immobilization of sharp bone ends reduces fur-
ther tissue trauma and allows lacerated blood
vessels to clot. In addition, the gentle pressure ex-
erted by the splint helps the clotting process by
giving additional support to compresses or dress-
ings already in place over open fracture sites.
Later in this chapter we will go into the sub-
ject of splinting in greater detail.
A tourniquet is a constricting band that is used
to cut off the supply of blood to an injured limb.
Use a tourniquet only if the control of hemorrhage
by other means proves to be difficult or impossi-
ble. A tourniquet must always be applied ABOVE
the wound, i.e., towards the trunk, and it must
be applied as close to the wound as practical.
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. It goes under the band. It must
be placed directly over the artery or it will actually
decrease the pressure on the artery and thus allow
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 this occurs, shift the ob-
ject 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 rub-
ber, or neckerchief maybe used; but rope, wire,
string, or very narrow pieces of cloth should not
be used because they cut into the flesh. A short
stick may be used to twist the band, tightening
the tourniquet. Figure 4-22 shows how to apply
To be effective, a tourniquet must be tight
enough to stop the arterial blood flow to the limb,
so be sure to draw the tourniquet tight enough
to stop the bleeding. However, do not make it any
tighter than necessary.
After you have brought the bleeding under
control with the tourniquet, apply a sterile com-
press or dressing to the wound and fasten it in
position with a bandage.
Here are the points to remember about using
Dont use a tourniquet unless you cant
control the bleeding by any other means.
Dont use a tourniquet for bleeding from
the head, face, neck, or trunk. Use it only
on the limbs.
Figure 4-22.Applying a tourniquet.
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 ex-
cept 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.
Be sure you draw the tourniquet tight
enough to stop the bleeding, but dont
make it any tighter than necessary. The
pulse beyond the tourniquet should
Dont loosen a tourniquet after it has been
applied. Transport the victim to a medical
facility that can offer proper care.
Dont cover a tourniquet with a dressing.
If it is necessary to cover the injured per-
son 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 on the
victims forehead or on a medical tag at-
tached to the wrist.