Application of a military tourniquet
Used for
- Life threatening extremity bleeding that
- Can't be immediately controlled with application of pressure
- OR when providers have equally urgent competing priorities for persons care (eg loss of airway, severe limb haemorrhage)
- A crushed lower limb about to be released
Irreversible ischaemia time depends on comorbidities, duration of shock and extent of tissue trauma
Attention
- Do not place too close to the wound — severed artery may have retracted. Position at least 5cm from wound
- Do not place over a joint
- Do not cover with bandage, clothing or blankets
What you need
- One or two military tourniquets
What you do
- Release windlass from it holder
- Roll out the velcro strap
- Pass velcro strap around limb at least 5cm proximal to the wound (between the wound and the heart)
- Feed strap fully through buckle and tighten
- Wind the windlass firmly then secure in its holder
- When the bleeding stops mesh velcro surfaces together and around the windlass in its holder
Figure 3.13
- Record time of tourniquet application
- Continue with primary survey — ABCDE
- Once you saved the life, try and save the limb — medical consult
- If help at hand AND vascular access secured and stabilised — when bleeding stopped, pack wound tightly and straighten fractures so that a trial of tourniquet release can be made
- Provide appropriate analgesia
- Arrange evacuation
- Medical consult about
- Plan to release tourniquet if transport times go beyond 2 hours
- Antibiotics
- Regularly and frequently recheck for haemorrhage as well as the tourniquet’s tightness and position
- Keep injured part in view — not concealed under blankets as further haemorrhage may go unnoticed
- If tourniquet placed for release of a crushed lower extremity, keep securely in place until right conditions for advanced resuscitation — CPR, intubation, IV fluids and monitoring