10/20 Wilderness Medicine Wednesday

This week's Wilderness Medicine Wednesday post is about how and when to apply a torniquet!

​By Coach Nick
Happy Wednesday everyone! For the next few posts I am going to talk about ways to improvise certain medical devices in the field in emergency situations. Today we are going to talk about the torniquet, when to use one, and how to make it out of readily available items.
As most of you probably know, a torniquet is used to cut off blood flow to any of our limbs in the event of a life-threatening bleed. The best way to think about it is that it’s always used as a last resort, never our first treatment option. Also, it is only used to treat arterial bleeding which can be recognized when blood is spurting or spraying from a wound as is bright red in color. The arteries we are concerned with here are the femoral (inside of your thigh), brachial (upper arm), and radial (wrist). Even with these kinds of bleeds we should always try to treat them first by applying pressure to the wound.
When we use a torniquet we are effectively cutting off all blood flow to the limb below the application site. This is why we want to be selective in deciding to use it because there is a significant chance that the patient will lose that limb if the torniquet is left on for longer than a few hours. In applying a torniquet the most important thing is that we need to be sure that it’s tight enough to stop all blood flow. The easiest way to check this is looking for what we call a distal pulse. In the arm, look for a pulse in the patient’s write, and in the feet, look for it right below their ankle. When the torniquet is applied you should not feel this pulse, if you do, tighten it. Applying a torniquet is extremely painful for the patient and it will continue to be so as it is left on however it is crucial not to loosen it until you get to a higher level of care. When deciding where to apply the torniquet we want to make sure that is directly on the skin (not over clothes) and 2-3 inches above the site of the bleeding. The last, and very important step, is to note the time the torniquet was applied. This will tell doctors how to approach the situation when the patient is evacuated to a higher level of care. This is commonly done by writing a “T” and the time on the patient’s forehead in Sharpie that way the information can not be lost as the patient is passed along to different medical teams.
The most effective torniquets are the ones sold commercially called CAT torniquets (https://www.narescue.com/combat-application-tourniquet-c-a-t.html). They cost $30 and are very light weight and easy to carry, I would highly recommend buying a good one and adding it to your first aid kit. If the situation arises where you need to improvise one I have attached a video giving you some basic instructions on how to make one. I would caution against this method as these will not always work the way we want them to and the presence of adrenaline will make them very difficult to construct. If a patient is suffering an arterial bleed that requires a torniquet they typically have between 1-3 minutes in which we can save their lives. Given this, I would highly recommend carrying an easily accessible professionally made device.
As always, especially in this case, I hope that this information never applies to you guys. If the situation ever arises I hope it helps you be more prepared. Have a great week everyone! 

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