How to Apply a Tourniquet

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The first line of defense against bleeding out of the arms or legs is a tourniquet. The myth that a tourniquet poses a threat to the limb has been debunked by numerous studies. Caleb Causey of Lone Star Medics demonstrates how to apply a tourniquet to an arm or leg and offers tips for efficient tourniquet employment based on his extensive field experience.

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9 Responses to “How to Apply a Tourniquet”
  1. Denver

    This video gives bad advice. There is good reason a tourniquet in an option of last resort for stopping bleeding. 1. If it is applied too tight or for too long, the tissue in the extremity can die and you will lose your arm or leg. 2. With the tourniquet applied, blood remaining in the extremity will begin to degrade because of lack of circulation. In this case when the tourniquet is removed the toxins in the blood will flood your circulatory system and can cause septic shock and lead to death. Always try direct pressure and elevating the limb first. There is no reason to risk using a tourniquet unless there is a life threatening bleedout occurring.

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  2. Lone Star Medics

    I guess the Committee on Tactical Combat Casualty Care (CoTCCC), over 12 years of combat on two fronts with thousands of injuries and deaths, and a simple understanding of human anatomy and physiology accounts for nothing, Denver?
    Regarding your reasons you think this is bad advice:
    1. Yes if the tourniquet (tq) is applied too tight it can tear tissue instead of occluding blood flow. This happens more often with certain tq’s than other brands. I have not been able to find any documented cases of either the CAT or SOFT T Wide causing such an injury. To do so would require a great amount of force and more than likely either one of these two tourniquets would break apart before that could happen.
    If you are worried about “losing the limb”; please show me any documented case in the history of tq use in a pre-hospital setting where the patient lost a limb due to an extended time frame.
    Also, let us not forget that if we don’t stop the bleeding, then we lose the entire patient. So do we want to lose or do we want to lose big? “Well doctor, we saved the limb… but the patient bled out and died. But hey! We saved the limb.”
    2. There are several recent (past 15 years or so) well documented case studies that prove that a tq can remain tight and left on a limb for up to six to eight hours before the concern of necrotic tissue. Granted it is a topic of discussion right now with CoTCC and other healthcare professionals on what pre-hospital protocols should be considered after that initial six to eight hours. Yes, there is a risk of circulating necrotic cells and the toxins related to necrotic tissue/cells throughout the human body resulting from either a penetrating traumatic injury or from tq use past the 6-8hr mark. Not to mention the fact we also risk circulating clots throughout the body. Which can cause pulmonary embolisms and that is bad for the patient.
    In regards to the old school of thought by “elevating the limb” first; this has proven to be absolutely useless and a complete waste of time on the battlefield. Now we may not be on a battlefield here back home, but bleeding is bleeding. When dealing with moderate to severe bleeding, time and blood are two things we don’t have a lot of. The average human adult only has about five to six litters of blood in their body. Once blood has been spilt on the ground, we can’t put it back in the body. Therefore we need to save and maximize as much as we possibly can… as effectively and efficiently as we can.

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  3. Lone Star Medics

    Anatomically and physiologically speaking; the brain must continue to function in order for the rest of the body to. The body may continue to function without the use of all the other organs, such as the spleen or even other body parts of the body like an arm or a leg. But if the brain stops, everything else stops; immediately. So we need to keep the brain working by feeding it. We feed it by giving it several things such as sugar and oxygen for example. Well if there is no blood left to send that sugar or oxygen to the brain, the body dies; immediately. This is bad. Another reason we no longer use the acronym “ABC” when assessing a patient. Instead we use “CAB” so as to identify and treat moderate to severe external bleeding first (the Circulation part); then assess a patient’s Airway then Breathing… in that particular order.
    If this still doesn’t make sense, I encourage you to attend a training course that teaches such modern-day techniques and why we do utilize tourniquets as such.

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  4. Denver

    Lone Star Medic: I don’t doubt that tourniquets can be safe, if applied by trained medics using proper procedures. But many viewers of this video do not have medical training, or access to those particular products that you mention. When most people think tourniquet, they envision something like a rope or article of clothing, tied with a knot, and a stick or tool inserted to provide torque when twisting. And you seem to miss my last sentence, which gave an exception for life threatening bleedouts. When creating an instructive video like this one, you have to consider the audience and how they will interpret the information. In this case, there are likely many people who will not understand the finer points and procedures that you have in your mind as basic assumptions.

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    • Praemonitus Praemunitus

      I am a former delayed, prolonged transport NREMT-I, and a former Wilderness EMT. I also taught Responding to Emergencies for the American Red Cross in a university health department program for over a decade, and was instructor certified with the American Red Cross to teach its Emergency Response course, initially developed for FEMA. As a first aid instructor teaching a semester course in Responding to Emergencies for ten years, I taught hundreds of students how to assess severe bleeding and apply tourniquets as a ‘last resort’, as it is one of the skill tests required for that certification. As a wilderness first responder we were taught to consider applying tourniquets ‘early’ due to the fact that our patients were almost always FAR away from advanced medical help. But back in the day, the application of a tourniquet also went with a monitoring protocol which involved timed reassessments along with timed loosing and retightening of the tourniquet, stuff that usually failed to work, I might add. It was a cumbersome protocol, to say the least. These were the old first aid protocols of the 80s, 90s and early 2000s, however, Thank God things change and medicine EVOLVES. Flash forward to 2017…

      I took Caleb’s EDC-X class this past summer. Before taking his course, I researched a few of the other programs in the US which were designed to teach civilians with no knowledge or first aid training (so from the ground up if you will), how to perform life-saving first aid when involved in a gun fight or active shooter situation. Presently, there are not many of these courses available to civilians. Money was not necessarily an object, and I could have travelled to any of the other courses. So my decision to select the Lone Star Medics class was purpose driven. We had to drive 6 hours to the course site and secure lodging for two nights. I was very careful in this decision because I wanted my 14-year old son to learn these life saving skills from an experienced, professional military combat and street medic, as these techniques are currently still not taught well in most civilian first aid courses, and as of this writing are almost never taught in almost any civilian firearm courses. The EDC-X was two days (16 hours) and involved the use of a hand gun, a tourniquet, an OLAES bandage and your BRAIN. I believe most of other folks in the class, while experienced shooters, were mostly unfamiliar with the subject and application of tourniquets. Everyone who took the course came away with the ability to accurately perform the required skills under stress. I know. I carefully and critically observed Caleb and all of the students.

      Caleb covered EVERY pertinent issue associated with ‘suspecting’ and ‘treating’ severe, life-threatening bleeding. He also did it in a way so as to integrate the need to be able to perform the skill in a variety of real-world scenarios, requiring one to THINK about what they were DOING. We were each then critiqued in a debrief. This is precisely the way one LEARNS any new skill. My son is now an ace at finding and stopping severe bleeding. He carries his ‘Causey Special’ severe bleeding kit every day to his high school, and I have absolutely no doubt that he knows what to do, and would be able to do it under stress. Thank you Caleb! Mission accomplished.

      PDN is offering this video as a free service to its members, and potential members. I applaud them for being on the cutting edge of ‘gun fight first aid’. Civilians should count themselves as blessed that Caleb was willing to do this video and let Rob post it up. I know it was done with 100% good intentions and the material presented can SAVE lives. Anyone who watches this video should consider finding and taking a course in how to stop severe bleeding using these modern protocols.

      Do I think that a person watching this video will misuse the information and cause harm to themselves and/or another person? No way. You did read the accounts of the Congressional baseball shooting, right? Victims had ‘make-shift’ tourniquets applied by other civilians … and wait for it, no one’s arm or leg was damaged by a tourniquet, even an improvised one done with a belt. It would have been better if everyone there had been properly trained in the current protocol and had used SOF-T wides, but remember these are smart humans. They quickly adapted. No lives were lost because everyone, especially law enforcement, quickly and intensely adapted. I bet that baseball field has some SOF-T wides now in a kit that folks have access to. In my opinion, there probably should be a modern tourniquet in every AED box, and every civilian first aid class should have a unit on dealing with active killers/terrorism in public spaces. Someday.

      And regarding Denver’s ‘exception for life-threatening bleed outs’ … you know there are a hundred scenarios that I could throw at you, and you would probably fail to detect a ‘life-threatening’ bleed out in 50% (or more) of them … in time to make a difference. That is unless you defaulted early to the proper and timely application of a tourniquet, or found the trunk bleed and applied the quick clot agent and/or OLEAS in time to buy your victim MORE TIME. The objective of these scenarios would not be to ‘make you fail,’ but rather to make you UNDERSTAND just how critical it is to THINK, and to ‘get it right’ and most importantly ‘get it right IN TIME’.

      And regarding what ‘most people envision.’ You know I learned a long time ago not to try and predict what ‘most people’ thought. And I learned in debate class to never pin an argument by trying to speak for ‘most people.’ This usually means that one has already lost the argument. The truth is that most people want to do the right thing in a bad situation. You do realize that in most every state a civilian responder is protected from liability for attempting to do the right thing to save someones life. With the ever-present and increasing threat of domestic terrorism utilizing knives, vehicles, bombs, etc, to trauma on civilians, information such as what Caleb briefly discusses in his video, and courses such as offered by Lone Star Medics (and a very short list of others) is critical for civilians to be aware of, train for and practice being proficient in.

      Praemonitus praemunitus

      Reply
  5. Geoff B

    Lone Star Medics, thank you for the informative video, demonstrating TK use with a proven device. As a retired USSF 18D, I agree that TK is the best choice for pre-hospital control of extremity hemorrhage caused by high velocity trauma, which is what your scenario addressed.

    Here are some scholarly articles supporting TK use. Providing scholarly support to the argument for TK application usually stops the anti-TK arguments, which are usually based on outdated, mythological thought.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660095/

    http://www.sciencedirect.com/science/article/pii/S0736467909006386

    http://journals.lww.com/annalsofsurgery/Abstract/2009/01000/Survival_With_Emergency_Tourniquet_Use_to_Stop.1.aspx

    http://journals.lww.com/jtrauma/Abstract/2008/02001/Prehospital_Tourniquet_Use_in_Operation_Iraqi.7.aspx

    Reply
    • Customer Service

      Hi Jim. The two that are most widely used are the SOF Tactical Wide (SOF-T Wide is being used in this video) and Combat Application Tourniquet (C-A-T). These two are the most widely used and issued in IFAK kits to our armed professionals as well as medics assigned to these units. The difference between the two is the material the windless is made of, the SOF-T has a metal and the C-A-T utilizes a polymer. Right out the wrapping the C-A-T is the easier to apply to yourself in a situation where you only have the use of one hand. This can be corrected on the SOF-T by adding a bit of paracord to the windless lock.
      Thanks
      Deryck-PDN

      Reply
  6. Curt Johnson

    Why not have a small pen that fits inside the tightening “handle” available for using to date/time when the tourniquet was applied? Make it so it snaps or clicks into position so it won’t easily come out during handling. What are the chances of having a pen or marker handing when treating a victim with severe arm/leg bleeding?

    Reply

Tags: Caleb Causey, First Aid, Free Videos, Gunshot wound, Tourniquet