A special thank you to Myles Francis of Archangel Dynamics for allowing me to publish his Tactical Medicine posts here on Vigilant Wolf. Myles is a friend and past guest of Ever Vigilant podcast (episode 59).
For today’s post, lets discuss Improvised Tourniquets (TQ). This post is provided for educational / information purposes only. Follow your local protocols, we are not responsible for what you choose to do with this information. Before we go any further, let me be very clear here: If you have no other option to control life threatening extremity bleeding, do whatever is needed, including improvising a TQ. Uncontrolled hemorrhage is still the leading cause of death in trauma, so #stopthebleed
With that out of the way, lets continue. Improvised TQs simply do not perform to the same level as a commercially produced device. Lets look at a few examples of improvised TQ failure.
On the left, you will see a photograph of a man sitting in a chair. He was injured at a shooting range when someone was clearing a rifle. The bullet, a .30-06, travelled through both legs, severing the popliteal artery in his left leg. Improvised tourniquets using belts were ineffective at controlling the bleeding. Luckily, the RSO had a trauma kit containing a SOFT-T, which was able to arrest the hemorrhage. .
Here’s Another example: The Boston Bombing. “66 patients with extremity injuries from the blast. 29 (44%) of the casualties had documented life-threatening hemorrhage at the point of injury (POI). 15 casualties had at least one lower extremity amputation. Of the 29 casualties with life-threatening hemorrhage, 27 “improvised TQs” were placed at the POI. 16 casualties with a lower extremity amputation all had “improvised TQs,” including those placed by Boston EMS (who were not carrying commercially available TQs at that time). At one receiving hospital, six casualties all had “improvised TQs” placed without a windlass and thus were “venous constricting bands.” All had to be replaced with commercial TQs to prevent ongoing hemorrhage.” So what’s my point here? Use commercially produced, purpose built TQ with a proven track record.
Use commercially produced, purpose built tourniquets with a proven track record. Currently, that would be the CAT, the SOFT-TW or the SWAT-T. There are many new tourniquets on the market undergoing evaluation, and I expect this list to grow soon! So, in the absence of a proper tourniquet, how should you improvise one? Belts are a poor choice. So are extension cords. Consider items like a neck tie, a cotton triangular bandage, or similar material folded into a 1.5” thickness. Create a windlass, such as a jack handle, broom handle, flashlight with a metal body carabiner or other sturdy object too apply pressure. Once bleeding is stopped, secure your windlass to the extremity and continuously monitor it.
This picture shows what an improvised tourniquet should look like. The example shows a Cravat (essentially a triangular bandage), a metal bodied flash light to functions as a windlass, and a carabiner to secure the windlass. Not bad. The key takeaways are this: Without a windlass, it is not a tourniquet. That windlass needs to be sturdy, so no pencils or other weak objects. The band needs to be wide enough to provide arterial occlusion - ideally around 1.5 inches.
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