Applying a tourniquet
Photo by ITS Tactical, Bryan Black

Tourniquets 101: How to Apply a Tourniquet Effectively

Let’s start off this discussion with a caveat on tourniquets. Your belt isn’t an acceptable tourniquet; the same goes for a bandanna with a stick twisted in it. Commercially available tourniquets are ubiquitous and have been proven over and over again to save lives. Don’t plan to improvise, plan to have a real tourniquet ready and available. Know how to apply a tourniquet effectively.

The No. 1 goal in treating any extremity hemorrhage (i.e. bleeding out) is to keep the blood in the body. The human body only has so much blood. While there’s no specific quantity that’s agreed upon for how much you can lose before you die, suffice it to say that you want to lose the least amount possible. Stopping it from leaving is paramount.

How to Apply a Tourniquet and the Proper Gear

When it comes to tourniquet selection, I would argue that your decision comes down to only two commercially available tourniquets, the SOF Tactical Tourniquet (SOFTT) and the Combat Application Tourniquet (CAT).

The CoTCCC (Committee on Tactical Combat Casualty Care) is a USSOCOM (United States Special Operations Command) body created to establish guidelines to properly train non-medics to treat preventable causes of death in the field. We refer to these as the TCCC Guidelines and they get updates on a fairly consistent basis. Within the guidelines, the CoTCCC only recommends the SOFTT and CAT Tourniquets.

It’s also been listed in the meeting minutes of the convening TCCC body that CAT tourniquets have broken when being applied. The most recent mention of this occurring is in the February 2014 meeting minute notes. While the CAT has been through design changes since this date and has also saved many lives, I feel it’s important to disclose that this is the reason my company ITS Tactical only carries the SOFTT.

Preparing Your Tourniquet 

Check the buckle before use
Photo by ITS Tactical

1. Take tourniquet out of wrapper. Don’t waste valuable time opening a package during a life-saving situation!

2. Adjust the strap loop size. There’s not a specific length to keep this measurement at, but there are pros and cons to larger or smaller loops. A larger loop allows the tourniquet to fit over boots, etc. without having to unbuckle it. A shorter loop means that there’s less slack to take up when pulling it tight. 

3. Adjust windlass slack. The adjustable webbing used to tighten the tourniquet shouldn’t be so loose that it increases the time it takes to twist the windlass to stop bleeding.

4. Check the buckle. Make sure the buckle is connected and creates a tight connection, but can still be unbuckled if necessary.

Practice folding the tourniquet for storage.
Photo by ITS Tactical

5. Fold up webbing. At ITS, we’ve developed a method for folding the SOFTT that takes up the least amount of space. We call it “flat folding”; if you’d like more information, research this method or just fold up the remaining webbing back onto itself for storage.

Tourniquet Application

1. Orient the tourniquet: The direction of pull to tighten the tourniquet should be towards the midline of the body. This is a good rule to remember and will make application easier if you must apply a tourniquet on yourself with one hand. Picture an imaginary line running vertically up and down the center of the body and that’s your midline.

Place it high, live saving
Photo by ITS Tactical

2. High as possible: Always keep the tourniquet as high as possible on a limb; never apply a tourniquet on a joint.

3. Grab the loop and pull. Don’t get in the habit of grabbing the tail of the tourniquet to tighten it right away. By grabbing the loop and pulling it towards the midline, you’ll keep the tourniquet from spinning. You can control it better during one-handed application. 

4. Pull the tail. Take all the slack out of the tourniquet by pulling the tail to tighten it.

Applying a tourniquet
Photo by ITS Tactical, Bryan Black

5. Manipulate the base. If there’s still slack left in the tourniquet or you can’t tighten it any further because of its position, grab the base and move it. Take up the rest of the slack.

6. Tighten the windlass. Continue turning the windlass until all bleeding stops or is controllable/manageable. It doesn’t matter what color the blood is, tighten it until it stops.

Anchor the windlass.
Photo by ITS Tactical

7. Anchor the windlass. Each side of the windlass has a groove that locks into the D-ring, preventing it from coming undone. Lock this in and ensure it’s locked in the windlass groove.

8. Time and date. At the end of the tail, the SOFTT has a sewn-in tag for writing the time and date. A Sharpie works great for this, but anything will do. It’s important to note this for higher-echelon care (i.e. hospital), so that they know how long the tourniquet has been in place.

9. Practice. You should be able to deploy and apply your tourniquet in 12 seconds, one-handed. Practice until you can meet that goal each time. You’re also not going to ruin your tourniquet by practicing with it, just be sure you’re checking it after each practice session. If you see anything damaged or that has the potential to fail, replace your tourniquet.

Practice using the tourniquet.
Photo by ITS Tactical

Don’t use this article as a replacement for medical training in the use of a tourniquet. Seek training for yourself and your loved ones from competent trainers like our friends at Lone Star Medics

Remember, a tourniquet shouldn’t be an afterthought! Purchase a tourniquet from a reputable source to avoid fakes, get familiar with your tourniquet’s operation and know how to use it. A failure to plan is a plan to fail. Most importantly, keep a tourniquet with you and be prepared to save a life.

Get To Know ITS Tactical

Author Bryan Black is a Navy veteran and the editor-in-chief of ITS Tactical; it’s an online resource established in 2009 providing skillset information, reviews and products that support outdoor enthusiasts and the tactically minded.

Skillset Magazine spotlights men and women with cool talents and abilities. Pick up some knowledge like these tourniquet tips in a back issue of Skillset, found at OutdoorGroupStore.com, and on our weekly podcast Skillset Live!

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