What Is a Tourniquet & Which Is the Right One for Me?

A tourniquet is a device for stemming (“occluding”) outgoing arterial blood flow from a limb, typically by compressing the limb with a commercial device or a tight bandage. It is a temporary measure that can keep an injured person from bleeding out before emergency medical services arrive.

To answer the question, “What is a tourniquet?”, we will focus on emergency tourniquets used to control life-threatening bleeding.

When Should You Use a Tourniquet?

Applying a tourniquet may be necessary in the case of life-threatening bleeding. The injured person may be bleeding uncontrollably, with blood squirting out, or have severe bleeding that cannot be stopped within a few minutes of applying direct pressure.

Common scenarios include:

• Industrial or farm accidents

• Car or motorcycle crashes

• Household accidents (especially involving sheet glass)

• Gunshot wounds

• Limb wounds

How to Use a Tourniquet to Stop Blood Flow: Step-by-Step.

If someone is bleeding severely, call (or send someone to call) 9-1-1 immediately. After checking that it's safe to approach, put on personal protective equipment (PPE), such as nitrile gloves, if available.

1. Find the source of the bleeding.

2. Apply direct pressure first to see if the bleeding can be effectively stopped or slowed.

3. If the bleeding doesn't slow significantly after a few minutes of direct pressure, or if the bleeding rate and volume are severe, tell the victim that you are going to apply a tourniquet (it will hurt, but it could save their life). Where to place the tourniquet:

• Fit the tourniquet a few inches above the wound to the extremity (arm or leg) on the side closest to the heart. Position it above the joint if the bleeding injury is close to the joint. 

• If the situation is chaotic or there are multiple wounds, place the tourniquet “high and tight.” 

• Put the tourniquet on the person's bare skin if possible, or over clothing if there is an immediate safety threat (such as in a conflict or fire situation).

• When applying the tourniquet over clothing, remove any objects in pockets or under the clothing that might interfere with tourniquet application.

4. For windlass tourniquets, such as the CAT or SAM-XT, follow the 4T’s: 

1. Thread the limb through the loop or wrap the strap around the limb.

2. Tighten the tourniquet with the strap as tightly as possible. (You should not be able to fit three fingers under the strap.)

3. Twist the windlass until blood flow stops and no distal pulse is present. For the SWAT-T, tightly stretch and wrap the tourniquet around the affected limb, continuing to stretch and wrap until you reach the end, which can be tucked under a previous wrap. 

4. Time the tourniquet application. Write down the time the tourniquet was applied with a black marker. There is often a white label on commercial tourniquets for this purpose. Otherwise, write the time on the person’s forehead: “T = TIME.”

5. Apply a second tourniquet under the first if blood loss continues.

6. When emergency personnel arrive, tell them the person has a tourniquet and the time it was applied. 

7. Never loosen or remove a tourniquet yourself. Tourniquets should not be left on for more than two hours.

Common Mistakes When Placing a Tourniquet

Applying a tourniquet correctly during a highly stressful emergency is not easy. Keep these pitfalls in mind:

• Not tightening the tourniquet enough: This is the most common mistake when using a tourniquet. You should not be able to fit three fingers under the strap, and it should be uncomfortable.

• Placing the tourniquet too low: When in doubt, it is better to be “high and tight” and never place it over a joint.

• Using inadequate, improvised materials: Materials that are too thin can cut through tissue without compressing the artery.

• Removing or loosening the tourniquet: Only qualified medical professionals in a hospital setting should remove or loosen the device.

When Is Tourniquet Application Not Appropriate?

If the bleeding injury is on a part of the body that cannot accommodate the tourniquet (i.e., head, chest, or abdomen), tourniquet use is not appropriate. 

• Junctional wounds: For junctional wounds (shoulders, hips, and groin), a special junctional tourniquet is required. The patient should alternatively be treated with standard wound-packing techniques.

• Abdominal wounds: These wounds should be treated with large trauma dressings.

• Chest wounds: Chest wounds that may involve the lungs should be treated with chest seals. 

• All of these dressings are included in top-tier bleeding control kits.

Commercial vs. Improvised Tourniquets

Emergency tourniquets (TQTs) are either improvised, made from whatever items are on hand when needed, or commercial TQT products designed to function as tourniquets.

What Should I Do if I Don’t Have a Tourniquet?

If you don’t have access to a professional tourniquet, you may be tempted to improvise by using anything on hand, such as a belt or a necktie. An improvised tourniquet should not be used unless the responder has the appropriate training to do so. 

Important note: If you don’t have a commercial tourniquet or the appropriate training, wound packing is often the best option, as most household items are not adequate:

• Belts: Are usually too stiff and narrow, and aren't able to compress the artery against the bone.

• Neckties/String: Are too thin and can actually cut into the skin, causing more damage without stopping the life-threatening bleeding.

Commercial tourniquets are typically designed to be safe for untrained (or minimally trained) first responders. It’s far better to purchase a commercial tourniquet in advance so you know you can treat severe bleeding effectively when the moment comes.

How Do Tourniquets Work?

When a tourniquet is applied around a limb segment, it is gradually tightened until the limb occlusion pressure is reached. 

Occlusion, or the closure of a blood vessel, can be determined by the absence of a palpable arterial pulse in the affected extremity. In the case of a life-threatening hemorrhage, effective occlusion can also be determined by the complete stoppage of blood flow from the wound to which the tourniquet is applied.

The required pressure varies with the patient’s blood pressure, muscle tone, and tourniquet width. The goal of a tourniquet is to achieve and maintain occlusion at the lowest possible pressure, as high pressures applied for an extended period may lead to nerve damage.

Can Tourniquets Cause Limb Loss?

The common fear that tourniquets can cause limb loss or amputation is false. Research shows that a tourniquet can remain in place for up to two hours without causing permanent damage.

Furthermore, emergency situations call for the “Life over Limb” philosophy that states it is better to take the risk of losing a limb than to bleed to death.

Which Tourniquet Is Right for Me?

There are many commercial tourniquets on the market. We’ve done most of the legwork for you and chosen what we believe to be the top-of-the-market tourniquets to include in bleeding control kits:

C-A-T: Combat Application Tourniquet

The tried-and-true standard in commercial tourniquets, the combat application tourniquet is renowned for its wide distribution, industry familiarity, and proven effectiveness in usage by the U.S. military. The CAT is a windlass-style (twisting rod) TQT that requires minimal training to achieve appropriate familiarity.

SAM-XT: Sam Extremity Tourniquet

A relative newcomer to the tourniquet business, the SAM-XT features an exceedingly clever auto-locking mechanism to eliminate slack after the tourniquet has been applied. Eliminating slack is key to maintaining occlusion pressures after application, and thus an imperative component of TQT success. This windlass-style TQT also requires some minimal training to achieve a good level of familiarity.

SWAT-T: Stretch, Wrap, And Tuck Tourniquet

The SWAT-T stands out with its simple design, ease of application, and low cost. Do not let “simple,” “ease,” and “low cost” let you think this is an inferior TQT, however. The SWAT-T’s width allows it to achieve occlusion at lower pressures than other tourniquet styles, and its intuitive design means minimal to no training is necessary to apply it properly. It is also compatible with rendering K9 and pediatric aid. 

Tourniquet FAQs

Can I use a tourniquet if I’m not medically trained?

Yes. Programs such as “Stop the Bleed” are designed for non-professionals to intervene in emergencies. Additionally, Good Samaritan Laws in many states protect those trying to save lives.

Will a tourniquet hurt?

Yes, a tourniquet can be very painful. It is important to warn the patient without reducing the tourniquet pressure.

Should every school or home have a tourniquet?

Yes. Severe bleeding is one of the top preventable causes of death and occurs within minutes. A tourniquet can stem life-threatening bleeding much faster than emergency services typically arrive.

Tourniquets Can and Do Save Lives

Appropriate tourniquet use can save someone's life if they are bleeding uncontrollably and EMS personnel have not yet arrived. The most effective kind to use is a commercial tourniquet, which is not present in first-aid kits but is included in all bleeding control kits. 

To stop blood flow, the tourniquet must be tightened until occlusion is achieved. This means blood flow has stopped, and there is no pulse on the other side of the device. As soon as you've applied a tourniquet, write down the time it was applied with a black marker, and stay with the victim until medical help arrives. 

If you ever need help deciding which tourniquet is right for you, don’t hesitate to reach out to our team. We will help you choose the right products for your setting and needs.

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Backup of the original article:

What Is a Tourniquet & Which Is the Right One for Me?

A tourniquet is a device for stemming outgoing arterial blood flow, typically by compressing a limb with a commercial device or a tight bandage. It is a temporary measure that can keep an injured person from bleeding out before emergency medical services arrive.

The term ‘tourniquet’ is often utilized for:

1. Surgical tourniquets, such as an elastic ring tourniquet or pneumatic tourniquet, applied to minimize blood flow during extremity surgery

2. IV/blood draw-style elastic restrictive bands designed to raise and pronounce veins (blood flowing back to the heart) to the surface of the skin for easier access

3. Emergency tourniquets used to stop severe bleeding

For the purpose of answering the question, “what is a tourniquet?”, we will focus on emergency tourniquets as used for life-threatening bleeding.

Commercial vs. Improvised Tourniquets

With the semantics out of the way, emergency tourniquets (TQTs) are either improvisational, created with whatever items are on hand at the time the TQT is needed, or commercial TQT products developed by safety companies with the expressed purpose of operating as a tourniquet.

Commercial tourniquets are typically designed to be safe for untrained (or minimally trained) first responders, whereas improvised tourniquets are not reliably applied without extensive training and may not be better for treating a bleeding injury than a wound-packing technique would be.

How Do Tourniquets Work?

When a tourniquet is applied around a limb segment, it is gradually tightened until the limb occlusion pressure is reached. Occlusion, or the closure of a blood vessel, can be determined by the absence of a palpable arterial pulse in the affected extremity. In the case of life-threatening hemorrhage, effective occlusion can also be determined by the complete stoppage of blood flow from the wound that the tourniquet is being applied for.

The pressure required can vary with the patient’s blood pressure, muscle tension, and tourniquet width. The goal of a tourniquet is to achieve and maintain occlusion at the lowest possible pressure, as high pressures applied for an extended period of time may lead to nerve damage.

When Is Tourniquet Application Not Appropriate?

If the bleeding injury is on a part of the body that cannot accommodate the tourniquet (i.e. head, chest, or abdomen), tourniquet use is not appropriate. For junctional wounds (shoulders, hips, and groin) a special junctional tourniquet is required.

Junctional wounds should be treated with standard wound-packing techniques, abdominal wounds should be treated with large trauma dressings, and chest wounds that may involve the lungs should be treated with chest seals. All of these dressings are included in top-tier bleeding control kits.

Important note: An improvised tourniquet should not be used unless the responder has the appropriate training to do so. Rather than wait and scramble for a suitable piece of cloth to use as a tourniquet at the last minute, it’s far better to purchase a commercial tourniquet ahead of time so that you know you can treat severe bleeding effectively when the moment comes.

Which Tourniquet Is Right for Me?

There are many commercial tourniquets on the market, and deciding which ones are appropriate for your needs can be a daunting task. Fortunately, we’ve done most of the legwork for you and chosen what we believe to be the top-of-the-market tourniquets to include in our bleeding control kits:

C-A-T: Combat Application Tourniquet

The tried-and-true standard in commercial tourniquets, the combat application tourniquet is renowned for its wide distribution, industry familiarity, and proven effectiveness in usage by the U.S. military. This is a windlass-style (twisting rod) TQT that requires a minimal amount of training to achieve appropriate familiarity.

SAM-XT: Sam Extremity Tourniquet

A relative newcomer to the tourniquet business, the SAM-XT features an exceedingly clever auto-locking mechanism to eliminate slack after the tourniquet has been applied. Eliminating slack is key to maintaining occlusion pressures after application, and thus an imperative component of TQT success. This windlass-style TQT also requires some minimal training to achieve a good level of familiarity.

SWAT-T: Stretch, Wrap, And Tuck Tourniquet

The SWAT-T stands out among the competition with its simple design, ease of application, and low cost. Do not let “simple,” “ease,” and “low cost” let you think this is an inferior TQT, however. The SWAT-T’s width allows it to achieve occlusion at lower pressures than other styles of tourniquets, and its intuitive design means there is minimal to no training necessary to apply it properly. In a scenario where every second matters, these advantages cannot be overstated. It is, however, important to apply this tourniquet well above the site of bleeding, as working with the SWAT-T can become slippery if in contact with large amounts of blood. It is also compatible with rendering K9 and pediatric aid. 

How to Use a Tourniquet to Stop Bleeding

Applying a tourniquet may be necessary in the case of:

• Industrial or farm accidents

• A car or motorcycle crash

• Household accidents (especially involving sheet glass)

• Gunshot wounds

• A crushed limb

• Partial or complete limb amputation

The injured person may be bleeding uncontrollably with blood squirting out or have severe bleeding that cannot be stopped within a few minutes of applying direct pressure.

After checking that it's safe to approach and putting on personal protective equipment (PPE), such as nitrile gloves:

1. Send someone to call 9-1-1.

2. Find the source of the bleeding.

3. Apply direct pressure first to see if the bleeding can be effectively stopped or slowed..

4. If the bleeding doesn't slow significantly after a few minutes of direct pressure, or if the bleeding rate and volume is severe, tell the victim that you are going to apply a tourniquet and that it will hurt but it could save their life.

5. Fit the tourniquet a few inches above the wound to the extremity (arm or leg) on the side closest to the heart, above the joint if the bleeding injury is close to the joint. Put the tourniquet on the person's bare skin if possible, or over clothing if there is an immediate safety threat (such as in a conflict situation or fire). When applying the tourniquet over clothing, be sure to remove any objects in pockets or under the clothing that might interfere with tourniquet application.

6. For windlass tourniquets, such as the CAT or SAM-XT, tighten the tourniquet with the strap and turn the windlass until the blood flow stops and there is no distal pulse. Secure the windlass. For the SWAT-T, stretch and wrap the tourniquet around the affected limb tightly, continuing to stretch and wrap until you reach the end, which can be tucked under a previous wrap. Ensure that blood flow has stopped and there is no distal pulse.

7. Apply a second tourniquet under the first if there is continued blood loss.

8. Write down the time the tourniquet was applied with a black marker. There is often a white label on commercial tourniquets for this purpose. Otherwise, write the time on the person’s forehead: “T = TIME.”

9. When the emergency personnel arrive, tell them that the person has a tourniquet and the time the tourniquet was applied. Tourniquets should not be left on for more than two hours.

10. Never loosen or remove a tourniquet yourself.

Tourniquets Can and Do Save Lives

Appropriate tourniquet use can save someone's life if they are bleeding uncontrollably and EMS personnel have not yet arrived. The most effective kind to use is a commercial tourniquet, which is not present in first-aid kits but is included in all bleeding control kits. 

To stop the blood flow, the tourniquet must be tightened until occlusion is achieved, which means the blood flow has stopped and there is no pulse on the other side of the device. As soon as you've applied a tourniquet, write down the time it was applied with a black marker, and stay with the victim until medical help arrives. 

If you ever need help deciding which tourniquet is right for you, please don’t hesitate to reach out to our team. We will help you prepare the product offering specific to you.