Tourniquet Update

If you've taken one of our courses, whether our regular first aid class or one with a Stop The Bleed(R) certification, I hope I've been pretty clear that tourniquets are really ONLY to be used for life threatening bleeding. Most injuries will not fit this criteria, and wounds that might take some time to manage, need that--some time, and no one should rush to use a tourniquet unless the situation really calls for it.

But, if it seems necessary, then yes, tourniquets have been proven to be useful, both in military settings and in regular life.

Previously, the recommendations were that once a tourniquet was applied, it should stay on until definitive care (emergency department or other medical setting) was available. 

However, there's been an update, that's pretty important, and may be applicable for those who are in the woods or who will otherwise have prolonged rescue. 

In many situations, a Tourniquet Conversion (TC) to a pressure dressing may be appropriate.

Here's the deal, studies have shown that about half of tourniquets applied (or more) in the pre-hospital setting didn't need to be used. 

And while "overuse" of tourniquets does not appear to be causing harm, it's time to consider if, after a tourniquet is applied, it can be converted to a pressure bandage.

There are a few situations where you don't want to try for conversion, one is if the injured person is in shock (lightheaded, passing out, confusion, weak pulse), another is if the extremity that had the tourniquet applied was amputated, and finally, if the bleeding can not be monitored conversion shouldn't be attempted. Also, if the tourniquet has been on for more than six hours, leave it alone. And finally, another time where it's probably okay to leave a tourniquet in place, even if it may not have been needed, is if the injured person can be evaluated by emergency medical services relatively quickly (settings where ambulances are readily available and a hospital is nearby). 

All that being said, if bleeding is controlled with a tourniquet, and the above criteria don't apply, conversion could be attempted. 

Here's how it works:

With the tourniquet still in place (which should be 2-3 inches above the wound), reassess initial efforts that had been made to control the bleeding. If bandages had been applied, but appeared to be ineffective, leave the initial bandage in place, but wrap more with pressure (such as with an elastic wrap, like an ACE wrap). You don't want to remove any dressings because doing so might disrupt any clotting that had started. If the tourniquet was the first attempt at controlling the bleeding, now is the time to try packing the wound (especially if QuikClot or other hemostatic dressing is available) and wrap the wound with a pressure dressing. With that done, the tourniquet can be SLOWLY loosened (over a minute). If bleeding has stopped, leave the loose (but with no slack) tourniquet on the extremity, but closer to the wound, in place. If the situation changes, it's there. If, when the tourniquet is loosened, bleeding returns, re-tighten; conversion won't work. 

As had been mentioned, tourniquets will hurt, so if they can be converted to something less painful, and potentially less harmful, then that should be done. But, if life threatening bleeding persists, a tourniquet can save a life.

Oh, and yeah, AI images can be pretty funny...

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