Severe Hemorrhage Control
Application of the
Sof-T Wide Tourniquet
1
Medical Director Approval
 Before using tourniquets, all services must have:
 Patient care guideline (protocol) signed by the
medical director
 Training, approved by the medical director, on the use
of tourniquets
 State EMS Unit approval of the protocol and training
2
Objectives
 Discuss the indications, contraindications and
considerations in the use of a tourniquet for
hemorrhage control
 Identify the steps required to control major
hemorrhage with a Tactical Medical Solutions
Sof-T Wide tourniquet
 Review documentation and communication
requirements of the procedure
3
Indications
 Severe bleeding of an extremity that is not
controlled with direct pressure
 Severe bleeding of an extremity when resources
to provide direct pressure are limited
 MCI, tactical situation, difficult extrication
Don’t wait!
Application of a tourniquet
before the patient goes into
shock has been shown to
improve outcomes in military
studies
4
Contraindications
 There are no true
contraindications to the
use of a tourniquet when
used to control lifethreatening hemorrhage
when direct pressure has
failed or is not practical
5
Considerations
 Tourniquet application will likely be painful
 Tourniquet application has been associated with
tissue damage but this is generally minor and
often temporary
 Tourniquets are typically safe for up to two
hours.
 A tourniquet should never be removed without
medical control consultation.
6
The Sof-T-Wide Tourniquet
Constricting
Band
Triangle Ring
Quick-Release Buckle
Windlass
Loose End
7
Procedure
 Remove clothing and expose wound
 Do not remove previously applied direct pressure
8
Procedure
 Disconnect the quick release buckle
9
Procedure
 Route the band around
the injured extremity
 Place the band 2 – 3
inches above the
wound
 Do not place it over a
joint
10
Procedure
 Reconnect the quick release buckle
 Remove the slack by pulling the loose end of the
band
11
Procedure
 Turn the windlass to tighten the tourniquet
 Tighten until major blood flow stops
 Slight seeping may still be present
12
Procedure
 Lock the windlass in place by slipping the
triangle ring over the end of the windlass
Triangle
ring
End of
windlass
13
Procedure
 Note time of application
 Keep tourniquet visible
 Do not cover with blankets
 Ongoing re-assessment for
return of active bleeding
 Tighten windlass, then
 Apply 2nd tourniquet if
bleeding remains active
14
Notify all caregivers involved in the care of the
patient that a tourniquet has been placed
http://www.bdems.com/med3.htm
ALS Ground Intercept
news.legalexaminer.com
ALS Air Intercept
http://www.postindependent.com/article/20050621/VALLEYNEWS/50620012
Emergency Room Report
15
Documentation
 Indication for tourniquet
 Severity of bleeding
 Failure of direct pressure
 Time of placement
 Tourniquet location
 Change in patient condition
 Provider performing skill
 Complications
 Communication to hospital
about tourniquet
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Complications
 Consider placing a second tourniquet above the
first one if severe bleeding continues
 Generally, tourniquet application is safe for up to
2 hours
 Contact medical control before loosening or
removing a tourniquet
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