How to Apply a Tourniquet
Caleb CauseyDescription
The first line of defense against bleeding out of the arms or legs is a tourniquet. The myth that a tourniquet poses a threat to the limb has been debunked by numerous studies. Caleb Causey of Lone Star Medics demonstrates how to apply a tourniquet to an arm or leg and offers tips for efficient tourniquet employment based on his extensive field experience.
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11 Responses to “How to Apply a Tourniquet”
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Where can a tourniquet like the one he is using be bought?
Do we still write a "T" on the forehead of the injured?
This video assumes that any responder carrying a tourniquet also has some common sense. Given the rise in the popularity of tourniquets as EDC items, I am not so sure that this is a valid assumption. The statement that a tourniquet is the "first line of defense against bleeding out of the arms or legs" is TOTAL NONSENSE if taken literally. A tourniquet is not appropriate for minor bleeding -- which brings us to two issues. 1. The individual treating the wound needs to have some common sense and make a quick judgement whether to do directly to a TQ, or use some other method to control bleeding. You don't use a TQ when a bandaid would be sufficient -- that much ought to be obvious but the current emphasis towards "always immediately use a TQ" is just as wrong as the advice two decades ago that the TQ is only a last resort. 2. There is an addage: "If your only tool is a hammer every problem looks like a nail." What that means here is that if you only carry a TQ, then you have nearly no choice about treating wounds of the arms and legs and (perhaps more importantly) you have no means of treating wounds anywhere else. The arms and legs represent only about half of the human body. There is a lot of body where a TQ is totally useless.
How to, in case I come across it?
Why not have a small pen that fits inside the tightening "handle" available for using to date/time when the tourniquet was applied? Make it so it snaps or clicks into position so it won't easily come out during handling. What are the chances of having a pen or marker handing when treating a victim with severe arm/leg bleeding?
What type of tq do you recommend and why?
Lone Star Medics, thank you for the informative video, demonstrating TK use with a proven device. As a retired USSF 18D, I agree that TK is the best choice for pre-hospital control of extremity hemorrhage caused by high velocity trauma, which is what your scenario addressed. Here are some scholarly articles supporting TK use. Providing scholarly support to the argument for TK application usually stops the anti-TK arguments, which are usually based on outdated, mythological thought. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660095/ http://www.sciencedirect.com/science/article/pii/S0736467909006386 http://journals.lww.com/annalsofsurgery/Abstract/2009/01000/Survival_With_Emergency_Tourniquet_Use_to_Stop.1.aspx http://journals.lww.com/jtrauma/Abstract/2008/02001/Prehospital_Tourniquet_Use_in_Operation_Iraqi.7.aspx
Lone Star Medic: I don't doubt that tourniquets can be safe, if applied by trained medics using proper procedures. But many viewers of this video do not have medical training, or access to those particular products that you mention. When most people think tourniquet, they envision something like a rope or article of clothing, tied with a knot, and a stick or tool inserted to provide torque when twisting. And you seem to miss my last sentence, which gave an exception for life threatening bleedouts. When creating an instructive video like this one, you have to consider the audience and how they will interpret the information. In this case, there are likely many people who will not understand the finer points and procedures that you have in your mind as basic assumptions.
Anatomically and physiologically speaking; the brain must continue to function in order for the rest of the body to. The body may continue to function without the use of all the other organs, such as the spleen or even other body parts of the body like an arm or a leg. But if the brain stops, everything else stops; immediately. So we need to keep the brain working by feeding it. We feed it by giving it several things such as sugar and oxygen for example. Well if there is no blood left to send that sugar or oxygen to the brain, the body dies; immediately. This is bad. Another reason we no longer use the acronym “ABC” when assessing a patient. Instead we use “CAB” so as to identify and treat moderate to severe external bleeding first (the Circulation part); then assess a patient’s Airway then Breathing… in that particular order. If this still doesn’t make sense, I encourage you to attend a training course that teaches such modern-day techniques and why we do utilize tourniquets as such.
I guess the Committee on Tactical Combat Casualty Care (CoTCCC), over 12 years of combat on two fronts with thousands of injuries and deaths, and a simple understanding of human anatomy and physiology accounts for nothing, Denver? Regarding your reasons you think this is bad advice: 1. Yes if the tourniquet (tq) is applied too tight it can tear tissue instead of occluding blood flow. This happens more often with certain tq's than other brands. I have not been able to find any documented cases of either the CAT or SOFT T Wide causing such an injury. To do so would require a great amount of force and more than likely either one of these two tourniquets would break apart before that could happen. If you are worried about "losing the limb"; please show me any documented case in the history of tq use in a pre-hospital setting where the patient lost a limb due to an extended time frame. Also, let us not forget that if we don't stop the bleeding, then we lose the entire patient. So do we want to lose or do we want to lose big? “Well doctor, we saved the limb… but the patient bled out and died. But hey! We saved the limb.” 2. There are several recent (past 15 years or so) well documented case studies that prove that a tq can remain tight and left on a limb for up to six to eight hours before the concern of necrotic tissue. Granted it is a topic of discussion right now with CoTCC and other healthcare professionals on what pre-hospital protocols should be considered after that initial six to eight hours. Yes, there is a risk of circulating necrotic cells and the toxins related to necrotic tissue/cells throughout the human body resulting from either a penetrating traumatic injury or from tq use past the 6-8hr mark. Not to mention the fact we also risk circulating clots throughout the body. Which can cause pulmonary embolisms and that is bad for the patient. In regards to the old school of thought by "elevating the limb" first; this has proven to be absolutely useless and a complete waste of time on the battlefield. Now we may not be on a battlefield here back home, but bleeding is bleeding. When dealing with moderate to severe bleeding, time and blood are two things we don't have a lot of. The average human adult only has about five to six litters of blood in their body. Once blood has been spilt on the ground, we can’t put it back in the body. Therefore we need to save and maximize as much as we possibly can... as effectively and efficiently as we can.