Having a tourniquet (TQ) in your gear but not knowing how to use it is both pointless and dangerous. The only positive thing you can do in that scenario is hand your TQ over to someone like me (and soon you) to put it on properly. In the military we call those people LTC (liability to command). You don’t want to be a LTC.
This post will detail what NOT to do when applying a TQ and conversely how to rectify common errors. If you want tips and tricks to help you avoid the 3 big mistakes EVERYONE makes when putting on a TQ read on…
All images and tips will assume you are using a NAR Combat Application TQ (CAT). If you don’t have one get one! Here’s an Amazon link to them: 2 Pack Genuine NAR CAT Tourniquet Gen 7 Black
Turning the windlass more than 3 times
Sounds intuitive right…if I turn the windlass more than 3 times it will become tighter and thus stop the bleeding - WRONG!
Majority of this error of thought actually stems from not tightening the TQ enough initially. However, very few operators also know that the CAT’s windlass is only designed to turn 3 times, never more, never less.
It’s simple, if you tighten the TQ initially correctly on a leg or arm you will not be able to turn the windlass more than 3 times. If you can turn more than 3 times, do not continue turning! Undo it and start again. This tip is without exception. In no circumstance will turning the windlass 4,5 or 6 times make the CAT more effective, I promise…and so does NAR (North American Rescue).
Equally, if you are on turn 2 and the casualty is screaming “this hurts more than the gunshot wound”, don’t stop. It should be music to your ears, letting you know that you are doing it right. Continue turning until you lock in the 3rd spin.
I don’t know about you but I like to use my kit the way it is designed to be used. Especially if that kit has been scrutinised by the FDA as much as the CAT has and PASSED!!!
Not exposing the wound to see the actual site of bleeding
You could be the fastest and most technically sound TQ applier, but if you put it in the wrong place what good is that? Commonly in first aid books, classes and YouTube videos I see people instructing where to apply a TQ. The shared rules they use are don’t apply it over joints, apply it 5 fingers above the wound and never apply it over a fracture. These are all WRONG…maybe not wrong but they aren’t best practice. Let me explain.
In the image we see the bleeding appearing on the lower leg about as high up as mid-calf. (Yes, I know there isn’t enough blood to warrant a TQ, just making a point). By those rules we would put a TQ on 5 fingers above the blood just below the knee joint. That would work 90% of the time but who wants to only be able to be effective 90% of the time?
Let’s get that 10% better…he is also sitting in a car, so it’s reasonable to think that the blood is moving downwards, maybe running down the back of his leg on the inside of his jeans, maybe truly bleeding from above his knee, maybe there is two wounds pooling blood in one area (one above the knee and one below). The point is we don’t know unless we expose.
When I say expose I don’t mean the lower leg, I mean the entire leg starting at the groin. Now you will really know where the bleeding is coming from and where you need to put your TQ.
If you feel you don’t have time to expose properly or you just have don’t have the confidence or tools I have an answer. Go as HIGH on the limb as you can and as TIGHT as you can. Say it with me HIGH and TIGHT x3
Leaving the tail unsecured
Now you know where to put a TQ and hopefully now it is tight enough to stop the bleeding. Good it’s on, now your job is to make sure it never comes off until the casualty is safely in surgery.
The main avoidable mistake everyone makes after they have correctly applied a TQ is leave the tail unfastened. What do I mean by this? Look at the two images below and it should become clear.
As you can clearly see in image 1 the tail of the TQ is loose. All that is stopping this TQ from completely loosening off is a small strip of Velcro. If this tail gets caught on anything during transport it is likely that it will undo. In the military we call this type of TQ the widow maker’s mark. Please, don’t mark your casualties. That is bad JuJu.
In Image 2 you can see that the tail is wrapped around the wind lace and secured under the time label. From there any excess tail is folded onto its self to shorten it. This is a perfect example of a TQ that will not loosen.
*Note, if the limb is big and there is no excess tail just make sure that it all sits flush on the Velcro with no tabs*
Go forward now and take the TQ off of the LTC (liability to command) and put it on the casualty properly. You have the knowledge to stop bad practices at the site of injury and save lives.