Tourniquet

If bleeding continues and all other measures have failed, or if the limb is severed, then apply a tourniquet. Use the tourniquet as a LAST RESORT.

A person whose arm or leg has been completely amputated may not be bleeding when first discovered, but a tourniquet should be applied anyway. This absence of bleeding is due to the body's normal defenses (contraction of blood vessels) as a result of the amputation, but after a period of time bleeding will start as the blood vessels relax.

Bleeding from a major artery of the thigh, lower leg, or arm and bleeding from multiple arteries (which occurs in a traumatic amputation) may prove to be beyond control by manual pressure. If the pressure dressing under firm hand pressure becomes soaked with blood and the wound continues to bleed, apply a tourniquet.

WARNINGS!

• The tourniquet should not be used unless a pressure dressing has failed to stop the bleeding or an arm or leg has been cut off. Use only on arm(s) or leg(s) where there is danger of loss of casualty's life.
• Tourniquets can injure blood vessels and nerves. If left in place too long, a tourniquet can cause loss of an arm or leg.
• Once applied, the tourniquet must stay in place, and the casualty must be taken to the nearest medical treatment facility as soon as possible.
• The tourniquet must be visible and easily identified. Mark the casualty's forehead, with a "T" to indicate a tourniquet has been applied. If necessary, use the casualty's blood to make this mark.

Improvising a Tourniquet

A tourniquet may be made from a strong, pliable material, such as gauze or muslin bandages, clothing, or kerchiefs. WARNING! DO NOT use wire or shoestring for a tourniquet band—serious injury will result!

An improvised tourniquet is used with a rigid stick-like object. To minimize skin damage, ensure that the improvised tourniquet is at least 2 inches wide.

Placing the Improvised Tourniquet

• Place the tourniquet around the limb, between the wound and the body trunk (between the wound and the heart).
• Place the tourniquet 2 to 4 inches from the edge of the wound.
• Never place it directly over a wound or fracture or directly on a joint (wrist, elbow, or knee).
• For wounds just below a joint, place the tourniquet just above and as close to the joint as possible.
• The tourniquet should have padding underneath.
• If possible, place the tourniquet over the smoothed sleeve or trouser leg to prevent the skin from being pinched or twisted.
• If the tourniquet is long enough, wrap it around the limb several times, keeping the material as fl at as possible.
• Damaging the skin may deprive the surgeon of skin required to cover an amputation. Protection of the skin also reduces pain.