Basically, a tourniquet consists of a pad, a band, and a device for tightening the band so that the blood vessels will be compressed. It is best to use a pad, compress, or similar pressure object, if one is available. The pressure object goes under the band and must be placed directly over the artery or it will actually decrease the pressure on the artery, allowing a greater flow of blood. If a tourniquet placed over a pressure object does not stop the bleeding, there is a good chance that the pressure object is in the wrong place. If placement is not effective, shift the object around until the tourniquet, when tightened, will control the bleeding.

Any long flat material may be used as the band. It is important that the band be flat: belts, stockings, flat strips of rubber, or neckerchiefs may be used; however, rope, wire, string, or very narrow pieces of cloth should not be used because they can cut into the flesh. Ashort stick may be used to twist the band, tightening the tourniquet. Figure 4-28 shows the proper steps in applying a tourniquet.

To be effective, a tourniquet must be tight enough to stop the arterial blood flow to the limb. Be sure, therefore, to draw the tourniquet tight enough to stop the bleeding. Do not make it any tighter than necessary, though, since a tourniquet that is too tight can lead to loss of the limb the tourniquet is applied to.

After you have brought the bleeding under control with the tourniquet, apply a sterile compress or dressing to the wound and fasten it in position with a bandage.

Here are the points to remember about using a tourniquet:

1. Use a tourniquet only as a last resort! Don't use a tourniquet unless you can't control the bleeding by any other means.

2. Don't use a tourniquet for bleeding from the head, face, neck, or trunk. Use it only on the limbs.

3. Always apply a tourniquet above the wound and as close to the wound as possible. As a general rule, do not place a tourniquet below the knee or elbow except for complete amputations. In certain distal areas of the extremities, nerves lie close to the skin and may be damaged by the compression. Furthermore, rarely does one encounter bleeding distal to the knee or elbow that requires a tourniquet.

4. Be sure you draw the tourniquet tight enough to stop the bleeding, but don't make it any tighter than necessary. The pulse beyond the tourniquet should disappear.

5. Don't loosen a tourniquet after it has been applied. Transport the victim to a medical facility that can offer proper care.

6. Don't cover a tourniquet with a dressing. If it is necessary to cover the injured person in some way, make sure that all the other people concerned with the case know about the tourniquet. Using crayon, skin pencil, or blood, mark a large "T" and the time the tourniquet was applied on the victim's forehead or on a medical tag attached to the wrist.