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

• 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