Review: Getting Tourniquets Right = Getting Tourniquets Tight

Area of Science:

• Emergency medicine
• Trauma care
• Medical device engineering

Background:

• Tourniquet application is a vital intervention for severe limb hemorrhage.
• Optimal technique is essential but often not consistently achieved, highlighting training and knowledge gaps.
• Evidence suggests issues with tourniquet application techniques, knowledge, and training.

Purpose of the Study:

• To review and define optimal tourniquet application techniques based on available evidence.
• To identify objective measures for correct tourniquet application.
• To evaluate the effectiveness of current training materials and methods.

Main Methods:

• Systematic review of PubMed peer-reviewed papers (January 2007–August 2018).
• Analysis of Stop The Bleed-related videos for application techniques.
• Comparison of techniques for nonelastic and Combat Application Tourniquets.

Main Results:

• Optimal tourniquet application involves direct skin contact and specific strap tensioning.
• Nonelastic tourniquets require tangential strap pull at the buckle (≥150mmHg).
• Combat Application Tourniquets need a 180° windlass turn (250–428mmHg) for arterial occlusion.

Conclusions:

• Objective measures and standardized training are necessary for correct tourniquet application.
• Current simulation models may not accurately reflect human limb responses.
• Visual aids must accurately depict optimal tourniquet application techniques for effective bleeding control.