the sight interesting. I always go high. The arm should always be above the elbow where there is only one bone and as well always above the knee due to two bones in the lower leg. This is something everyone should not only know but practice as well but remember the CAT is a once only use and yes I do carry one in my jump bag my EDC and my vehicle. Better to have and not need than need and not have.

2 Art March 21, 2012 at 7:40 pm

One note, at least from the EMS perspective: don’t use a rope if you can avoid it! You want your tourniquet to be wider in order to be effective. They teach us at least 2″. This isn’t just because something narrow is going to cut the skin and could actually cause worse injury. A wider tourniquet will displace the force over a larger area and will actually be much more effective at slowing the bleeding to a point that it can be controlled–which is the point of the tourniquet in our world.

3 Mike March 21, 2012 at 7:50 pm

Good article, Bruce. The only thing I would add is that when selecting a tourniquet, ensure it isn’t anything that would cause lacerations such as wire, shoe strings, headphone cords, etc. A good rule of thumb is to find something at least an inch thick. Having taught CLS, I am sure you have had to address this before.

4 Robert March 21, 2012 at 8:15 pm

+1 on the wide tourniquet.

Another important thing is DO NOT store gloves in the glove compartment… it gets hot. They degrade over time. Even in a backpack be sure to swap them out every several months. Treat them like condoms (also something that shouldn’t be left in a car). Doing that is asking for a glove that will fail. You don’t want that to happen. Don’t take chances.

5 Stephen March 21, 2012 at 8:18 pm

Yeah, tourniquets are safe as long as they’re removed pretty quickly.

They really are still the nuclear option in terms of stopping bleeding, even today, even though they may be used more readily than they used to be. The issue with military medicine is the severity of injury they’re dealing with — the risk of necrosis after a few of hours of no blood flow to a limb pales into insignificance if you’ve hit an IED.

Misusing one can absolutely end in someone losing a limb, so do be careful.

6 Kerry March 21, 2012 at 8:34 pm

As a TCCC qualified SOF medic, I can attest to the wonders of a properly applied TQ. I have to disagree with Stephen’s opinion on them still being the nuclear option to stopping bleeding. If it is dark, oozing blood (venous) then a properly applied pressure dressing should do the trick but if it’s bright red spurting blood (arterial) then immediate TQ application is the correct course of action. Misusing one can end in someone losing a limb but not using one can cost a life, as has been proven in many combat situations in the military and pointed out in the article. Definitely be sure to use something 1-2 inches if at all possible. Another good alternative in a first aid or blow out kit would be the SOF-T TQ.

7 Mathew Larmer March 21, 2012 at 9:01 pm

As a Hospital Corpsman(Navy and Marine Corps ‘combat medic’ and therefore TCCC qualified) I must agree with the TCCC instructor Mr. Allen. if you’re going to put a tourniquet on, put it on very high into the limb. If it’s the arm, put it on up near the shoulder, and if it’s the leg, put it very close to the groin area. This prevents you from missing parts of the injury, or accidentally crunching down on a kneecap, or a broken femur, which would both make a tourniquet less effective and harder to stop bleeding. Another reason being is that if the femoral artery is ever completely severed, it has a tendency to shrink up into the leg(and sometimes into the thigh- typical a life ending situation.)
TQ’s can stay on for roughly 8 hours before any real nerve damage occurs, beside the fact that if you need to use a TQ, its a life over limb situation.
And a well applied TQ WILL hurt. there is no avoiding it. a lot of people stop when they hear their friends screaming, but before they stopped bleeding. Dont stop till the bleeding stops.

8 Michael Morris March 21, 2012 at 9:16 pm

Good article! It replaces a lot of outdated knowledge. I’m glad you pointed out where the technique differs from practices of old.

9 Paul March 21, 2012 at 9:38 pm

Great article! As an outdoors-man, knowledge is definite power.. though this is information I hope never to need to use.

10 Lucas March 21, 2012 at 9:39 pm

Nice article! I had thought that tourniquets were outdated and widely discarded, but my preconceived notions have been proven wrong once again.

On a side note, regarding your comment about gloves not angering the people you’re saving. I’ve never had someone I’m “saving” (nothing I attended to as a lifeguard was ever life threatening) mad at me, but I have had some parents be rather pissed off that I took the time to put on gloves before helping their six-year-old with their minor scrap.

11 Zachariah March 21, 2012 at 9:54 pm

“a female observer’s brazier? All tourniquets!”

I’m surprised this hasn’t happened in any movies–that I know about. Seems like something House MD might do…

12 Nick March 21, 2012 at 10:05 pm

My county just updated our EMS protocols to allow the use of tourniquets again. About time – when done right they’re the only way to stop major arterial or venous bleeds

13 M March 21, 2012 at 10:31 pm

Tourniquets are back in New Jersey as well. If the bleeding can’t be controlled by direct pressure, it’s tourniquet time. (NJ also has the advantage of comparatively short transport times for EMS.. there’s much less of a time factor involved than some remote places out west.)

14 Andy March 21, 2012 at 10:49 pm

I am an instructor for Wilderness First Aid for the American Red Cross, and tourniquets are still presented as kind of “last resort” in that program. It doesn’t specifically say that in the manual, but it says “for UNCONTROLLABLE bleeding”. So I can certainly see why people would think they’re not recommended. Also, something that we teach is to mark down when the tourniquet was put on, ON the patient if possible (think Sharpie) so that other can get that information if you’re not around, or have forgotten. Of course, any time you give any medical care you should keep a record.
A plug for the RC, any of you interested in this sort of thing would probably find the Wilderness First Aid class through the Red cross very helpful. Also, an organization called NOLS has some excellent programs.

15 Amir March 22, 2012 at 12:16 am

Informative article and nice pictures. Is the ciggy part of the TQ technique to calm down the medic/soldier? They are both are in a hyper situation…

16 bryon March 22, 2012 at 2:13 am

Not sure how outdated my old first aid info is, but during my time with a volunteer fire department, we were taught to let the wound profuse every so often to allow blood back into the extremity downstream of the TQ. Also, if treating many victims at a scene, those to which a TQ was applied were to have a “T” written on their forehead using pen, lipstick, charcoal etc.to alert others.

17 JonEdanger March 22, 2012 at 3:34 am

Great article. I’d suggest one change: Add a section 1a. – ABCs. Joe Neophyte gets so wrapped around the axle (excuse the pun) with using his newfound TQ knowledge he forgets to check to see if his buddy’s airway is open or if he’s breathing. (D)eadly Bleeding comes 4th.
Did I miss the CPR article or is it forthcoming?

18 Stuart March 22, 2012 at 3:52 am

Hi here in Australia,
I’m a first aid instructor with St john ambulance. When we talk of bleeding control we use a constrictive bandage as last resort. It could be veiwed as a tornique if you consider a 5cm, about 2inch, bandage a tornique.
We apply the bandage above the elbow, or knee on the single bone. this enables the blood to be completely stopped.
We teach to leave the bandage on for only half an hour, and remove it to check if the bleeding has stopped. If it has not, reapply it as necessary.

19 Bruce West March 22, 2012 at 3:55 am

This is a bleeding control instruction, not an an airway obstruction lesson.
ABC’s are included. They come after tourniquets in this writeup.
ABC is a wonderful mnemonic, but not the perfect solution.
For a lot of folks ABC is all you need; but for someone bleeding uncontrollably, if you don’t tourniquet first you’re going to lose them.
Say they’re not breathing – you can fix that. But if they’re not breathing and you jump immediately to rescue breaths or CPR, and meanwhile they’re bleeding out their femoral artery: you’ll lose them.
I’ll be teaching a new acronym in my next submission that works for trauma with significant bleeding.
Don’t forget your ABC’s, just know they don’t save all lives in all cases.

20 Bruce West March 22, 2012 at 3:57 am

Michael Morris,
Thank you sir.

21 Stephen March 22, 2012 at 4:15 am

@Kerry

It’s a nuclear option, metaphorically, because you’re not just applying a dressing or drug to the wound, you’re cutting off blood to the whole limb. The only more nuclear option to control bleeding would be stopping the heart.

The relative merits of that depend on the severity of the injury — you would never recommend a tourniquet for a paper cut. Spurting, arterial bleeding gets a tourniquet because it is really, really serious. You don’t tie them for fun.

22 Stephen March 22, 2012 at 4:19 am

Just to clarify, I’m not advocating cardiac arrest as a bleed control measure. It’s to show the significance of a tourniquet compared to a pressure dressing.

23 Bryan March 22, 2012 at 8:35 am

I took a Red Cross EMT course last year, and the instructor told us that the real risk of a tourniquet is the possibility of a blood clot forming that then starts to move after the tourniquet is released. (potentially life-threatening). We were told that some hospitals would automatically amputate a limb that had a tourniquet because of the risk of blood clot. They taught to instead use pressure points to stop the bleeding as much as possible. I would be interested in hearing more from an authoritative source on this.

And the point of the tourniquet is to completely stop the bleeding, so loosening it every so often can undo what you’re trying to accomplish.

Don’t just throw a tourniquet on because there’s a little bit of blood and you always wanted to try it.

24 Dominic March 22, 2012 at 8:41 am

As a paramedic, I love reading articles like this! The doc in charge of my med command is an Army doctor who did at least two tours in Iraq. As a result, a lot of our protocol is based on military techniques. For bleeding, if direct pressure doesn’t work, we go straight to the tourniquet/CAT. It’s simple and effective.

The only thing I would suggest, is that if a tourniquet is applied, we’re told to not removed them for any reason. Doing so, especially if the tourniquet has been on for a while, will introduce a whole host of backwash toxins into the patient’s circulatory system (unless you happen to have a dose of sodium bicarb in your first aid kit).

25 Doug March 22, 2012 at 9:46 am

Outstanding article. I am currently in the process of a pioneer program at my school to have our students form an Campus EMS Branch. A very good insight to a very profound field.

To both the author of the article and the commenters, I am seriously considering enlisting as a corpsman in the Navy. I currently attend a maritime college, and want to go into the military after college; what route I wind up taking is still up for debate, however if you guys could give me any advice on a corpsman’s life, that would be greatly appreciated. My email is deuce592@sbcglobal.net.

26 Joshua S. March 22, 2012 at 10:12 am

I was taught how to use a tourniquet in Boy Scouts. Pray to God I never have to use it.

27 Erik March 22, 2012 at 10:47 am

I agree with an earlier comment by Art. Not only will a wider tourniquet be more effective at cutting off blood flow, studies have shown that the wider a tourniquet is the less chance there is of losing the limb.

28 Mike March 22, 2012 at 10:47 am

Just a word to the wise. In many years as an active Paramedic you don’t encounter many situations where a good old pressure bandage doesn’t stop the bleeding. So always try firm pressure with a bandage first. You will mostly see the use of tourniquets in a ripping or tearing injury. The body has a natural defense mechanism called vascular spasm which just means the arterial wall can spasm constricting itself and choke off blood loss on it’s own. It primarily loses the ability to do this when the artery is torn or ripped. Most of the clean cut injuries can be controlled with pressure.

29 PFC Reep March 22, 2012 at 12:22 pm

Might have missed it somewhere but it’s critically important to write the time applied. Whether it be lipstick on the face or a sharpie on the tourniquet, it lets medical authority know whether or not they can save the limb. It’s good to see a combat medic post. I’m a NCEMT-B and 68W combat medic in training.

30 Earl of Essex March 22, 2012 at 3:11 pm

Its pretty simple- Life before limb. In my ambulance, if your bleeding all over the place and I cannot stop it with all the gauze and bandages and towels etc on hand- You’re getting a tq before I lose you.

31 Firefighter Tyler March 22, 2012 at 7:03 pm

+1 on wide tourney
+1 on civilian EMS use. NREMT is now teaching pressure then tq (just like this article suggests) rather than arterial pressure.

32 Bruce West March 22, 2012 at 7:24 pm

Bryan,
NREMT changed it’s standards on bleeding control recently. You’ll likely cover that when you go in for refresher training. If you’d like to see the chances in practical standards, the manuals are all available on nremt.org.

33 Mike March 22, 2012 at 10:42 pm

PA DOH also has revised their external hemorrhage protocol to include tourniquets.

http://www.jems.com/article/patient-care/civilian-ems-should-consider-tourniquets

34 DClark March 23, 2012 at 12:18 am

You could get to say with a straight face though, “Madam. I need to save this person’s life. Please remove your bra.”

35 Justin W March 23, 2012 at 10:42 am

I feel like a few steps were missed between direct pressure to the wound and applying a tourniquet. I’ve always been taught how to control bleeding in this order: direct pressure to the wound, and if that doesn’t work then elevate the wound higher than the heart (if possible), and if that doesn’t help then apply pressure to the wound as well as the major artery running through the leg or the arm (put pressure on the inside of the thigh or inside of the bicep to do this). Then if these steps don’t contain the bleeding, you will need to try something else, such as a tourniquet. Also, if a dressing gets soaked in blood, don’t take it off and add a new one. Leave the old dressing on and add layers of dressings to it.

All in all, a very helpful article to people that are unfamiliar with this

36 Scott Lesovic March 23, 2012 at 11:52 am

The trauma phrase I’m familiar with is “You’re not mine until you’re naked and mine.” I do like the happy phrase too.

For the ambulance driving folks, ABC is nearly out and being substituted with CAB.

Just remember… all bleeding stops… eventually.

37 Michael Main March 23, 2012 at 5:46 pm

I loved this article. Believe it or not I went through the combat lifesaver’s program a million years ago at Fort Hood (First Team!). I have to admit, having two buddies that were combat medics, that those guys are amazing.

I loved the class, and have often wished I could take it again. Alas, being a plain old civilian for over a decade now, I haven’t seen that opportunity come up again. Maybe we need some of these SOF Medics and Combat Medics to offer manly workshops for AOM subscribers.

Loved the first article, looking forward to the next one Stephen.

38 Sam March 24, 2012 at 12:00 am

http://www.cinchtq.com/

What’s your take on the Cobra Tourniquet?

39 Anon E. Mouse March 24, 2012 at 1:02 am

Cobra looks good. Think I’d still prefer the CAT though.n Cobra looks incredibly easy to apply. It’s probably faster too. I have little confidence in my ability to self apply it with a wet hand though.

40 Bruce West March 24, 2012 at 2:32 pm

That Cobra looks pretty nice! Would be a handy tool to have. I like it.

41 Mike March 25, 2012 at 2:18 pm

Justin, those are the old ways that were taught to control bleeding. There’s been an overhaul on treatment in the last two years.

Scott, the reason civilian ems teaches medics ABC first is the fact that we never operate alone. It’s easy to direct someone else to control bleeding but controlling an airway is generally an advanced skill. So most of the time ABC is being done simultaneously.

Also, calling civilian medics Ambulance drivers is a pretty derogatory term in the world of EMS.

42 jeremy March 28, 2012 at 2:16 pm

Great post, missed one step though if direct pressure does not stop the bleeding combine elevation of the limb with direct pressure.

in my 5 years of working as an EMT I have found the combination almost always works.

Btw elevation is also a text book next step after direct pressure.

43 Krieg March 29, 2012 at 4:15 pm

Whenever you apply a tourniquet you should write down the time you applied it. If you don’t have anything else to write it down on use the blood and put it on the person’s forehead for the paramedics.

44 Gabe Long March 31, 2012 at 8:51 am

I am a civilian medic and I am indeed incorporating the tourniquet earlier. In tx for major bleeding. As far as elevation and pressure points and cold packs, they’ve been skipped over in the NREMT guidelines. Direct pressure, straight to tourniquet.

45 DK March 31, 2012 at 7:42 pm

I was involved in a very serious mountain bike accident once where my broken seat punctured my superior femoral vein located right next to my crotch. It was unfortunately too close to my body to allow for a tourniquet. Luckily veins are lower pressure so we were able to control the bleeding enough by applying heavy pressure for an hour until the medics could reach me. However, if I had hit the artery (just a few millimeters away) it would have been game over for me. That is kind of a scary thought.

I really appreciate this article (and this website in general – including all of the great, informative comments) for posting quality information regarding all aspects of life. Information like this can easily help save lives.

46 Lil' kevy April 1, 2012 at 4:50 am

First i must say I love this site and the wealth of knowledge of the people that comment. That being said, I am not in any way certified but believe in the use of tourniquets but the one thing I have read which I believe no one has addressed is the possible formation of a blood clot that could potentially kill the victim. Is this a real concern?

47 Lil' kevy April 1, 2012 at 4:51 am

First I must say I love this site and the wealth of knowledge of the people that comment. That being said, I am not in any way certified but believe in the use of tourniquets but the one thing I have read which I believe no one has addressed is the possible formation of a blood clot that could potentially harm the victim. Is this a real concern?

48 Lil' kevy April 1, 2012 at 4:53 am

First I must say I love this site and the wealth of knowledge of the people that comment. That being said, I am not in any way certified but believe in the use of tourniquets. The one thing I have read which I believe no one has addressed is the possible formation of a blood clot that could potentially be fatal to the victim. Is this a real concern?

49 Lil' kevy April 1, 2012 at 4:55 am

First I must say I love this site and the wealth of knowledge of the people that comment. That being said, I am not in any way certified but believe in the use of tourniquets. The one thing I have read which I believe no one has addressed is the possible formation of a blood clot that could potentially be fatal to the victim. Is this a real concern?

Thanks for any further info.

50 Bruce West April 1, 2012 at 6:27 pm

Lil’ Kevy,
A thrombosis (clot) is treatable through IV medication, and very serious ones can be surgically removed. Put a tourniquet on a person and they can develop a thrombosis distal to the tourniquet (farther down from), but the tourniquet keeps the clot from finding its way to the heart, just as it keeps the limb from bleeding. Fear of thrombosis is no reason not to apply a tourniquet, because if you don’t the person can very likely die. The hospital will get rid of the clot, and most of the time they’ll still save the limb. You get the pleasure of saying you’ve saved their life.

51 Rocky April 13, 2012 at 1:17 am

A combat medic, there are two phases of care. First is care under fire, just throw a tourniquet as high as possible to stop bleeding. Later on the tourniquet can be adjusted, if needed. People seem to forget that surgeons leave tournequets on for hours will no ill effects, tissue necrosis is a much lower priority than extenguation and clots are easily treated by warfarin. I’m a pa student and the same information is taught to us, I’ve used tourniquets and there is no doubt they save lives, be it improvised, a cat or more expensive soft t. Good article, it applies.

52 Jason April 19, 2012 at 10:19 pm

In the care under fire phase of T3 they are recomending the tourniquet be applied as far up as possible. Easier landmarks instead of trying to figure out two inches above the wound site. You may only see blood in one spot while the wound is superior to the bleeding. Plus its hard to see wounds under BDU and other long clothes. Purpose of the tourniquet is to stop hemmorage and to keep the blood closet to the vital organs. Also remember to apply direct pressure to the wound site while you are applying the tourniquet.

53 Chris October 3, 2012 at 9:33 am

One of the posted said (paraphrase) “I pray I don’t have to use these skills”. If we are trained, capable, and “ready for action” men, should we not pray that we CAN use our skills to save a life? Better us then an untrained person. We should pray (or hope, or desire) that WE are the ones put in situations to help.

54 Gavin November 21, 2012 at 2:01 pm

As a combat medic and graduate of BCT3 (advanced trauma course), I can tell you that if you need to quickly apply a tourniquet, you do NOT expose the wound first. That takes way too much time. FIRST (always first!) is to apply proximal pressure. Drop a knee with all your body weight near the armpit (for arm bleed) or near the seam of old-school briefs near the crotch for leg bleeds. After proximal pressure is applied FIRST, then open the tourniquet and slide it under the leg or arm and above where your knee is located on the limb in a saw motion. Next, apply the tourniquet and turn the windlass until you cannot turn it any more, then secure it. Proximal pressure reduces bleeding while you fumble with a tourniquet. This has been proven in recent wars.

55 Gavin November 21, 2012 at 2:11 pm

Also, remember that combat medicine is 5-10 years ahead of civilian emergency medicine.

56 g November 30, 2012 at 8:44 am

Surgeons use TQ’s to manage blood flow during surgery on limbs.

A Blood Pressure Cuff is also a TQ.

57 price December 3, 2012 at 4:03 pm

“A victim isn’t dead until he’s warm and dead” ~ favourite first aid saying when dealing with patients that you have no clue what happened to.

58 XPO172 April 16, 2013 at 6:18 am

As a civilian who is a regular at a gun range and the “outdoors”, I’ve found it helpful to get updated hands on first aid training. Look first for an ex-military trainer that uses TCCC protocols. If you don’t have any classes nearby, then look for Red Cross Wilderness First Aid or worst case Red Cross First aid.

Here’s my trainer of choice in Texas.
http://lonestarmedics.com/

59 Don April 16, 2013 at 11:21 am

I have two SOF-T TQs and a blowout kit within easy reach at all times, part of my EDC. Proper training is essential though.

60 KA Turner February 14, 2014 at 10:47 pm

CAB instead of ABC is taught in the 2010 AHA guidelines for ALL rescuers. BTW the “ambulance driving” moniker is probably for civilian, non-tactical EMS. It still diminishes the strides that EMS has taken in the past fifty, forty, even thirty years.

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