Learn to Stop the Bleeding, Literally

Tourniquets save lives and you should know how to use one.

Posted Apr 10, 2018

Another shooting at a high school or college campus. Another church shooting. Another shooting at a mall or a movie theater. The list of these events gets longer and sadly, more frequent. If there is a bad guy with a gun where you or others are at, and you or they are injured with a wound that could bleed out, the response time by the paramedics could be long enough to be fatal. The police will arrive on scene to stop the shooter, not provide immediate first-aid to you. The EMTs may not go inside the facility until it is safe for them to do so. Therefore, you must become the saver of your life and the lives of others who get wounded. That’s the bad news. The good news is you can do that, if you get trained how to use a tourniquet and/or to pack a bleeding wound.

Used by permission from Wikipedia.
Source: Used by permission from Wikipedia.

And if you don’t think you’ll ever be at a place where someone starts shooting with a gun, okay. But consider the myriad of ways you, or someone you care about, or a complete stranger, could be injured badly enough to bleed out. This includes car accidents, home accidents, shootings or suicide attempts, or accidents in public places that are serious enough to cause an open wound, an avulsion, or a full or partial amputation. You can buy a combat-level tourniquet, on Amazon, as one example, for about $20. It’s small enough to fit into your purse, backpack, or glove compartment. Consider this: Uncontrolled bleeding is the number one cause of preventable death from trauma.

After the Sandy Hook school shooting in 2012, an emergency medicine protocol called the Hartford Consensus (https://www.facs.org/about-acs/hartford-consensus) was created by trauma surgeons and other concerned medical and law enforcement professionals to train law enforcement and the public to be able to address life-threatening shooting injuries following mass casualty events, without always having to wait for paramedics to come inside. The life you save may be a stranger’s, a family member’s, or even your own, since you can apply a tourniquet or direct pressure to your own wound and live to tell about it. 

Although emergency healthcare is certainly stressful and complex, and many patients have multiple issues that can threaten their lives, the solutions to preventing them from bleeding to death are two: use a tourniquet placed just above a bleeding limb and/or pack or stuff the open wound with bandages (or even a t-shirt or the victim’s socks) and use direct, continuous pressure on the area until medical help arrives. 

According to www.BleedingControl.org, who offer one-hour free “Stop the Bleed” training classes, here are the necessary steps to stop someone from bleeding to death:

Ensure your own safety. You can’t take care of someone if the scene is not safe, and you’re not safe from immediate harm. In other words, the lifeguards can’t drown at the beach, so your first order of care is to yourself. If you have to move the victim to provide care, then do it. Wear gloves anytime you’re near blood-borne pathogens.

A - Alert someone to call 9-1-1 and report back to you that he or she did. 

B – Bleeding site: Where is it? Cut, tear, or remove the victim’s clothing to find it specifically (be wearing gloves that this point). Look for blood that spurts or pulses, (which suggests an arterial bleed), pools, soaks the victim’s clothing or existing bandages, or is coming from the full or partial loss of a limb. Serious bleeding can make people confused, agitated, or even combative, until they lapse into unconsciousness. 

C – Compress the bleeding wound, by applying direct pressure, pack as much gauze for other material into the wound, and cover the area with a clean cloth (anything you can find to use from the patient’s or your body or a first-aid kit). Push on the wound site with both hands (one on top of the other, like you would position your hands when doing CPR). Or use a tourniquet, placed two or three inches above the wound site and tightened down (and never loosened) until the bleeding stops. The goal is simple, even in the stress of that moment: compress bleeding blood vessels to stop the flow. Keep the pressure on by hand until relieved by paramedics. Doctors are the only ones who should remove a tourniquet. 

The old thinking about tourniquets has changed, thanks largely to their frequent use in combat theaters in Iraq and Afghanistan. Tourniquets can be in place for up to two hours without causing permanent damage to the patient’s limb. They aren’t useful for wounds in the shoulder, neck (and never around a victim’s throat), or groin; that will require wound packing and a fast run to a hospital by the paramedics. They should never be placed around a joint, like a knee, wrist, elbow, hip or shoulder; using them there damages the joint and does not stop the blood flow sufficiently enough. 

And the previous Boy Scouts thinking about using belts, cloths, ropes, or other similar ligatures as tourniquets is no longer appropriate. These attempts can cause more damage to the wound and surrounding nerves, so it’s best to use a combat-type tourniquet that features a wide nylon band and a t-shaped device called a “windlass” that can be tightened and clamped into place. Paramedics and doctors want anyone who applies a tourniquet to themselves or to an injured person to write the time the device was applied, either on the patient’s forehead (e.g., T-1035, for tourniquet applied at 1035 hours) or on the tourniquet itself if there is a space. 

Tourniquets hurt quite a lot when they are applied correctly, because they impinge nerves and blood vessels. That means they are working properly. Despite a patient’s long and pitiful complaints, they should never be loosened to check for bleeding or to help the victim feel better. Paramedics can give people pain medications for their discomfort, but the purpose of the tourniquet is to go on and stay on.

Your local hospital may offer a free training program called “Stop the Bleed,” that covers in more detail what you’ve read here, and give you the chance to practice using tourniquets and stopping blood flow on mannequin limbs. You can take the short course yourself or schedule at your workplace with your colleagues. Go to www.BleedingControl.org for more information. Like knowing how to give CPR or operate an AED device, stopping someone from bleeding to death is a skill that takes some training, practice, and forethought. You can do this!