Step-by-Step Tourniquet Application Guide for Adults – 15 Minute Slide Show Presentation

Instructions

This worksheet is designed as a self-led review of the principles of emergency tourniquet application. Life-threatening bleeding from a limb is a critical emergency where seconds count. Understanding these steps can help save a life. Read each section carefully and answer the questions to the best of your ability. An answer key is provided at the end.

Part 1: Is a Tourniquet Needed?

A tourniquet is a tool for a specific, life-threatening situation: severe bleeding from an arm or a leg that cannot be controlled by direct pressure. For each scenario below, decide if applying a tourniquet is the appropriate initial action.

1. You are at a worksite and a colleague's arm is caught in a machine, resulting in a full amputation below the elbow. Blood is spurting from the wound.
   Appropriate? (Yes / No)


2. A friend cuts their hand while cooking. The cut is deep and bleeds steadily, soaking a paper towel, but it slows significantly when you apply firm pressure with a cloth.
   Appropriate? (Yes / No)


3. At the scene of a car accident, a victim has a large, deep gash on their thigh. The pant leg is completely saturated with bright red blood, and blood is pooling rapidly on the ground.
   Appropriate? (Yes / No)

Part 2: The Correct Sequence

The following are the key steps for applying a commercial windlass-style tourniquet (like a C-A-T or SOF-T). The steps are jumbled. Number them from 1 to 6 in the correct order.

______ Write the time of application on the tourniquet's time strap or on the patient's forehead ("T=HH:MM").

______ Place the tourniquet high and tight on the injured limb, 2-3 inches above the wound. Never place it over a joint (like an elbow or knee).

______ Twist the windlass rod until the bleeding stops completely. The bleeding, not the patient's pain, is your guide.

______ Expose the limb and identify the source of the bleeding. A tourniquet is only for limb injuries.

______ Secure the windlass rod in its clip or holder to lock it in place. Check again for bleeding and a distal pulse. If bleeding continues, consider a second tourniquet just above the first.

______ Route the strap through the buckle, pull it as tight as possible, and secure it back on itself with the Velcro.

Part 3: Critical Knowledge - Fill in the Blanks

Complete the following sentences with the correct term or concept.

1. A tourniquet should be placed approximately __________________ inches above the wound, but never directly on a joint.
2. Once a tourniquet is applied and has stopped the bleeding, it should __________________ be loosened or removed by anyone other than a medical professional.
3. The main purpose of the __________________ is to apply the mechanical leverage needed to compress the artery against the bone.
4. When applying an improvised tourniquet, the windlass should be a strong, rigid object, and the band should be wide (at least 1.5 inches) to prevent __________________ tissue damage. Never use wire or string.
5. It is critically important to note the __________________ of application. This information is vital for the receiving hospital staff.

Part 4: Myth Busting - True or False?

Read the following statements and determine if they are true or false. This section addresses common misconceptions about tourniquets.

1. TRUE / FALSE: Applying a tourniquet almost always means the person will lose their limb.
2. TRUE / FALSE: A leather belt is an excellent improvised tourniquet because it is strong.
3. TRUE / FALSE: A properly applied tourniquet will be very painful for the injured person.
4. TRUE / FALSE: If bleeding is not controlled by one tourniquet, you should remove it and try again in a different spot.

Answer Key

Part 1: Is a Tourniquet Needed?

1. Yes. A traumatic amputation with spurting blood is a classic indication for a tourniquet.
2. No. The bleeding is controllable with direct pressure, which should be the first line of treatment for non-life-threatening wounds.
3. Yes. Blood that is pooling rapidly and soaking clothing indicates severe hemorrhage that direct pressure may not control. This is a life-threatening situation.

Part 2: The Correct Sequence

6 Write the time of application on the tourniquet's time strap or on the patient's forehead ("T=HH:MM").

2 Place the tourniquet high and tight on the injured limb, 2-3 inches above the wound. Never place it over a joint (like an elbow or knee).

4 Twist the windlass rod until the bleeding stops completely. The bleeding, not the patient's pain, is your guide.

1 Expose the limb and identify the source of the bleeding. A tourniquet is only for limb injuries.

5 Secure the windlass rod in its clip or holder to lock it in place. Check again for bleeding and a distal pulse. If bleeding continues, consider a second tourniquet just above the first.

3 Route the strap through the buckle, pull it as tight as possible, and secure it back on itself with the Velcro.

Part 3: Critical Knowledge - Fill in the Blanks

1. A tourniquet should be placed approximately 2-3 inches above the wound, but never directly on a joint.
2. Once a tourniquet is applied and has stopped the bleeding, it should NEVER be loosened or removed by anyone other than a medical professional.
3. The main purpose of the windlass rod is to apply the mechanical leverage needed to compress the artery against the bone.
4. When applying an improvised tourniquet, the windlass should be a strong, rigid object, and the band should be wide (at least 1.5 inches) to prevent underlying / localized tissue damage. Never use wire or string.
5. It is critically important to note the time of application. This information is vital for the receiving hospital staff.

Part 4: Myth Busting - True or False?

1. FALSE. This is a dangerous myth. Modern medical care allows for tourniquets to be left in place for hours with a high likelihood of limb survival. Permanent damage is rare, whereas death from blood loss is permanent.
2. FALSE. A belt is difficult to tighten sufficiently to stop arterial bleeding and is generally not effective as a tourniquet. Commercial tourniquets or properly improvised ones are far superior.
3. TRUE. Compressing tissue and nerves to the degree needed to stop arterial flow is extremely painful. You should not stop tightening because the person says it hurts; you stop when the bleeding stops.
4. FALSE. Never remove a tourniquet once it is in place. If the first is not effective, apply a second tourniquet just above (proximal to) the first one.