An emergency tourniquet is a tightly tied band applied around a body part (an arm or a leg) sometimes used in an attempt to stop severe traumatic bleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...

. Tourniquet
An emergency tourniquet is a tightly tied band applied around a body part sometimes used in an attempt to stop severe traumatic bleeding. Tourniquets are also used during venipuncture and other medical procedures. Severe bleeding means the loss of more than 1,000 ml of blood. This flow of blood...

s are also used during venipuncture
In medicine, venepuncture, venopuncture or venipuncture is the process of obtaining intravenous access for the purpose of intravenous therapy or for blood sampling of venous blood. This procedure is performed by medical laboratory scientists, medical practitioners, some EMTs, paramedics,...

 and other medical procedures. Severe bleeding means the loss of more than 1,000 ml (1 litre) of blood. This flow of blood can soak a paper or cloth handkerchief in a few seconds. In such a situation, the bleeding will cause the death of the casualty in seconds to minutes.

In most applications, a tourniquet is a last resort method of bleeding control
Emergency bleeding control
Emergency bleeding control describes the steps or actions taken to control bleeding from a patient who has suffered a traumatic injury or who has a medical condition which has led to bleeding...

 as all blood flow below the application of an emergency tourniquet is stopped, and can subsequently kill the tissue, leading to eventual loss of the limb below application.

Even in cases of amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...

, most bleeding can be controlled through alternative methods such as direct pressure. The rare exception is when a limb is shattered by massive trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

 or when a major blood vessel is torn along its length. Even in these cases, the use of a pressure point
Pressure point
A pressure point in the field of martial arts refers to an area on the human body that may produce significant pain or other effects when manipulated in a specific manner...

 above the wound (i.e. proximal to the wound), or application by a doctor of a hemostat
A hemostat , is a vital surgical tool used in almost any surgical procedure, usually to control bleeding. Therefore, it is not uncommon to see the initial incision lined with hemostats closing blood vessels awaiting ligation during the initial phases of surgery...

 to clamp the blood vessel above the tear can be used.

However, the use of tourniquets is widespread in military applications, and have the potential to save lives during major limb trauma. Analysis has shown that in cases of major limb trauma, there is no apparent link between tourniquet application and morbidity of the limb.

Risks of a tourniquet

As the tourniquet stops the perfusion of the limb, the resulting anoxia
Hypoxia (medical)
Hypoxia, or hypoxiation, is a pathological condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise...

 can cause the death of the limb, forcing the later surgical amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...

 of the limb just below the level the tourniquet is applied. This is likely to occur when the tourniquet stays in place several hours. In any event, once a tourniquet has been applied, advanced medical care from a doctor or hospital will be required to salvage the limb if not save the life of the patient.

Pressure bandages are sometimes confused with tourniquets in non-trained civilian use. A pressure bandage is applied either directly to the wound or just above the arterial path to slow blood flow and reduce blood loss, without occluding blood flow to the injury. In many cases, pressure bandages are effective for premedical first aid treatment.


United States (civilian)

Tourniquets are still widely considered in the civilian field to be an option of last resort. This practice is changing, with many EMS services carrying tourniquets.

The decision to employ a tourniquet should be made by an emergency medical technician
Emergency medical technician
Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...

 or a doctor
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 if at all possible. But when severe external bleeding cannot be controlled by other means, a tourniquet may be the only way for a first-aider to save the casualty.

Most civilian first aid
First aid
First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...

 instruction in the United States do not teach the use of tourniquets for the following reasons:
  • the effectiveness of direct pressure, elevation and pressure points (controlling severe bleeding in up to 90% of cases as estimated by US medical sources)
  • the increased difficulty of reattaching an amputated limb when a tourniquet has been applied to the victim
  • unnecessary use by poorly trained bystanders
  • the unavoidable risks to both limb and life even when properly employed
  • the rare nature of injuries that require tourniquets, which typically occur in unusual settings such as working with agricultural or industrial machinery and the battlefield

The use of a tourniquet by a layperson in countries where it is considered outside the scope of practice of first aid may result in civil lawsuits and/or criminal charges, especially if the application was later found to have been unnecessary.

United States military

Battlefield experience in Iraq
Iraq ; officially the Republic of Iraq is a country in Western Asia spanning most of the northwestern end of the Zagros mountain range, the eastern part of the Syrian Desert and the northern part of the Arabian Desert....

has caused the US military to reconsider the 'conventional wisdom' regarding tourniquets. Life threatening bleeding from extremities is more common because body armor protects the torso. Blast injuries to limbs rarely result in a clean amputation or a salvageable limb, and a rapidly applied tourniquet can be immediately lifesaving when arterial (spurting red) bleeding results from such major injuries.

The US Military has also found (through experience in Iraq) that due to the ability to transport a casualty to a surgeon in less than an hour of being wounded, tourniquets are used far more frequently for injuries from gunshot wounds to amputations. Formerly, tourniquets were not used as much, due to the difficulty of transporting the casualty to a skilled physician in time to save the limb.

All US Army soldiers and US Marines are now required to carry a tourniquet as part of their individual first aid kits. First aid training for soldiers now addresses the "prompt and decisive" use of tourniquets to control life-threatening extremity bleeding. Soldiers are also trained in proper self application of the tourniquet.

Canadian military

As with the US military, the Canadian Forces utilizes combat tourniquets. Their use in Afghanistan has greatly reduced the mortality of troops suffering severe extremity trauma. Every soldier is issued a tourniquet and trained to use it as part of his pre-deployment training.

In France

Since 2007, the tourniquet is not taught to the general public. It is, however, part of the basic life support training given to medical and paramedical staff, firefighters, swimming-pool and sea rescuers, and members of first aid associations.

In Australia

In Australia, people undergoing a first aid course will be instructed to never use a tourniquet. They are further instructed that if you have a first aid certificate there can be legal issues with using a tourniquet.

Norwegian military

In Norway, all soldiers are required to carry a tourniquet in their personal aidkits. Under medical training, the instructions are clear on that 15 minutes after applying the tourniquet, one is not allowed to remove it, only professional trained doctors are allowed to remove it.

External links

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