Procedure 48 Tourniquet Application 08/13/2019

Introduction to Tourniquets

• Tourniquets are critical for controlling bleeding from severe hemorrhagic wounds when other methods fail.
• They are especially vital in cases of significant extremity bleeding requiring urgent intervention.

Precautions

• Incorrect tourniquet application can worsen blood loss and potentially lead to death.
• Risk of severe nerve and tissue damage exists regardless of correct application.
• Proper selection of patients for tourniquet use is essential to minimize risks.
• If a tourniquet is removed by a physician within 2 hours, permanent damage is unlikely.
• Prioritizing the avoidance of hypovolemic shock is crucial, even if it increases tissue damage risks.
• Tourniquets should remain visible and not be obscured by clothing.

Procedure for Application

• Initial attempts should focus on controlling bleeding through direct pressure or pressure dressings.
• If unsuccessful, proceed to apply the Combat Application Tourniquet (C-A-T).
• Position the tourniquet 2 to 4 inches above the wound on single-bone structures (humerus, femur) and avoid joints.
• Route the band around the limb and thread it through the inside and outside slits of the buckle for secure application.
• Tighten the band significantly and use the twisting rod to stop bright red bleeding and eliminate the distal pulse.
• Secure the rod in place, check for continued bleeding and pulse; if necessary, apply a second tourniquet.
• Document the time of application on both the tourniquet and the patient (e.g., "TK 20:30"), as well as on a triage tag if applicable.
• Leave the tourniquet uncovered for ongoing monitoring of hemorrhage.
• Maintain the tourniquet during transport, only to be removed by hospital staff.
• Continuously monitor patient vitals and inform all receiving personnel about the tourniquet placement.
• If ineffective, consider tightening the existing tourniquet or applying a second one.

Tourniquet Downgrade or Conversion

• If evacuation is delayed by over two hours, consider downgrading or converting the tourniquet.
• Four criteria for downgrade or conversion include:
  • Patient is not in hemorrhagic shock.
  • Wound can be monitored closely for bleeding.
  • Tourniquet is not controlling bleeding from an amputated or partially amputated limb.
  • No previous unsuccessful attempts to remove the tourniquet.
• To downgrade, expose the wound, identify a new location above the injury to apply a new tourniquet while leaving the old one in place.
• For conversion, expose the wound, pack it, apply a pressure dressing, and loosen the prior tourniquet while keeping it in place. Monitor for bleeding afterward.