- Emergency medical personnel, both civilian and military,
should be trained in and equipped for the proper use
of tourniquets; the focus of first aid training for civilian
populations should continue to deemphasize their use
and focus instead on early medical assistance and the use
of direct pressure to control hemorrhage.
- No patient should exsanguinate from an extremity
wound because of the hesitance of a medical professional
to utilize a tourniquet to control bleeding due to fear of
potential complications.
- In circumstances- such as combat (or the civilian equivalent
thereof), high risk of building collapse, fire, or
explosions- where expedient movement of the patient is
necessary for the safety of the patient and the caregivers,
the use of a tourniquet is appropriate to gain control of
life threatening hemorrhage
- The existence of a mass casualty incident may be an indication
for the use of tourniquets for temporary control of
hemorrhage while the situation is brought under control.
- The need for a tourniquet applied to allow movement of
a wounded person or during a mass casualty incident
should be reevaluated at the earliest possible time;
- The mere presence of an amputation with hemorrhage
does not necessitate the use of a tourniquet; most bleeding
from such injuries are controllable through use of
direct pressure, elevation and packing of the wound. If
these actions do not achieve hemostasis, then the use of a
tourniquet is indicated.
- Tourniquets may be placed proximal to the site of
uncontrollable bleeding around an impaled object; under
no circumstances should the tourniquet be applied over
the impaled object.
- Tourniquets should not be applied over joints, or over
clothing. It should also be at least 3–5 centimeters from
the wound margins. The rule of the thumb the author
used when teaching was to place it the width of the palm
of a hand proximal to the wound whenever possible, as
this provides an easy frame of reference.
- Any limb with an applied tourniquet should be fully
exposed with removal of all clothing, and the tourniquet
should never be covered with an form of bandage. The
patient should be clearly marked so as the presence of a
tourniquet will be know, along with the time it was
placed. It may also be advisable to instruct a conscious
patient to tell every medical provider they come in contact
with about the presence of a tourniquet.
- Continued bleeding (other than medullary oozing from
fracture bones) distal to the site of the tourniquet is a sign
of insufficient pressure and a need to tighten the tourniquet
further.
- A tourniquet should not be loosened in any patient with
obvious signs of shock, amputation that necessitated use
of such a device to control bleeding, recurrent hemorrhage
upon release of the tourniquet or any case where the
hemorrhage associated with the wound would be
expected to be uncontrollable by any other means.
- Any tourniquet that has been in place for more than six
hours should be left in place until arrival at a facility capable
of definitive care.
Nice visual though. 