Tourniquets are one of the most effective interventions for controlling life-threatening extremity hemorrhage. When applied correctly, a tourniquet can rapidly stop severe bleeding and significantly improve patient survival.

Tourniquets should be considered for:

• Life-threatening extremity hemorrhage
• Partial or complete traumatic amputations
• Bleeding that cannot be controlled with direct pressure
• Situations where direct pressure is impractical or ineffective

General tourniquet application principles include:

• Apply the tourniquet 2 to 3 inches above the wound when possible.
• Avoid placement directly over joints.
• Tighten until bleeding stops and distal pulses are absent.
• Secure the windlass and reassess for continued bleeding.
• If bleeding continues, tighten further or apply a second tourniquet above the first.

Commercially manufactured tourniquets are preferred whenever available, as they have been tested and proven effective in controlling severe hemorrhage. Improvised tourniquets may be considered when commercial devices are unavailable; however, they are often less effective and carry a higher failure rate if not properly constructed and applied.

Following application, continue to monitor the patient, reassess the effectiveness of hemorrhage control, and document the time of tourniquet placement.

Remember: A properly applied tourniquet may be uncomfortable, but uncontrolled hemorrhage is far more dangerous. Stop the bleeding first.