EMERGENCY DEPARTMENT · WALL POSTER

Tourniquet Application

DECIDELimb bleeding not stopped by pressure, a traumatic amputation, or pressure not feasible. · Pediatric: adult windlass devices are validated down to about age 2, roughly 13 cm limb circumference. Below that, direct pressure with hemostatic gauze — there is no data.

STEPS · ◆ KEY STEP — LOGGED WITH ITS TIME

TECHNIQUE — STEP BY STEP

Cannot assess the wound: high and tight, as proximal as possible.
Once time/safety allow: convert to direct skin application, 2–3 inches above the wound, not over a joint.
Wrap the band around the limb, thread it through the buckle, remove all slack.
Twist until bleeding stops AND the distal pulse is gone.
Lock the rod with the clip, secure the strap over it, mark the time on the strap. ◆ TOURNIQUET APPLIED
Still bleeding: a second tourniquet side by side, proximal if the anatomy allows.

EQUIPMENT

Windlass tourniquet (e.g. CAT Gen7) — trauma/code cart.
Permanent marker for time documentation · a second tourniquet within reach in case bleeding continues.

FIGURE

Limbs only. Place 2–3 inches proximal to the wound, directly on skin, clear of any joint. Tighten until the distal pulse is gone. Write the time on it.

2–3 IN ABOVE THE WOUND, ON SKIN, NOT OVER A JOINT

TIGHTEN UNTIL BLEEDING STOPS AND PULSE IS GONE

ATTEMPT CONVERSION <2H IF SAFE TO DO SO

CAUTION / MONITORING NEEDED BEYOND 6H

PITFALLS & PEARLS

“Venous tourniquet” — too loose, so bleeding gets worse.

Left over clothing once time/safety allow direct-skin application — convert as soon as feasible.

Improvised: use the widest material available.

Not documenting the time — this single number drives every downstream conversion and transfer decision.