How to apply a tourniquet

Recent events, including a surge in mass shootings, are underscoring the importance of self-reliance among law enforcement officers, in instances when Emergency Medical Services (EMS) are not immediately available, or are not allowed on the scene of the incident. These incidents highlight the importance of first responders providing prompt lifesaving measures to persons who have been hurt, particularly to control hemorrhage and save lives. Although fire departments are looking at ways to access the warm zone and give medical care, law enforcement must be the first responders in the field until emergency medical services arrive or the environment is deemed safe for other emergency personnel to enter.   Carrying a tourniquet on the officers’ duty belt, and knowing how to properly use it, can spell the difference between life and death, in situations like a severed artery, where every second counts.   As more-and-more frequent news story show, police officers who know how to properly apply a tourniquet are often the first (and sometimes the only) line of defense for a wounded individual. Law enforcement officers use tourniquets to save the lives of citizens, as was the case in this story, when an off-duty Indiana State Police officer used a tourniquet to save the life of a woman hurt in a motorcycle crash, as well as to save fellow officers’ lives, as this story explains.  

What is a tourniquet?

A tourniquet is a device that applies pressure to a limb or extremity to prevent blood flow. It can be utilized in a variety of situations, including emergencies, surgery, and post-operative recovery.   A tourniquet is particularly important in emergency situations, where the victim is suffering from a wound that causes profuse bleeding, which, if not stopped, can lead to death.   A simple tourniquet can be obtained with a stick and a rope (or a leather belt). However due to their ineffectiveness when compared to a commercial or professional tourniquet, their use has decreased over time.   Tourniquet placement and use is critical to avoid permanent injury: while the use of a tourniquet may stop the flow of blood, it also has the potential to cause soft tissue and nerve injury.   There are three types of tourniquets: surgical tourniquets, emergency tourniquets, and rehabilitation tourniquets.   In this article, we will refer to emergency tourniquets.  

Why do law enforcement officers need to carry a tourniquet?

While, several years ago, some debated whether or not law enforcement could effectively use EMS equipment like tourniquets, those debates have died out a long time ago, especially in the face of events that saw law enforcement in situations where tourniquet use was the only option, and officers were isolated behind the line of fire.   Cops have utilized them to save their own lives, the lives of their companions, and the lives of citizens all across the world.   Tourniquets have undoubtedly been used to save lives on city streets and battlefields. They have been instrumental in rescuing countless lives that would otherwise have perished. As a result, providing tourniquet training to all police officers will undoubtedly prepare them for a circumstance in which one of them, or a citizen, has been shot or injured in some way.   Every officer’s equipment should include a tourniquet. It, like a flashlight or handcuffs, should be part of every officer’s standard carry, something they have with them on a daily basis, and on their belt. This is why, along with proper training, law enforcement should be provided with a tourniquet holder that fits on the officer’s duty belt.  

How do you apply a tourniquet?

Knowing how and when to use a tourniquet is as important as the use itself. Even when applied correctly, tourniquet problems can cause serious tissue injury.   In the case of serious bleeding and life-or-death situations, however, appropriately applying a tourniquet can effectively stop bleeding and keep an injured person stable until medical help arrives.  

Steps to apply a tourniquet

Here are the steps to follow:  

Find the Source of the Bleed

You must first establish the source of the bleeding before applying a tourniquet. It may be visible in some circumstances, such as close or total limb amputation. Other injuries may not be obvious at first, especially if your view is obstructed by debris, wrecks, shredded clothing, or other things.   Have the injured individual lie down if possible so you may assess them from head to toe. Keep cool and concentrated because you’ll need to discover the source of the bleeding as soon as possible.   Shop all tourniquets

Apply pressure on the wound

Once you’ve figured out what’s causing the bleeding, start by putting direct pressure to the wound. You’ll need to access your tourniquet if the bleeding does not slow or stop when pressure is applied.   If the injured person is awake and attentive, inform them that a tourniquet will be applied to their injuries. Unfortunately, putting a tourniquet can be exceedingly unpleasant, especially if the person is already in a lot of discomfort. Inform the person that applying the tourniquet will be painful, but that it may save their life.   Remove any clothes that is close to the wound by cutting, tearing, or otherwise removing it. The tourniquet must be applied directly to the skin.  

Position the tourniquet

If you are using a proper tourniquet, slide it above the location of the wound.   If you are using an improvised tourniquet, place the cloth, towel, or other material for the tourniquet several inches above the injury on the limb.   No matter what you are using, the tourniquet should be applied on the part of the limb that is closest to the heart. If the damage is below the knee or elbow, for example, the tourniquet should be tied above the joint.   If you are using a piece of cloth or other improvised device, tie the tourniquet around the limb with a typical square knot (similar to tying your shoelaces but without making a bow).   If you are using a proper tourniquet, tighten the band around the limb.  

Use the tourniquet windlass or add a windlass

A tourniquet windlass is a lever that can be used to tighten the tourniquet. If you carry a proper tourniquet, your device will have a windlass designed to provide torque.   If you need to improvise, you should find a stick or other strong item. Make sure that, whatever you use, it is strong enough to provide leverage.   As long as it is strong enough to hold the tourniquet and can be held in place, anything can be utilized as a windlass. Pens or pencils, sticks, or spoons are all good options.   Place your windlass on the knot, then bind the tourniquet’s loose ends around it with another square knot.  

Tighten the tourniquet using the windlass

To increase the pressure, start turning the windlass. Keep a close check on the bleeding and note when it starts to slow down. Turn the windlass until the bleeding stops or is greatly reduced.   Secure the windlass by tying one or both ends to the injured person’s arm or leg once the bleeding has slowed or stopped.  

Keep track of the time

Tourniquets are only effective for a limited amount of time—no more than two hours. Knowing when you placed the tourniquet will be critical for first responders and medical personnel treating the injuries.   If feasible, make a “T” on the person’s forehead or another visible spot to emergency responders with the date and time you applied the tourniquet.   Important: Only a doctor in the emergency room should remove a tourniquet.  

Conclusions

Even when performed by non-technical staff, tourniquets can and do save lives, according to a 2018 study published in the Journal of the American College of Surgeons. The goal of the study was to see what influence civilian use of tourniquets had on mortality.   In patients with peripheral vascular injuries, the risk of death was six times lower when individuals applied tourniquets before they arrived at the hospital (blunt trauma to the extremities).   Tourniquets and tourniquet holders should be a standard issue for law enforcement officers across the United States, along with ongoing training to perfect the use and application of these life-saving devices.