Tourniquet Hub
Why this matters. Severe limb bleeding can be fatal in minutes. A purpose‑built, CoTCCC‑recommended windlass tourniquet, applied correctly and quickly, can stop arterial hemorrhage and keep a responder in the fight until definitive care arrives. This hub explains when to use a tourniquet, how it works, how to choose the right design, and how to avoid the most common mistakes.
Anatomy & the “why” behind tourniquets
Arterial bleeding requires pressure that exceeds systolic blood pressure and compresses soft tissue against bone. Proximal placement (high and tight when the wound location is uncertain) shortens the vascular segment and improves mechanical advantage. A mechanical device (windlass or ratchet) is needed to achieve reliable arterial occlusion under stress; elastic bands alone are inconsistent.
When to use a tourniquet
- Life‑threatening limb bleeding (spurting, pooling, soaking through clothing) or partial/complete amputation.
- When direct pressure or wound packing is failing or impractical (e.g., Care Under Fire, vehicle extrication).
- Use first‑line for obvious arterial hemorrhage. Mark application time and reassess frequently.
Types of tourniquets & how they compare
- Windlass (single‑route) — strap pre‑tighten, then turn the rod (windlass). Excellent one‑hand usability when trained; compact; widely fielded.
- Ratchet/lever — incremental tightening via lever mechanism; strong control but bulkier and more complex.
- Elastic/pressure bands — compact but unreliable for arterial occlusion under stress.
| Criterion | Windlass (single‑route) | Ratchet/Lever | Elastic Band |
|---|---|---|---|
| One‑hand application (upper extremity) | Excellent | Good | Poor |
| Arterial occlusion reliability | High with training | High | Low/variable |
| Bulk / packability | Low | Med–High | Very low |
| Cold/wet performance | Good | Good | Poor |
| Common failure modes | Insufficient strap preload; windlass not locked | Complexity under stress | Inadequate pressure |
How to choose (by scenario)
- Solo responder / LEO: prioritize simple routing and one‑hand application; carry two.
- EMS / Teams: standardize one primary model for training; consider a backup ratchet for confined spaces.
- Cold / wet: grippy windlass, glove‑friendly buckle, visible time tab.
Training vs duty: dedicate training‑only units; avoid fatiguing operational units.
How to apply (field shorthand)
- Expose limb. Place proximal to the wound (or high & tight if unknown).
- Preload: pull the strap aggressively tight before turning the windlass.
- Turn windlass until bleeding stops and no distal pulse is present; lock it.
Mark the time. Reassess. If needed, apply a second tourniquet proximal to the first.
Storage, inspection, replacement
- Protect from UV/heat; avoid hard creases. Inspect windlass, buckle teeth, stitching, and strap friction.
- Replace after heavy training cycles, contamination, or if components loosen under stress testing.
Evidence & Training Rationale
- Modern, CoTCCC‑recommended windlass tourniquets demonstrate higher first‑pass arterial occlusion versus elastic bands when correctly applied.
- Training on strap preload and adequate windlass turns reduces failure modes more than switching brands.
- Large limbs or high MAP states may require a second tourniquet placed proximal to the first.
Training focus: one‑hand upper‑extremity drills, two‑hand lower‑extremity drills, gloves‑on lockout, verbal confirmation of no distal pulse.
Reviewed: Oct 2025 • Sources: CoTCCC guidelines; prehospital hemorrhage control literature.
Related MED‑TAC resources
- Collection: /collections/ tourniquets
- PDPs: /products/ combat-application-tourniquet-cat-gen7, /products/ tourniquet-training-unit
- Skills: /blogs/skills/ tourniquet-application-drills, /pages/tq-inspection-checklist
Tourniquet Drill Card
Field sequence (H‑T‑C‑W‑L‑T‑R): High & tight → Take up slack → Crank windlass → Watch for no distal pulse → Lock → Time → Reassess (add 2nd TQ proximal if needed).
- Do clear bulky clothing; avoid joints. Expect pain—tighten past pain.
- Common errors: poor strap preload, too distal, clothing bunching, failing to lock.
Practice: one‑hand UE, two‑hand LE, gloves on; target <30s to occlusion.
Incident Report (Trauma Response)
- Date/Time: ____ / ____ / ______ • ______
- Location (address/coords): __________________________________________
- Responder(s): __________________________________ Role(s): ___________
- Mechanism/notes: ____________________________________________________
- Interventions (check & timestamp):
- TQ applied (time): __________ Limb: __________ Effective: ☐
- Hemostatic packing start: ______ 3-min hold complete: ☐
- Pressure dressing applied: ☐ Stable on movement: ☐
- Chest seal(s) placed: ☐ Front ☐ Back
- NPA placed (size): ______ Tolerated: ☐
- Hypothermia prevention (blanket/bivy): ☐
- AED used? ☐ Shock delivered? ☐ Pads replaced post-event? ☐
- Hand-off to EMS time: __________ Agency: ___________________________
- Items used (for restock): _____________________________________________
- Follow-ups / lessons learned: _________________________________________
Overland / Remote Pre-Trip Checklist
- Kits staged & mirrored across vehicles; QR restock link tested
- Redundancy: lights + batteries • space blanket/bivy • extra dressings/gauze
- Comms plan: coverage, relay point, emergency contacts, GPS/coords card printed
- Training cue: night-ops drill; movement with TQ/seals/dressings in place
- Vehicle mount secure; access paths clear; tool roll present (shears/marker/light)
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