What Is a Tourniquet and When Should It Be Used?

A tourniquet is a simple device that stops blood flow through an extremity. Its three components are a band, a windlass, and a securing mechanism such as a clasp or D ring. 

Tourniquet used to be almost a dirty word in emergency medical services. It was your absolute last resort to use only after everything else had failed. After all, you wouldn't want to be responsible for someone losing a limb. But all that's changed in the recent decades of war. 

"In a Baghdad hospital it was found, 87 percent of patients who came in with tourniquets survived. Among those who were good candidates for tourniquets but did not receive them, there were no survivors.” 

Girion, Lisa. “Tourniquets, once out of favor, helped save lives in Vegas shootings” Reuters, 13 Oct. 2017, https://www.reuters.com/article/us-lasvegas-shooting-tourniquet/tourniquets-once-out-of-favor-helped-save-lives-in-vegas-shootings-idUSKBN1CI16I

In this section you’ll learn:

• What a tourniquet is
• When you would need to use a tourniquet
• Why you should carry a tourniquet
• How to apply a tourniquet

We’ll also go over some potential mistakes and things not to do when applying a tourniquet.

Can I Make My Own Tourniquet?

Yes, in a pinch, you can make an improvised tourniquet out of items like the following:

• Band: a shirt, scarf, belt, lanyard, or shemagh (will restrict around the extremity)
• Windlass: a screwdriver, stick, or flashlight (when twisted uses leverage to bind the band tightly around the extremity)
• Securing mechanism: a rubber band, hair tie, carabiner,  or keyring (restricts the windlass from unwinding once it's twisted tightly into position)

Keep in mind, that a makeshift device like that is not what we want people's lives to depend upon. There are excellent commercial tourniquets available out there. We recommend everybody own a high-quality commercial tourniquet for everyday carry and integration into home and vehicle employment.

In our step-by-step tutorial below, we’ll reference two of the most popular tourniquets: the CAT and the SOF-T Wide. These are both recommended by the Committee on Tactical Combat Casualty Care. But they are by no means your only options.

View the Armored Republic Tourniquets.

Why Carry a Tourniquet?

Before 2001, medics generally were taught not to use tourniquets or hemostatic agents. The U.S. Department of Defense developed Tactical Combat Casualty Care (TCCC) in 1996, but much of the practices were still not in place by the inception of the global war on terror. Most of the U.S. military members deploying to Iraq and Afghanistan went without tourniquets. 

The use of tourniquets increased dramatically when the early battlefield data started trickling in on TCCC and tourniquets. By 2006, they had become more of a priority in treatment. By 2011, preventable deaths due to extremity hemorrhage were down by about 67%. The number of lives TCCC and tourniquet applications have saved is now in the thousands. 

Tourniquets have saved many lives on our own soil in combat situations. With the ongoing threat of terrorism and active shooter situations here in the U.S., a tourniquet is a small and unimposing device that can pay off big when needed.

When to Use a Tourniquet

Generally speaking, if you look at an injury and say “That's a lot of blood”. When you see any sort of potentially lethal injury to an extremity - realize seconds matter and apply a tourniquet on it immediately. 

The point of a tourniquet is to stop life-threatening bleeding from an extremity. We recommend receiving proper training as soon as possible so you feel confident in your abilities. Speed matters here so being proficient and fast while ensuring proper seating and securement is important.

"Bleeding to death can happen very quickly. If the hemorrhaging isn’t stopped, a person can bleed to death in just five minutes. And if their injuries are severe, this timeline may be even shorter.”

Holland, Kimberly. “Bleeding to Death: What Does It Feel Like, How Long Does It Take, and Am I at Risk?” Healthline, 27 July 2018, https://www.healthline.com/health/bleeding-to-death

 The prevailing thinking used to be to apply direct pressure, elevate the extremity, apply additional dressings if the initial dressing soaks through, and eventually apply a tourniquet if the bleeding doesn't stop. That approach led to countless unnecessary deaths due to hemorrhaging.

Going straight to the tourniquet for an injury involving bright red, spurting blood, is a life-saving approach. It’s the quickest way to keep someone from bleeding out, and then you can address the wound site directly from there. 

Keeping blood in the body is the goal and the faster you can do that the better. This also has the added benefit of preventing shock from blood loss, keeping your patient conscious, and with a higher probability of survival.

How to Apply a Tourniquet

Follow the instructions that come with your specific tourniquet, because the setup varies. 

Let’s assume you’ve noticed life-threatening bleeding from an extremity (yours or someone else’s). You determine you need to act.

Follow these steps:

Step 1. Remove your tourniquet from its pouch and open the band wide enough to go over the injured extremity.             

Step 2. Position the tourniquet as far up on the extremity as possible, since you may have trouble identifying the precise location of the wound. Placing the tourniquet too close to the wound can worsen the patient's condition and may not even stop the bleed. 

Step 3. Make sure your tourniquet placement is not over any joints or items in the clothing like a cell phone or car keys.

Step 4. Cinch the tourniquet band down tightly on the extremity. It's very important to get it nice and snug on this step, regardless of which tourniquet you’re using. 

Step 5. Turn the windlass to cause the tourniquet to constrict on the limb. Continue turning the windlass until the bleeding stops and there's no distal pulse. This may take 3-5 (or more) complete revolutions of the windlass. Keep in mind, this will be painful for the patient. But it is a lifesaving measure.

Step 6. Secure the windlass inside the clasp or D-ring so it doesn't unravel. You'll want to wrap the tail around until there's none left so it doesn't snag. 

Step 7. If you have a CAT, pull down the white Velcro retention strap. If you have a SOF-T Wide, tuck the end of the windlass into the D-ring.

Step 8. Ensure there's still no bleeding or distal pulse. If you find either, you may need to tighten your tourniquet or place a second tourniquet next to the first one.

Step 9. Write down the time you placed the tourniquet on the time tag. On the CAT, you can find this on the white or gray retention flap. On the SOF-T Wide, there's a label at the end of the hanging strap. 

Step 10. Periodically reassess your intervention as you prepare for transport to a medical facility.

Looking for a step-by-step video guide to tourniquet application? We’ve got you covered. Check out our How to Use a Tourniquet video. 

Staging a Tourniquet

Keep in mind that having a tourniquet staged ready to use in the right place matters. There are certain do’s and don'ts when mounting a tourniquet to a plate carrier, storing in a vehicle, or on your person. Here are some tips:

1. Stage your tourniquet so it is at its widest when opened up. You never know what limb your tourniquet will go on, so having it wide enough to slip around your upper thigh is a good minimum size to keep your tourniquet adjusted to. You can always make it smaller on the fly with little effort. DO NOT keep the clasp securement strap (with the word TIME written on it) closed. You need to slip your windlass in that quickly and do not want to be trying to open that strap after you have applied tension to the windlass. 
2. When storing your tourniquet on your plate carrier make sure your tourniquet is accessible by BOTH HANDS, or have multiple tourniquets, accessible by each hand. Likewise, make sure your tourniquet's windlass is facing INWARD toward you, not outward, away from you.
3. Keep your tourniquets accessible and store multiple tourniquets in your vehicle. You never know when you will be the first one on an accident scene and car crashes usually involve multiple parties. 
4. Always keep a tourniquet on your person. If you carry a knife, a light, a spare mag, and a gun, you can also fit a tourniquet into your everyday carry with little change in accommodation and a massive uptick in your readiness capabilities.     

What Are Common Tourniquet Mistakes?

The commercial tourniquets we've mentioned are easy to use, but there are potential mistakes to watch for. Here are a few:

• Never apply a tourniquet over joints.
• Never apply a tourniquet over items in the clothing like a cell phone or car keys.
• Never apply a tourniquet over or near the wound.
• Once the tourniquet is in place, leave it there. Hospital staff will have a specific method for releasing it once the patient is in that higher level of care.
• If you need to use a second tourniquet, adjust its positioning so the windlass can turn unimpeded by the windlass on the original.

Conclusion

Since the early 2000s, the data has been clear. Tourniquets save lives. They're small devices that you won't realize you're carrying until you need them. Tourniquets are for active military, law enforcement, and responsible citizens. We recommend you get at least one per limb - with two being the minimum carry for field use and another dedicated for practice purposes. 

Don't forget to get proper training on tourniquet and IFAK use.  Lastly, if you need to use a tourniquet, you also need EMS. Call 911 and be sure to transfer the injured person to a higher level of care. 

Helpful Additional Resources

• FREE online course on “Stop The Bleed” that's packed with great information on tourniquet use and other bleeding control information and techniques: https://www.stopthebleed.org/training