What's new

First aid/response - Tourniquet Use

JEVapa

Joined
Sep 16, 2023
Messages
1,853
Reaction score
5,331
Trophy Points
113
Member
Fren
DISCLAIMER: This post and similar are for education/discussion. This is not in lieu of treatment or attention by professional medical personnel, nor should it be construed as medical advice.


I'm going to post his here because IDK where else for it to go...maybe training? Maybe Gear? It encompasses training, gear, and survival stuff. I might post various stuff for reference and links and such. I was an IDM in the Army for 14yrs so I know a little about medic-ing.

In commieland, multiple people had aid bags and IFAKs and things for their vehicles and the range and such. At first I though many of these folks were trained but later on I realized not so much. In fact, most not at all.

This one is to go over Tourniquet (TQ) use. The worst thing a human can do medically/first responder in any situation is to render some kind of medical intervention and fuck it up like a football bat. A tourniquet in the hands of an untrained person can be catastrophic.
You need to know the indications for one to be used and how to PROPERLY employ it.
You should also know treatments in lieu of a TK if one isn't indicated.
You need to understand enough A&P (Anatomy and Physiology) and mechanism of injury to help determine the indications (or not) for TQ use. This is high school A&P shit but important for Tx.

ROT: Arteries perfuse tissue (carry oxygenated blood to organs and tissues) under active pumping of the heart. Because of this, they tend to be protected by their placement in the body - core, inside joints (fossae), the interior (medial) aspect of limbs/bones.

Veins do not perfuse tissues. They return deoxygenated blood to the heart to be sent to the lungs for reoxygenation. Only a few Veins are big enough to exsanguinate, but they are easier to address because they move blood from backpressure and not direct pressure from the heart. These tend to clot much easier and faster than arterial blood. Veins also run closer to the surface whereas Arteries run close to the core/bone. 99% of the bleeding you see when you cut yourself is venous.

See pictures: Note, not to be a plagiarist like those fools in commieland, I'll note the source of pics and things so OK Balls has a less chance of a cease and desist order - https://humanbiology.pressbooks.tru.ca/chapter/16-4-blood-vessels/

Arterial_System_en.svg_-679x1024.pngVenous_system_en.svg_.png

Now that we have looked at the diagrams and understand where those vessels lie in the human body, what are indications of tourniquet use? Think of Anatomy and MOI...MOI is how the injury was caused. GSW, MVA, fall (impact sickness), farm accident, etc. Is it penetrating trauma or blunt trauma?

The two simplest primary indicators for tourniquet use are bright red exsanguinating bleeding and extremity trauma - think a GSW to the right arm with a fractured humerus. That's the easiest. Bright red squirting/spurting blood in large volume.
Venous bleeding can look really bad, but it's not going to be coming out of the wound bright red, it will pour or flow vs spurting. It will turn red when it's exposed to air...which also people may mistake for arterial
.
A harder one is blunt trauma to say the left calf where it's crushed but not open and actively swelling and turning purple and red...TQ? or Not?
Extreme blunt trauma to the medial aspect of the thigh? TQ or not? MOI? Femur Fx? etc

TQs only go on extremities. Nowhere else. Everything else gets pressure or packing. Look at the below pics from commieland. This is a perfect example of not only improper TQ placement, but it is 100% contraindicated. But dude put it on because he had it and fucked it up. It's too high above the wound, it's not an arterial bleed, and it's not tight enough anyway. Also, he had complained that it kept bleeding...most likely from compartment syndrome cause by applying a TQ to a venous bleed. He's on thinners, so even a venous bleed will look bad. The amount of blood shown is minuscule.

tqplacement.jpg


Bottom Line, if you're going to run around with a TQ in your kit, know when, why, and how to use it PROPERLY.

Remember, Exsanguinating Bleeding (arterial squirting bright red) from an Extremity. 4"-6" or Four Fingers above the wound (exceptions can be high thigh wounds depending on location of wound). You don't want it too close or too far away from the wound. Turn windlass enough to stop the Arterial bleeding, not enough to just make dents in your skin. If you or the Pt is fat, it'll look like a fucking balloon animal when it's on correctly, not like the pic. A tourniquet is one of the most painful treatments you can apply. Most times, you cannot apply one correctly to yourself on a leg wound. Arms, yes, leg, especially a thigh, nope. To much squeezing and pain. CAT tourniquets are junk. Only good for women and kids. Use a SOF tourniquet or something with an aluminum windlass or make one out of wood and a cravat.

How many of y'all have TQs in your kits and think you know how to use them or actually have used them?
 
Last edited:
My thoughts were always to use one on a limb if person was gushing blood that you couldn't ebb the flow.

I've only got basic first aid, cpr/aed training.

If able, I just call 911 with injured person's phone & do the basics I know to do until first responders arrive and take over.
 
So my background is this:

Dated, last serious/reputable class I had was circa summer vacation 2010. It was a combat lifesaver course. My job was to prevent someone from going into shock or bleeding out while we were waiting on the doc to get to us. If doc was a casualty as well, then hopefully, if we’re extremely lucky, maybe keep them alive long enough to get a 9 line sent out and have a medical bird show up if the air wasn’t red.

In regards to tourniquets, I figure my training reflected my role: dumbed down Corpsman. I was told that if bleeding was veinous or worse, or if it was questionable, put an Israeli bandage on with lots of pressure. If under lots of pressure it’s bleeds through, throw a tourniquet on as high up on the limb as you can. If they aren’t distracted from their injury with the pain of tightening the TQ windlass, than they’re either dead or you’re being a weak bitch. Tighten more. If you break a bone, or one tq doesn’t stop the bleed, move down 6 inches, and repeat. By the time you’re done with this, doc should be there if he’s still alive, and you needs to help him drag and/or yell at the boys on the 240s to throw out some hate.

How out of date am I?
 
throw a tourniquet on as high up on the limb as you can.
This is the only thing I’d contest. You want go as high as required. If you have an Israeli or other pressure dressing applied, then use the four finger rule above the dressing.
 
Last edited:
This is the only thing I’d contest. You want go as high as require. If you have an Israeli or other pressure dressing applied, then use the four finger rule above the dressing.
Sweet, I’m glad I’m not too far behind the curve. Why the 4 finger rule? Is it to limit tissue damage, like worse case scenario kinda shit, or is it more effective from a medical standpoint?
 
Most TCCC trains 4”-6” proximal. I’d have to go look at the newer POI. Tissue damage…once a TQ goes on, it doesn’t come off until the pt is in surgery. There’s advanced training and whatnot but I won’t discuss it here…doesn’t really apply and I’m not running a clinic or UW hospital so I don’t need to worry about it. Remember we’re talking about peacetime US and not Afghanistan or some place. Now maybe when the ball drops…
 
Last edited:
How many of y'all have TKs in your kits and think you know how to use them or actually have used them?
I have a SOF tourniquet in my kit. I know more about them than I did five minutes ago, but I'm under no illusions about knowing enough to safely use it on my own. Training is one of my long range goals, but right now it's one of those things that I at least have available for someone who is trained to use it.

Thanks for this thread. This is actually one of the reasons I looked for this place after you got booted.
 
Most times, you cannot apply one correctly to yourself on a leg wound. Arms, yes, leg, especially a thigh, nope.
I listened to Nick Lavery (the first Green Beret to return to combat after an above the knee amputation) on Andy Stumpf's and Jack Carr's podcasts, talking about the incident where he lost his leg. I think he had help getting the tourniquet on his thigh, but then he had to release it and stuff packing into the wound (I think he called it a "powerball"?), then retighten it, to get the bleeding under control. That sounded like a hell of an ordeal, but, as he said, the alternative was to bleed out...
 
I’ve only used one once while not at work, and it was on my dog; saved her life and thankfully no issues from it.

I carry a TQ, pressure dressing, and chest seal, and though there’s definitely other things I’d recommend that’s my bare necessities list for interventions that must take place for survival during transport to the ED. The best medicine is diesel, and lots of it.
 
I listened to Nick Lavery (the first Green Beret to return to combat after an above the knee amputation) on Andy Stumpf's and Jack Carr's podcasts, talking about the incident where he lost his leg. I think he had help getting the tourniquet on his thigh, but then he had to release it and stuff packing into the wound (I think he called it a "powerball"?), then retighten it, to get the bleeding under control. That sounded like a hell of an ordeal, but, as he said, the alternative was to bleed out...
So he actually had three tourniquets applied and packing/pressure dressings to mitigate a femoral bleed. In a thigh, you can bleed out with most of the volume in the actual leg. It's really hard to get enough compression on the thigh of a westerner, especially and American who's in shape and carries heavy shit. Packing and hemostatic agents in combo with TQ's are usually the order of the day. We never called it a powerball but, maybe someone coined a new term in the last 10 years.
ETA: I'm retracting this last sentence. Talked to a buddy today and the guy I'm referencing had a BKA...but it's high on the lower extremity and his prosthesis rides up high on his thigh.

The premise for this post is to make aware that although you have a tool (a tourniquet in this case), doesn't mean you necessarily know how/when to use it and if used improperly, can do more harm than good. If you have TQs, then learn how and when to use them. I see a lot of folks (civilians) on the net with their aid bags and IFAKs with TQs in them and sometimes talking about how they'll use them in an event and realized most folks have no idea when or how to use one. It's better to throw it in the trash and use something else than to use one that could really fuck you or the recipient up. TBH, I've met EMTs and such whose dressings and TQs look like a big ball of fuck.
That said, it's fairly easy to learn correctly...there are online resources and classes that can be taken. Sometimes it may be the best intervention, and sometime the worst. It may be a secondary tx to a pressure dressing for a GSW to the medial thigh (like @HoLeChit 's CLS training above). It may be the primary tx for a traumatic amputation (like a farm accident) or a primary tx for an arterial laceration to an arm, then follow up with a pressure dressing. It all depends and requires some training, but not much. It's pretty simple. Maybe the next post will be pressure dressings.
 
Last edited:
There’s a bunch of stuff here in this thread that I should know. Keep it coming. I appreciate it. Every time I head to the woods and am loading out all my chainsaw gear I tell myself I should have some sort of first aid kit. I really should do something about it. So far in life the only first aid I’ve used or known is that diesel that Roy mentioned. I’m going to have to get my shit together or block out this thread because it’s really a wake up call and if I know I should be prepared but do nothing then that makes me a sorry sonofabitch when shtf.
 
I'll edit this post later...I use the abbreviation TK almost all the time and we (being me and others in the past) have used TK and TQ interchangeably. IDK where I got that from but it came from somewhere over 10 yrs ago. Anyway, I'll take care of it.
Also, I added a disclaimer at the top of the post. Word will get back to commieland and next thing you know, dr. Bob and his Respiratory Therapist sidekick will be over here to shit their medical expertise in here and snitch to some authorities somewhere. Why? Because that's what they do, is snitch.
 
So can anyone recommend a good trauma kit and where to get it or should I just put one together myself from a well conceived list?
Those are usually spendy when you say good. My recommendation is to get something from NAR or SOTECH. They both supply equipment to Mil and various agencies. Bare min if you're going to get something is a pouch of some kind, some bandage scissors (trauma shears) aka penny cutters, roll gauze/square gauze, tape, ACE wrap, bandaids, big fat safety pins, and some cravats. Cravats can be made by cutting out a 36"x36" square from an old cotton, linen, or muslin sheet, and cutting it in half diagonally. SAM's has a bunch of stuff you can get as well as the drugstores. Kotex/maxi pads make great dressings. Vaseline gauze is good for chest seals or 10 gal trash bags. And get a first aid book or two that you can throw in your vehicle so you can read wherever you go.


 
Last edited:
Most TCCC trains 4”-6” proximal. I’d have to go look at the newer POI. Tissue damage…once a TK goes on, it doesn’t come off until the pt is in surgery. There’s advanced training and whatnot but I won’t discuss it here…doesn’t really apply and I’m not running a clinic or UW hospital so I don’t need to worry about it.
Ah ok thanks! Learning has occurred.


Remember we’re talking about peacetime US and not Afghanistan or some place. Now maybe when the ball drops…
This is a good point, and forget that occasionally.
 

I like these for shears. Cheap enough that you don’t mind misusing then tossing them but they’re a little more robust than the usual shears you get in kits. The more flimsy shears will screw you when you’re cutting through thicker material like a carhart coat or the doubled denim around the top of a pair of work jeans.
 
So can anyone recommend a good trauma kit and where to get it or should I just put one together myself from a well conceived list?
I’ve put mine together on my own over the years. Some things get added as needed, some things get removed. It’s been really useful and is always in my truck. If I have the time this evening I’ll try to get everything out and make a list/photo.
 
Top