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Apply a Tourniquet

Apply a Tourniquet

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Andrew’s Note:  Today we’re providing a lesson from the Army’s Combat Lifesaver Course (ISO871 Edition C Approved For Public Release) on how to properly apply a tourniquet.  Before we get started let me be perfectly clear…this is a refresher for those that have been trained in the proper use of a tourniquet and a gentle prod for those who haven’t received any training to seek training through a first aid or wilderness medicine course. 

Over the years the use of a tourniquet in first aid situations has fallen into and out of favor.  Currently the military medical community is promoting the proper use of tourniquets as an important lifesaving skill and the incredible wound survival rates in our current and recent conflicts are based in part on the training and proper use of this lifesaving technique.  That said…never use a tourniquet unless the life or the limb is in danger…and all other bleeding control measures (elevation, direct pressure and pressure dressing) have failed or aren’t suitable.  Additionally, seek qualified medical care IMMEDIATELY if you have to apply a tourniquet.

This lesson  teaches how to apply the Combat Application Tourniquet (CAT) but similar techniques can be applied to the much simpler and more reasonably priced Tourni-Kwik-4 (TK-4).  I own and like both the CAT and the TK-4 but the CAT runs about $28.00  each and the TK-4 runs just $5.50.  Both of these tourniquets can be applied one handed which is very important for self aid.  The TK-4 is the one that rides with me every day in the car…accessible from the drivers seat…just in case…

APPLY A TOURNIQUET

DETERMINING IF A TOURNIQUET IS REQUIRED

A tourniquet is a constricting band placed around an extremity to stop arterial bleeding by stopping blood circulation to the part of the limb below (distal to) the tourniquet.  A tourniquet is only used on an arm, forearm, thigh, or leg when there is a danger of the casualty bleeding to death.

WARNING:  A tourniquet is not used for wounds to the head, neck, or trunk (chest and abdominal area).

a.  Wound on an Extremity.  Bleeding from a major artery of the thigh, lower leg, arm, or forearm and bleeding from multiple arteries may prove to be beyond control by the methods discussed in Section II.  If you have applied a pressure dressing and firm hand pressure, but the dressing has become soaked with blood and the wound continues to bleed, apply a tourniquet.

NOTE:  The tactical situation may not allow the time or safety for conventional methods of controlling the bleeding if you are under fire.  The recommended means to control bleeding while under fire is a rapidly applied tourniquet.  Tourniquets may be left in place for two hours without major complications.

REMEMBER:  If you are unable to control bleeding except with a tourniquet, it is better to sacrifice a limb than to lose a life due to excessive bleeding.

 b.  Amputation.

(1)  An amputation may be complete (the limb is completely severed) or partial (the two parts of the limb remain connected by some skin or other tissue).  Both require a tourniquet.  Both involve bleeding from multiple arteries and are beyond control by the methods discussed in Section II.

(2)  A person who has suffered an amputation of the arm, forearm, thigh or leg may not be bleeding severely when first discovered, but a tourniquet should be applied anyway.  Lack of bleeding is due to the body’s normal defenses (contraction and spasm of blood vessels) because of the amputation.  However, bleeding will start when the blood vessels relax or if the clot is knocked loose while moving the casualty.

Combat Application Tourniquet

Figure 4-6. The Combat Application Tourniquet

APPLYING A COMBAT APPLICATION TOURNIQUET

A Combat Application Tourniquet (CAT) (figure 4-6) is the tourniquet of choice.  It is effective and can be applied quickly.  Use the CAT from the soldier’s Improved First Aid Kit (IFAK) [Andrew's Note: they want you to the other guy's tourniquet, not yours].  Procedures for applying the CAT are given below.

NOTE:    The Combat Application Tourniquet in figure 4-6 is shown in its one-handed application configuration.  The CAT is delivered in this configuration and is the recommended storage configuration.

a.  One-Handed Application.  The one-handed application is normally used when the CAT is applied to the upper extremity (upper arm or forearm).

(1)  Remove the CAT from its pouch.

(2)  Slide the wounded extremity through the loop formed by the tourniquet band (figure 4-7A).

(3)  Position the CAT so the tourniquet band is two inches above the wound.

Applying the CAT Using the One Handed Technique

(4)  Pull the band tight and securely fasten the tourniquet band back on itself (figure 4-7B).

(5)  Adhere the tourniquet band around the limb (figure 4-7C).

NOTE:  Do not adhere the tourniquet band past the rod-locking clip.

(6)  Twist the windlass rod to tighten the tourniquet band (figure 4-7D).  Continue tightening until the bright red arterial bleeding has stopped and the distal pulse is eliminated.  The darker bleeding from the veins may continue draining for a while.

(7)  Place the windlass rod inside the rod-locking clip, locking the rod in place and keeping the tourniquet from untwisting (figure 4-7E).

(8)  Check to make sure that the arterial bleeding has not started again and the distal pulse is still absent.  If arterial bleeding has resumed or the pulse is present, remove the windlass rod from the clip, tighten the tourniquet band until the bleeding and/or pulse are absent, and replace the rod in the clip.

(9)  Adhere the end of the tourniquet band over the rod, inside the clip, and fully around the limb (figure 4-7F).

(10)  Secure the windlass rod and tourniquet band with the rod-securing strap.  The CAT is now properly applied and the casualty is ready for transport.  If the casualty is not to be transported at this time, check the tourniquet periodically.

b.  Two-Handed Application.  The two-handed application is normally used for the lower extremity when greater pressure is needed to stop the bleeding.  The two-handed application is always used when the tourniquet is applied to the casualty’s thigh.  The two-handed application is also used if the tourniquet band has become dirty since the friction buckle locks the band in place and help to prevent loosening during transportation.

NOTE:  The CAT friction buckle is used with the two-handed application, but is not normally used with the one-handed application.

(1)  Remove the CAT from its pouch.

(2)  Route the tourniquet band around the casualty’s limb so that the band is two inches above the wound.

(3)  Pass the red tip of the tourniquet band through the inside slit of the friction buckle (figure 4-8A) and pull the tourniquet band tight.

(4)  Pass the red tip of the tourniquet band through the outside slit of the friction buckle (figure 4-8B).  The friction buckle will lock the tourniquet band in place.

Figure 4-8 Applying CAT using Two-Handed Technique

(5)  Pull the tourniquet band until it is very tight and securely fasten the tourniquet band back on itself (figure 4-8C).

NOTE:  When the tourniquet band is pulled tight and secured, no more than three fingers will fit between the tourniquet band and the limb.

(6)  Twist the windlass rod using both hands to tighten the tourniquet band (figure 4-8D).  Continue tightening until the bright red arterial bleeding has stopped and the distal pulse is eliminated.  The darker bleeding from the veins may continue for a while.

(7)  Place the windlass rod inside the rod-locking clip, locking the rod in place and keeping the tourniquet from untwisting (figure 4-8E).

(8)  Check to make sure that the arterial bleeding has not started again and the distal pulse is still absent.

(a)  If arterial bleeding has resumed or the pulse is present, apply a second tourniquet proximal to the first tourniquet.

(b)  If a second tourniquet is applied, reassess to make sure the arterial bleeding is controlled and the distal pulse is absent.  Do not remove the first tourniquet.

(c)  If the second tourniquet does not control the arterial bleeding, transport the casualty as soon as possible.

(9)  Secure the windlass rod and tourniquet band with the rod-securing strap (figure 4-8F.  The CAT is now properly applied and the casualty is ready for transport.  If the casualty is not to be transported at this time, check the tourniquet periodically.

c.  Storing the Combat Application Tourniquet.  Follow the following procedures if you need to store an opened Combat Application Tourniquet.

(1)  Pass the red tip of the tourniquet band through the inside slit in the friction buckle.

(2)  Pull six inches of the tourniquet band through the slit, fold the tourniquet band back, and adhere the tourniquet band to itself (figure 4-9A).

(3)  Flatten the loop formed by the tourniquet band, placing the friction buckle in the middle of the flattened tourniquet band (figure 4-9B).

(4)  Fold the CAT in half so the friction buckle is at one end (figure 4-9C).

(5)  The CAT is now ready to be placed in your medical equipment set or other container.

Figure 4-9.  Placing the CAT in the One-Handed Configuration for Storage Andrew’s Final Thoughts:

  • Seek training on the proper use of a tourniquet
  • Don’t apply a tourniquet over a joint as the joint may keep the tourniquet from performing properly.
  • A Tourniquet should only be removed by a qualified medical professional
  • Don’t hide/cover the tourniquet if possible so that medical professionals can readily see that tourniquet has been applied.  Additionally, write ‘tourniquet’ or place a large ‘T’ on the casualty’s forehead so that medical professionals can’t miss the fact that the casualty has a tourniquet (if there’s a triage situation).
  • The pictures above show tourniquets being applied over pockets…if you apply over a pocket make sure that you empty it first or the tourniquet may not perform properly.
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