One of the most common questions we get when teaching is "Are you going to show us how to make a tourniquet?" I'm not sure if this stems from watching old westerns with cowboys twisting handkerchiefs around a stick, but apparently this is something that people know to ask about, but not how to do properly. This blog post is designed to teach you how to fashion an effective improvised tourniquet.
But before we begin, it's absolutely essential that we start with one caveat. Improvised tourniquets are poor substitutions for commercial tourniquets. Improvised / makeshift tourniquets should be converted to a commercial tourniquet as soon as possible.
Fill in the Blanks below :
A tourniquet should only be used as a _______ __________ .
If you said Last Resort you need to keep reading. Tourniquets have been around since the middle ages and they have saved countless lives. However, there is A LOT of confusion surrounding them. The intent of this post is to clear up some of the confusion and teach you how to make a tourniquet if someone is bleeding to death and you do not have a commercial tourniquet.
Here is a short list of what we'd love for you to take away from this post:
- A mindset shift that Tourniquets are safe & effective
- An understanding that Tourniquet application is NOT likely to lead to amputation of a limb *1
- Tourniquets should be considered a First Resort (not a last resort) for life threatening extremity bleeds
- Improvised Tourniquets are rarely effective at stopping arterial blood flow and far less effective then commercial ones
- Commercial Tourniquets are affordable and widely available and you should have them on hand in the event of an accident
- Stopping a Bleed in an arm or leg is a manageable task, and NO ONE should ever bleed to death from an extremity wound
- Anyone can save a life, and you don't need years of training to do it. Four hours of First CARE Provider training results in certification & peace of mind for yourself and your family
The Department of Homeland Security has recently launched the Stop the Bleed campaign to raise public awareness, and promote public access to hemorrhage control kits. First Care Provider has empowered thousands of people by showing you how and when to use these kits.
When is a Tourniquet needed ?
whenever you have uncontrollable bleeding from an Arm or Leg
whenever their is an amputated or partially amputated limb
when other attempts to control a bleeding extremity have failed (direct pressure,bandages)
when you have multiple injuries or multiple victims to address
when your description of the bleeding limb begins with an expletive "Oh S#*% that's a lot of blood!"
STEP 1: Apply Pressure
Stopping bleeding requires pressure - apply firm and aggressive manual pressure
Its possible that direct pressure over the wound site may not be the most effective means of controlling a bleed (think gunshot wound)
Pressure above the wound on the artery should slow down or even stop blood flow to the injured portion below
Applying pressure above the bleeding area is a stop gap fix that will buy you time to locate a commercial tourniquet or the materials needed to improvise one
With injuries below the elbow you may be able to slow or stop the bleeding by applying pressure above the wound, over the brachial artery (Figure 1).
* You may be able to utilize this technique for self-aid if you're injured.
With Leg injuries you can slow down or stop the bleeding by applying firm pressure over the iliac artery in the inguinal canal (Figure 2).
Step 2 : Apply a Commercial Tourniquet
OK it's a blog post on improvising a Tourniquet but I wanted to stress how much more successful the outcome can be if you have the right tool for the job. I also would love for you to purchase your Tourniquets from us by clicking here, we're a non-profit organization and your purchases help fund training and program development efforts.
Step 3 : Improvise a Tourniquet
To make an effective Tourniquet you will need 3 things:
Material - a band of some sort to wrap around the extremity
Windlass - rigid object to twist the material (hand tightening is ineffective)*2
Securing mechanism - something to keep the windlass from unwinding
Material should be at least one and a half inches in width, but no one is going to take time to measure. Utilizing material thinner then one and a half inches is less likely to stop arterial blood flow and more likely to cause nerve damage. The photo at top of the page you can see an FCP student using an A/V cord wrapped circumferentially around an arm. The cord is clearly not one and a half inches wide, but if it's all that you can find, then make it work. In those cases, wrapping the cord around the limb with each pass laying next to the previous, may improve success rates. Tourniquets that are not wide enough are more dangerous and less likely to be effective. Remember, your largest artery is approximately the thickness of your thumb, so compressing/standing on/kneeling on that limb is a far better option then bleeding out.
Good options for material:
- Neck Tie
- Neckerchiefs, scarves, bandanas
- fabric long enough to wrap around limb
- nylon webbing
- Ace bandage
Poor Options for Material:
- Belt - seems to be the number one thing people suggest using, however it's a poor choice for an improvised tourniquet. Under stress people will try to tighten a belt around a limb the same way it's tightened around a waist and that will never be tight enough to stop arterial flow. Option two is to use an object as a windlass to gain a mechanical advantage. A windlass is a crucial step in fashioning an improvised tourniquet but is unable to to create enough torque or pressure due to the belts rigidity.
- Zip Tie - likely to be very painful and cause tissue and or nerve damage
* Again I feel the need to say that if a belt is the only option you have, it's far better then nothing.
Should be sturdy and at least 5 inches in length
Good windlass options:
- Carabiner - these make a great windlass provided they are sturdy enough. You can pick up one at any local big box store for just a few dollars. VIDEO LINK
- Stick - a good old fashioned stick, sturdy enough to not break with pressure.
- Jack handle - trauma is often the result of a motor vehicle crash and most vehicles are equipped with a jack. Check out this great article on how to create a tourniquet with a towel and jack handle from our good friends at TacMed Australia.
- Broom handle - may need to be cut down but should be sturdy enough.
- Pocket Knife - closed blade or else you made need a tourniquet too
Poor Windlass Options:
- Pens / Pencils - another item that is frequently on hand but very likely to break
- Hands - trying to rely on your hands and brute strength is a bad idea and likely to result in an ineffective tourniquet.
* Adding a windlass to an improvised tourniquet is a crucial step in the process and should not be skipped. Studies show a 32% failure rate with use of a windlass compared to a 99% failure rate when no windlass is used. *3
The securing mechanism will keep your windlass from unraveling which results in tourniquet failure.
Steps 4 - 7
Step 4 - Once the tourniquet is complete the next step is to reassess the wound and confirm that the bleeding has stopped or slowed down to an inconsequential amount. *Bonus Tip - if possible check for a pulse in the injured limb, a pulse should not be present below the tourniquet.
Step 5 - complete a thorough hands on evaluation of the victim to assure they have no other life threatening bleeds
Step 6 - Note the time of tourniquet application (Certified First Care Providers continue with CARE treatment)
Step 7 - Evacuate the victim to advanced care or await First Responders
If you're attempting to save yourself obviously time is of the essence.
Do your best to remain calm and call for help.
If you can't access a commercial tourniquet and you need to create an improvised one.
It is also possible that you may not be able to use the injured arm and you will have to apply the tourniquet using one hand (big selling point for commercial tourniquets) if it's not possible to fashion a tourniquet then use your working hand to apply pressure to the brachial artery and become a manual tourniquet until help arrives.
We strongly advocate the purchase of commercial Tourniquets, and we plan to do further posts and videos on the various Tourniquets currently on the market. Having and utilizing the right tool for the job, is and will always be the best way to go. There may come a time when you need to fashion a Tourniquet because you don't have access to a commercial tourniquet or you've have more bleeding extremities than you have Tourniquets (Boston Marathon bombing) and an improvised makeshift Tourniquet may be the only option.
Buy a tourniquet and not only have piece of mind but help support a Non-profit and make the world a safer place.
Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma John F. Kragh, Jr., MD, Thomas J. Walters, PhD, David G. Baer, PhD, Charles J. Fox, MD,
Charles E. Wade, PhD, Jose Salinas, PhD, and COL John B. Holcomb, MC
Tourniquet use at the Boston Marathon bombing: Lost in translation King, David Richard MD; Larentzakis, Andreas MD; Ramly, Elie P. MD; The Boston Trauma Collaborative
Role of the Windlass in Improvised Tourniquet Use on a Manikin Hemorrhage Model. Altamirano MP, Kragh JF Jr, Aden JK 3rd, Dubick MA.