In Tactical Combat Casualty Care (TCCC), a casualty can bleed to death in as little as three minutes from an injury. Uncontrolled bleeding or hemorrhage is the most common preventable cause of death in trauma situations. Based on available statics at this time, massive, uncontrolled bleeding accounts for about 40% of trauma-related deaths worldwide. Applying a tourniquet as soon as possible is the first treatment option one should chose when faced with this type of emergency medical pre-hospital situation.
When faced with a severe injury that involves significant bleeding, applying a Committee on Tactical Combat Casualty Care (CoTCCC) approved commercial tourniquet correctly can be a life-saving skill. In the case of commercial tourniquets, such as the widely used North American Rescue distributed "Combat Application Tourniquet" (CAT), proper application is crucial for effective hemorrhage control.
Here are the steps to correctly apply a commercial tourniquet, such as the NAR distributed CAT GEN7 Tourniquet:
Step 1: Assess the Situation
Before applying a tourniquet, assess the severity of the bleeding. If the bleeding cannot be controlled with direct pressure or other methods such as Hemostatic Gauze, and blood is squirting from the wound, or blooding is pooling around the victim or soaking through their clothing, a tourniquet should be your first choice for pre-hospital emergency medical care.
Step 2: Position the Tourniquet
You will be placing the tourniquet around the limb, between the wound and the heart. For example, if the injury is on the lower leg, the tourniquet should be placed two to three inches above the actual wound to ensure proper compression of the blood vessels. Never apply the tourniquet directly on a joint area. If a joint area comes into play, such as the location of the wound or is the area two to three inches above the wound, always apply the tourniquet above the joint. In emergency active threat situations where you may not have time to identify the exact wound location, but can identify which limb it is on, place the tourniquet as high up on the affected limb as possible and tighten until bleeding stops.
Step 3: Tighten the Tourniquet
Once the tourniquet is in position two to three inches above the wound, or as high on the limb as possible depending on your situation, and all slack has been removed from the Band, secure the Band with its Hook & Loop and use the "Windlass Rod" to tighten the Band by turning the rod until the bleeding stops. The tourniquet should be tightened until the bleeding is completely controlled. Avoid overtightening the tourniquet, as this can cause further damage to the limb.
Step 4: Secure the Tourniquet
Once the bleeding has stopped, secure the tourniquet in place by locking the Windlass Rod in the Windlass Cup, then securing it further by bringing the Windlass Retention Strap across the Windlass Cup opening, attaching it to the Hook & Loop. Most commercial tourniquets have similar securing mechanisms to keep the tourniquet in position. Make sure the tourniquet is secure and where possible, not cutting off circulation to the rest of the limb.
Step 5: Time Stamp the Tourniquet as to when it was Applied
Write the time the tourniquet was applied directly on the tourniquet Windlass Retention Strap where it says "TIME:." Most commercial tourniquets provide a small area on them specifically for completing this task. This lets emergency medical professionals know when the tourniquet was applied and how long it has been on the patient.
Step 6: Seek Medical Help
After applying the tourniquet, seek emergency medical help as soon as possible. A tourniquet is a temporary measure and should not be left on for an extended period of time. (A max time of two hours is the accepted practice to avoid tissue and/or nerve damage.) Make sure to inform medical professionals that a tourniquet has been applied and provide them with any other necessary information.
Remember, proper training and practice are essential for effectively applying a commercial tourniquet. Stay informed on the latest techniques and guidelines for tourniquet application to ensure you are prepared to handle emergency situations.