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TOURNIQUET APPLICATION

CLINICAL INDICATIONS:
• Extremity trauma with continued hemorrhage or amputation.
CONTRAINDICATIONS:
• None
PROCEDURE: All medical personnel should be regularly practiced in deploying and applying all CoTCCC
approved tourniquets. Tourniquets should be pre-set and removed from wrapping (ready for immediate use and
application).
Initial HASTY placement (over uniform, clearly proximal to bleeding. If site of life-threatening bleeding is not
readily apparent, place the tourniquet “high and tight” as proximal as possible on the injured limb.) HASTY
tourniquet placement is appropriate for initial treatment of massive hemorrhage or hemorrhage while in care
under fire phases. Reassess all HASTY placement tourniquets and asses if hemorrhage is manageable by other
methods while in tactical field care or transition to tactical evacuation care. If tourniquet is necessary to manage
hemorrhage, replace all HASTY placement tourniquets with DELIBERATE placement tourniquets, preferably
prior to patient evacuation, per the following steps:
• Remove clothing as necessary to visualize bleeding area.
• Place tourniquet (commercial or any 2” wide piece of fabric, leather, etc.) directly on skin proximal to wound.
Tourniquet should be placed at least 2-3” above bleeding site, proximal or distal to joints, as appropriate.
• Tighten tourniquet by twisting included rod (commercial) or piece of 6” rigid material (e.g., stick) until
bleeding stops. If converting from HASTY to DELIBERATE tourniquet placement, loosen HASTY tourniquet.
If bleeding is not well controlled with the first tourniquet, apply a second tourniquet side-by-side with the first.
• Secure ends of tension bar to prevent unwinding.
• Document presence of tourniquet and time of placement. (“T” signifies tourniquet). Do not cover tourniquet.
Recheck tourniquet intermittently (q15min) and after any movements to ensure no new bleeding/loosening
has occurred.
• TCCC recommendations:
o Limb tourniquets … should be converted to hemostatic or pressure dressings as soon as possible
if three criteria are met: the casualty is not in shock; it is possible to monitor the wound closely
for bleeding; and the tourniquet is not being used to control bleeding from an amputated
extremity. Every effort should be made to convert tourniquets in less than 2 hours if bleeding can
be controlled with other means.
o Convert all necessary HASTY tourniquets to DELIBERATE tourniquets as soon as tactically
feasible.
o Do not remove a tourniquet that has been in place more than 6 hours unless close monitoring and
lab capability is available.
Document procedure, results, and vital signs.

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