Tourniquet

A tourniquet is a device used to apply constrictive pressure to a limb to stop or control arterial blood flow, primarily to treat life-threatening bleeding from the arms or legs when direct pressure is insufficient or impractical. Tourniquets may be improvised from belts, cloth, or rope, or be commercially manufactured devices such as windlass- or pneumatic-type systems. Modern tourniquets are designed to be quickly applied and to maintain circumferential pressure while minimizing additional injury to surrounding tissue.

Types and design: Tourniquets can be improvised or purpose-built. Improvised versions use everyday items such as belts or wraps, while commercial devices include windlass and pneumatic designs that allow rapid tightening and securement. Contemporary medical and military practice favors devices that provide reliable, adjustable tension and clear time indication to aid subsequent care.

Application and use: The device should be placed on the limb proximal to the wound, outside the bleeding site, and tightened until bleeding is controlled and distal perfusion is reduced. The device is then secured and, when available, the time of application is recorded. Once applied, tourniquets are generally not loosened unless directed by medical personnel, and distal signs of circulation should be monitored.

Indications and cautions: Indications include life-threatening limb bleeding where direct pressure cannot control the hemorrhage quickly. Contraindications include non-bleeding injuries or sites where pressure alone does not address the issue; tourniquet use is not advised on the neck or torso. Risks include nerve injury, muscle damage, ischemia, and complications from prolonged application.

Removal and care: Removal is typically performed by trained medical professionals in a controlled setting. After placement, prompt transport to definitive care is essential, with ongoing monitoring for signs of neurovascular compromise and tissue injury. History and training emphasize rapid, controlled use to improve survival from severe extremity bleeding.