Can't be immediately controlled with application of pressure
OR when providers have equally urgent competing priorities for persons care (eg loss
of airway, severe limb haemorrhage)
A crushed lower limb about to be released
Irreversible ischaemia time depends on comorbidities, duration of shock and extent
of tissue trauma
Attention
Do not place too close to the wound — severed artery may have retracted. Position at least
5cm from wound
Do not place over a joint
Do not cover with bandage, clothing or blankets
What you need
One or two military tourniquets
What you do
Release windlass from it holder
Roll out the velcro strap
Pass velcro strap around limb at least 5cm proximal to the wound (between the wound
and the heart)
Feed strap fully through buckle and tighten
Wind the windlass firmly then secure in its holder
When the bleeding stops mesh velcro surfaces together and around the windlass in its
holder
Figure 3.13
Record time of tourniquet application
Continue with primary survey — ABCDE
Once you saved the life, try and save the limb — medical consult
If help at hand AND vascular access secured and stabilised — when bleeding stopped, pack wound tightly
and straighten fractures so that a trial of tourniquet release can be made
Provide appropriate analgesia
Arrange evacuation
Medical consult about
Plan to release tourniquet if transport times go beyond 2 hours
Antibiotics
Regularly and frequently recheck for haemorrhage as well as the tourniquet’s tightness
and position
Keep injured part in view — not concealed under blankets as further haemorrhage may
go unnoticed
If tourniquet placed for release of a crushed lower extremity, keep securely in place
until right conditions for advanced resuscitation — CPR, intubation, IV fluids and monitoring