Using Tourniquets to Stop Bleeding

JAMA PATIENT PAGE | Trauma Using Tourniquets to Stop Bleeding

After the April 15, 2013, Boston Marathon bombings, 27 patients with life-threatening bleeding were saved by placement of tourniquets by people at the scene.

What Is a Tourniquet? Applying a tourniquet with a windlass device A tourniquet is a device that is placed around a bleeding arm or leg. Apply direct pressure 1 Place a 2-3” strip of material Tourniquets work by squeezing large blood vessels. The squeezing to the wound for about 2” from the edge helps stop blood loss. at least 15 minutes. of the wound over a long bone between the wound and the heart. Use a tourniquet only How Do I Put a Tourniquet On? when bleeding cannot be stopped and Tourniquets can be made out of any available material. For ex- is life threatening. ample, you can use a bandage, strip of cloth, or even a t-shirt. The material should be at least 2 to 3 inches wide. The material should also overlap itself. Using thin straps or material less than 2 inches wide can rip or cut the skin. Tourniquets often use a windlass device to increase tighten- 2 Insert a stick or other strong, straight ing. Inflated tourniquets (for example, those made from blood pres- item into the knot to act as a windlass. sure cuffs) can work well. But they must be carefully watched for small leaks. The injured blood vessel is not always right below the skin wound. Place the tourniquet between the injured vessel and the heart, about 2 inches from the closest wound edge. There should be no foreign objects (for example, items in a pocket) beneath the tourniquet. Place the tourniquet over a bone, not at joint. 3 Turn stick to tighten tourniquet What Else Do I Need to Know? until pulse below the tourniquet cannot be felt. All bleeding should stop soon after you tighten the tourniquet. You must place a second tourniquet above the first if bleeding does not stop and you cannot tighten the tourniquet, or if the arm or leg swells above the tourniquet. Once bleeding is controlled 4 Secure windlass in place with a second piece of material. • Mark the time on the arm or leg • Keep the tourniquet visible • Check the arm or leg every 2 hours for • Swelling • New bleeding • Increased muscle stiffness Keep tourniquet visible and monitor wound for bleeding. Note time and watch for swelling below tourniquet. Do not remove or loosen the tourniquet until professional care is available.

FOR MORE INFORMATION About Health: How to Use a Tourniquet http://firstaid.about.com/od/bleedingcontrol/ss/07_tourniquet .htm#showall

Author: Joseph M. Galante, MD The JAMA Patient Page is a public service of JAMA. The information and Source: King DR, Larentzakis A, Ramly EP; Boston Trauma Collaborative. Tourniquet recommendations appearing on this page are appropriate in most instances, but they use at the Boston Marathon bombing: lost in translation. J Trauma Acute Care Surg. are not a substitute for medical diagnosis. For specific information concerning your 2015;78(3):594-599. personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

1490 JAMA April 11, 2017 Volume 317, Number 14 (Reprinted) jama.com

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