Video: How to Apply a Tourniquet Properly

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Video: How to Apply a Tourniquet Properly

by James Hubbard, MD, MPH

Video: How to Apply a Tourniquet Properly | The Survival DoctorTourniquets have been on my mind lately. It’s a shame many people don’t know how to properly apply one to stop bleeding. It’s so easy. But, like most things, someone has to show you before you can learn.

I read of a man bitten on his thigh by a beaver. The large femoral artery that runs from the groin down the inner thigh was severed, and the man bled to death. My first thought was, maybe he could have been saved if someone had known how to stop the bleeding—in particular, how to apply a tourniquet.

Then I read about a man in a Home Depot sawing deeply into his arms, apparently on purpose. A quick-thinking fire captain applied a tourniquet around each arm and, yes, saved the man’s life.

But you also have to know how to combine methods. A woman recently came up to me after a wound-treatment talk I gave at the Get Prepared Expo in Missouri. She told me her husband’s inner upper arm was once cut with some sheet metal and he almost bled to death. Someone applied a tourniquet, but it didn’t help much. Fortunately, the good ol’ paramedics and EMTs arrived in time. But I thought, if his colleagues who tried to help had only known what else they could have done, in addition to the tourniquet, to stop bleeding.

All this made me check my past posts on how to stop bleeding only to discover that, although I mention tourniquets as a last resort to save a life (and they should be a last resort since the person may very well lose a limb even if the tourniquet is applied properly), I haven’t explained the correct way to apply one.

After you watch the video a time or two, practice on yourself or some volunteer so you’ll know what to do if the time comes when you need one. Don’t practice this if you bleed easily since the tourniquet could cause a bruise. Also, don’t practice on someone with “poor circulation.”

  1. Find your radial pulse. It’s on the inside of your wrist. Just follow your thumb to your wrist, press down with two fingers, and you should be able to find it.
  2. Apply the tourniquet to your upper arm and tighten until you can’t feel your pulse.

That’s it. Take it off right away, of course. Even if you’re applying it for real, you want to loosen it every few minutes to try to get some blood flow to the rest of your arm and hand, or leg and foot—and get expert medical help as soon as possible.

What do you think? Did you try it? Did it work?

One last thing. As I talk about in the video, whether it’s pressure or pulse points, or a tourniquet, you don’t have to go with just one method at a time to stop bleeding.

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  • Lynn Rutan Parsons-Perez

    Dr. Hubbard, Thank you for taking time to share this very important information. I was a little puzzled watching you kind of struggling to knot the tee shirt to either end of the stick, as well as taking time to find something to make holes in the sock. Time is, of course, so important, and a layman is, most likely, going to be very nervous. It has been my experience to simply knot both ends of the sock, shoe lace or shirt, what have you, together, forming a loop. Slip it over the affected limb, and then place the stick, or what have you, in the loop as well, and twist. It makes releasing, if you so chose, so much easier, and it seems to me to be much faster, and easier to apply. Thank you again!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks, Lynn, for the great tip.

  • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

    Thanks, James.

    • kaf

      I am a health aide at an elementary school, should you also raise the arm or leg while the tourniquets is on?

      • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

        Yes, that’s a good idea. Thanks for the question.

  • Rich Adams

    Dr. Hubbard, I’m a disabled army veteran, a former army medic, a former paramedic, and a former civilian instructor at one of the military’s Medical Simulation Training Center (MSTC). I would like to discuss two issues regarding comments made by you in the video and in the article.

    First, the use of tourniquets does not mean that the individual will lose a limb. It’s the severity of the injury that indicates whether a limb will need to be amputated. Studies show that field tourniquets can be left on a casualty for between 4-6 hours without any dangerous detrimental metabolic effects. Surgeons use tourniquets everyday in our OR’s across the globe when doing common extremity surgeries such as a knee replacement. Those tourniquets are left on for hours as the casualty goes through the procedure.

    Second, it is erroneous to advise loosening (you said “taking it off” in the video) a touniquet after a few minutes to get blood flow to other parts of the limb. It increases the chance of having the casualty becoming septic, thereby compounding the dangers to the casualty. Tourniquets should never be removed in the field. Even if you can control the bleeding with the use of direct pressure or pressure dressings, the tourniquet should remain secured, but not tightened to the extremity in case profuse or arterial bleeding returns.

    My experience is to place the tourniquet as high (proximally) on an extremity as possible. There is less chance of the tourniquet coming loose or sliding off if placed on the upper third of the extremity. Tourniquets should never be placed on the forearm or on the calf/shin as it is more difficult to stop the bleeding and may even cause further injury such as a fracture or splintering. It is much easier to stop the bleeding by compressing the artery against the single long bone of the arm or leg, humerus or femur.

    Only when you are in a secure environment should you attempt to loosen a tourniquet and only if you have readily available materials to control the bleesding. The use of hemostatic agents can be very beneficial in conjunction with proper bandaging of the wound. As always, if you are unable to control the bleeding re-tighten the tourniquet and seek proper medical care.
    I hope my comments lend some more light on this subject. I look forward to reading your comments or anyone else’s for that matter.
    With God’s grace.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Hi, Rich. Thanks for your comments and for your service. Perhaps it’s the “defensive medicine” entrenched in me, but I feel obligated to warn people about the prolonged use of a tourniquet and damage of tissue. While tourniquets definitely save lives in combat situations and have been found to rarely cause extra damage to the tissue in those situations, the victims are usually otherwise healthy, the tourniquets are applied by someone who knows how, and the victim usually gets to a medical facility within hours, wouldn’t you agree? The typical person who listens to my video has never applied a tourniquet and the circumstances I’m talking about are where medical help is more than two hours away. At some point, I think you’d agree, if a tourniquet is not taken off, the distal will die resulting in gangrene and a high risk of death. So, if medical help is more than 2 (maybe 3) hours away I think it would be worth to keep the tourniquet tight, say, thirty minutes, and then try to loosen a bit to see if the bleeding is letting up and perhaps direct pressure will keep it under control. It’s not ideal but, if you don’t the risk of death is likely anyway. As far as the safe time of tourniquet use in surgery, I’m no expert there, but I looked up a couple of studies and one advised leaving it in place no more than 11/2 hours before letting a little blood get through, and the other advise no more than two hours. Here’s an excerpt from the latter one. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421924/ “Safe duration and pressure for tourniquet use remains a controversy. No strict guidelines have been laid down. A safe time limit of 1–3 h has been described.33 Horlocker et al. (2006) have found a strong correlation of nerve injury with prolonged total tourniquet time with an approximate threefold increase in risk of neurological complications for each 30 min increase in tourniquet inflation. The duration of uninterrupted tourniquet inflation also increased the likelihood of neural dysfunction.14 Use of tourniquet for >2 h and pressures of >350 mm Hg in lower extremity and >250 mm Hg in upper extremity increases the risk of compression neurapraxia. If >2 h is required, the tourniquet should be deflated for 5 min for every 30 min of inflation time.34Safe duration and pressure for tourniquet use remains a controversy. No strict guidelines have been laid down. A safe time limit of 1–3 h has been described.33 Horlocker et al. (2006) have found a strong correlation of nerve injury with prolonged total tourniquet time with an approximate threefold increase in risk of neurological complications for each 30 min increase in tourniquet inflation. The duration of uninterrupted tourniquet inflation also increased the likelihood of neural dysfunction.14 Use of tourniquet for >2 h and pressures of >350 mm Hg in lower extremity and >250 mm Hg in upper extremity increases the risk of compression neurapraxia. If >2 h is required, the tourniquet should be deflated for 5 min for every 30 min of inflation time.”

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  • Bobby W

    Doc I am an active duty medic and have used tourniquets numerous times on casualties and have for many years. We are taught to never release pressure unless we are sitting on the casualty for more than 6hrs after that we have to worry about cell damage and tissue death. We are taught that if we release the pressure every few minutes that you may not get the tourniquet seated properly again allowing it to continue bleeding. In the case of multiple casualties you don’t want to be in the middle of loosening a tourniquet when one of your other casualties codes or you have more casualties come in. Also in the case of a femoral bleed it may allow the femoral to retract into the abdominal cavity and continue to bleed. Also in the process of applying tourniquet is the use of direct pressure ie putting your knee or having someone else stand on the groin to try and slow the bleed while you are getting the tourniquet in place. This also goes for a knee on the brachial as you work the tourniquet into place. I hope I haven’t offended you or any of the other docs here that’s just my personal experience.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      On the contrary, Bobby. Please comment at any time. I welcome you sharing your real-life experience. Thank-you very much.

  • Randy Marriott, MD, FACEP

    Dr, Hubbard, I really enjoy your daily emails. RE Tourniquets, they are no longer considered last resort. In fact, they are to be used after a brief attempt at control with direct pressure per the National Registry of EMTs. The military experience has demonstrated that they are essentially not limb threatening. They are now often carried on medic units, tactical medics, and police officers.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks. Excellent point. Please comment any time. I need the feedback from other docs. I wonder, though, is that because these responders are going to be able to get to a medical facility rather quickly.

  • Suni

    Thank You for this information. A few years ago my nephew was on a dirt road he was on a motorcycle and was hit by a car traveling the opposite direction. His leg was severally injured. The man that hit my nephew pulled his belt off and actually saved his life by correctly applying the tourniquet. By the time the man got my nephew to the hospital all but about 1 pint of blood was gone but it took about 35 minutes to get him to the hospital. My nephew did lose his leg but it was due to the extent of the injury and not the tourniquet. Thank You again and keep up the great work.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Suni, thanks for sharing that great, but tragic, example. I wish your nephew the best.