Severe bleeding is one of the most dramatic first aid emergencies — and also one of the most lethal. A severed artery in an arm or leg can kill in minutes — usually, it will kill in minutes without rapid and effective aid. Many people bleed out and die in the brief chaos that follows an accident before first responders can get to them and decide who needs help most urgently. Maybe the worst thing is that most of these deaths can be prevented. If you know what you’re doing, it’s possible to close down a cut artery, avoid bleeding out and be alive when responders get to you.
All you need is a tourniquet.
Modern tourniquets are easy to use and extremely effective, and if you can carry one you should. Most of us don’t, though, so if you suddenly find yourself with blood spurting from an arm or leg you’re going to have to improvise. You’re going to have to do it in a hurry, too, so you don’t have time for trial and error. You need to know what to do.
A tourniquet has three parts, and without all of them, it’s not going to work. Forget what you’ve seen in the movies — here’s the reality:
- Band. This is the part that actually goes around the limb and applies pressure to close down the artery. You want a band at least an inch and a half wide; using 550 cord, electrical cable or zip ties is less effective at stopping bleeding and will also cause severe pain and probably nerve damage. A wide, but strong, band of cloth is much better. Good materials include neckties, nylon webbing straps, lengths of seat belt or folded bandannas, scarves or triangular bandages. Belts are bad; securing it with the buckle will never be tight enough, and they’re hard to twist.
- Windlass. A windlass is something that can be twisted to tighten the tourniquet. It’s almost impossible to tighten one enough by hand; studies show that tourniquets without a windlass fail 99% of the time, while those with a windlass only fail 32% of the time. Karabiners, large nails (6-inch or longer), strong sticks or lengths of broom handle all work well.
- Fastener. Once the tourniquet is in place you need some way to prevent the windlass from unwinding. A strip of cloth, drawcord or bootlace will do for this — it just has to be strong enough to hold the windlass in place.
To make a tourniquet, first, apply pressure to the wounded limb above the wound. This should slow blood flow and buy you time to collect your tourniquet materials. You can use direct pressure with a hand, or place a hard rubber ball, stone or other object over the artery then bandage it tightly in place.
Now wrap the band around the limb above the wound; it has to be far enough above it that it’s pressing on an undamaged artery. Tie the ends of the band snugly, but don’t worry about making it tight — you need room to get the windlass under it, anyway.
Put the windlass through the band, ideally on the opposite side of the limb from the artery, and twist it. This will take up the slack in the band and tighten it around the limb. Keep twisting until the blood flow stops. Even if you can’t stop it completely you should still be able to reduce it to a survivable level.
Fasten the windlass with a cord, bandage or strip of cloth. This just has to be tight enough to stop the windlass from unwinding. Now check the effectiveness of the tourniquet by feeling for a pulse above and below it. You shouldn’t be able to feel a pulse below the tourniquet; if you can, it’s not tight enough.
Finally, lie back, elevate the limb if you can and wait to be rescued.
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