First Aid for Severe Bleeding Certification Manual: Tourniquets & Hemostatic Agents

TOURNIQUETS

A tourniquet is a device designed to be used in the event that direct pressure does not control the bleeding, such as an injury from a gunshot. Tourniquets help manage blood flow by constricting blood vessels to stem the flow of blood. The tourniquet is designed to be used on the arms and legs only. Tourniquets should always be placed above the injury site. However, they should not be placed on a joint. The time of application should always be recorded after the tourniquet application.

The two most common types of tourniquets are an elastic band or a windlass. Each have a different process of application. Tourniquets are particularly effective in controlling extremity arterial hemorrhage, which is critical in managing severe bleeding.

The windlass tourniquet is applied by:

1. Sliding the tourniquet approximately 2 inches above the area of injury
2. Tightening the tourniquet strap and attach the windlass
3. Twist the windlass until bleeding stops
4. Record the time

The elastic tourniquet is applied by:

1. Sliding the tourniquet approximately 2 inches above the area of injury
2. Tighten the tourniquet until the squares and ovals become rectangles and circles
3. Tuck and tie the tourniquet
4. Record the time

Special Note: Elastic tourniquets are recommended for children and individuals with smaller limbs. Other tourniquet types such as: pneumonic (pressurized air pump) and ratchet (strap with ratchet mechanism) are also available.

TOPICAL HEMOSTATIC AGENTS

Hemostatic agents are chemical substances that work to stop bleeding by clotting blood and contracting tissue to seal injured blood vessels. These agents work by concentrating clotting factors and coagulation factors at the site of bleeding, promoting the formation of a platelet-fibrin plug. Hemostatic agents can be found in some first aid kits in powder form or already in pre-made bandages.

Hemostatic dressings are extensively used in emergency settings to control life-threatening bleeding in traumatic injuries. In trauma care, pre hospital haemostatic dressings and prehospital topical hemostatic agents are crucial for managing acute trauma and uncontrolled hemorrhage. There are different types of topical hemostatic agents, each with specific applications based on their mechanisms of action, such as chitosan-based options and combat gauze.