No Tourniquet? Time to Improvise!*
Situations may arise in both civilian and military environments calling for a stop to bleeding without specially designed tools. For that reason it is essential not only to acquire skills in the application of certain medical equipment, but also to be aware of the steps to be taken in the case of it being unavailable.
“Sure, it’s best if the first aid kit contains a tourniquet”, says “Patriot Defence” instructor Mykola Korobenkov. “It can be used straight away, since it has been designed to stop critical bleeding as fast as possible. It’s a good thing when the first aid kit has several of these.”
A critical situation with the need to apply a tourniquet may occur not only in combat conditions, but also in case of, for instance, a traffic accident, when a person is wounded with glass or ragged metal. According to the instructor, the main drawback of improvised tourniquets is the amount of time necessary for their ‘production’. Yet, they are still effective and can save lives. According to figures from around the world, 60% of preventable deaths in the battlefield result from critical blood loss.
“Before improvising a tourniquet, the best thing to do is to press the blood vessels in the armpit or on the inside of the hip, where they are closest to the bone”, Mykola shares his experience.“You can do this with your fist or your knee. The next thing to do is to call for help or start looking for the material for your improvised tourniquet.”
“As a matter of fact, with critical bleeding in a civilian situation, when there is no external danger and the wounded doesn’t need to be transported, this may just as well be it – you can apply pressure to the veins and wait for an ambulance to arrive”, says Mykola. “If it’s a remote situation (tourists or soldiers, for example), with no medics or ambulances around, you’ll have to come up with something improvised if there’s no tourniquet available.”
An improvised tourniquet can be crafted out of a piece of durable and supple cloth (material) and a solid object that will act as a rod to pull the tourniquet tight around the limb. The best choices of material are kerchiefs and shawls – that is something wide and soft. Gauze or a piece of cloth torn off a garment can also be used.
Why choose a wide piece of cloth? A wire or a rope will painfully cut into the skin, damaging it and thus causing another, subcutaneous, bleeding. Why make it soft? Why not use a belt, for instance? When the rod is twisted, the belt will start cutting into the skin with its edge, same as a rope. This is both painful and traumatizing. What works best is a kerchief or a shawl – that is a piece of soft and wide cloth that will be no less than 5 cm wide when twisted up. It should not be too wide, though, as extra width requires extra pressure for tightening.
The application of an improvised tourniquet crafted of a shawl, a kerchief and a pair of atraumatic scissors to the leg:
During trainings from “Patriot Defence”, our instructors teach both to use the contents of IFAKs and tactical backpacks and to make do without some of them if the need arises. At the “Critical bleeding control” and “Care under fire” stages of the Combat Lifesaver Course, they devote time to the use of the CAT (Combat Application Tourniquet), Esmarch’s tourniquet that most Ukrainian servicemen have, and to guidelines in case none of these materials are available.
* This article is for information purposes only, and should not replace proper tactical medicine training with a qualified instructor.