Continuing where we left off, we have just dealt with any junctional bleeds and have progressed to extremity bleeds. We could pack these the same way we treated the junctional bleeds but that takes quite a bit of time. This is where the deliberate tourniquet steps in. Applying a tourniquet will always be faster than packing a wound.
There are several brands of tourniquets out there. To save yourself the headache of potentially buying yourself a sub-par tourniquet, stick with the ones that have been studied and approved by CoTCCC. My preferred tourniquet is the CAT by North American Rescue, I like them so much I included them in both of the kits I’ve put together.
When we apply a tourniquet in TFC it will be a deliberate tourniquet. A deliberate tourniquet is different from a hasty in a few ways. Hasty Tourniquets are high and tight and over the clothing. A deliberate tq is directly on the skin, 2-3 inches above the wound, not over a joint, taped, and timed. As we talked about in the beginning, a hasty tourniquet is a hail mary attempt at stopping bleeding we see as soon as we approach our casualty. We don’t have time to cut away clothing so it is placed over clothing. It is placed high becuase we don’t have the time to see exaclty where the wound is.
With a deliberate tourniquet we do have time to cut away clothing and actually see exactly where the wound is. Hence it being directly on the skin and 2-3 inches above the wound. Placing a tourniquet on a joint would do damage to the joint, and we want to avoid that. Tape is applied to secure the tourniquet, we don’t want it coming loose during transport. The time is very important, especially for the next higher level of care. Once applied, tourniquets can not be removed after they’ve on for 6 hours. It has a lot to do with tissue damage from the lack of blood flow and from build up of toxins due to anaerobic metabolism.
Tighten the tourniquet until all bleeding stops. One thing to keep in mind, if you applied a hasty tourniquet and it is working, leave it. We don’t convert tourniquets until Circulation. We are only in Massive Hemorrhage. We’re only applying tourniquets to wounds we are now finding.
If you want to actually learn how to apply a deliberate tourniquet, and how to handle the rest of MARCH, come on out to a class. We’ve got room for you. Class Schedule
What tourniquet do you carry?