A tourniquet should be applied immediately in all cases of life-threatening bleeding from the extremities (arms and legs) as such:

1. Pulsating or profuse blood flow from a wound

2. A rapidly enlarging pool of blood around the casualty

3. Clothes soaked in blood

4. Simple bandages or other means of stopping bleeding are ineffective

5. Amputation of a limb has occurred

6. Bleeding has caused shock, even if the profuse bleeding is no more present (the casualty looks pale, covered in cold sweat, weak, difficult to wake up or is unconscious).

A life-threatening bleeding could occur on the road (e.g. severe extremity injuries in road traffic accident), on the street (e.g. knife attacks, terror attacks), in the nature (e.g. an accidental injury while hunting, falling on a protruding tree branch), or in the household (gas explosion, careless work by the machine-tool, using a handsaw or an angle grinder).

No, the tourniquet has to be made of high quality, durable and non-breakable parts. It has to be wide enough, so it would not crush the surrounding tissues and stop the arterial blood flow. The tourniquet should consist of a sufficiently wide elastic band (minimum 4 cm) and a tightening mechanism. It can also be made of a wide elastic band with tightening indicators. Neither wire locking straps nor a leather trouser belt function as effective tourniquets.

Yes, it can cause damage, if the tourniquet in use is of poor quality, too narrow or too weak, has no tightening mechanism or in those cases, when the tourniquet is not sufficiently tightened and stops venous blood flow only. In latter cases, the blood brought by the arteries cannot return back through the veins, causing more bleeding. Tight bandaging of the wound, which seemingly ceases the bleeding, leads to further swelling and internal tissue damage. It is also life threatening to apply the tourniquet too late, or if it is briefly released or completely removed by non-medical personnel, leading to bleeding to death.

Life-threatening bleeding is ceased by using a tourniquet and compressing the arterial blood circulation i.e. those blood vessels that carry blood from the heart to the extremities. The proper application of tourniquet includes tightening it at a distance of a palm (5-7 cm) above the bleeding wound. In cases when bleeding site is not visible, it should be placed as high as possible (at the armit or groin). he higher the tourniquet is placed, the higher along the arterial blood flow is stopped, the more the tissue of the extremity is deprived of oxygen and nutrients. It leads to increased pain, more tissue breakdown products and higher risk of complications. In all cases when the site of injury is evident, the tourniquet should be placed at a distance of a palm (5-7 cm) above the bleeding wound. If the wound is not clearly visible, but the bleeding is massive (blood-soaked clothing, enlarging pool of blood, impaired consciousness), the tourniquet should be placed directly on the clothing and as high as possible (i.e. at the groin or armpit), and as tight as possible.

After applying the tourniquet, it is important to note or remember the time of application, call the emergency medical services on 112, and follow further instructions from the emergency centre dispatcher. While waiting for the medics to arrive, it is necessary to evaluate for any other injuries, and to continuously monitorwhether the tourniquet remains effectively stopping the bleeding. If the bleeding resumes, tighten the tourniquet more firmly. If the latter step fails, a second tourniquet should be placed next to the first one (and if possible above it). Make sure the casualty is in a comfortable position and cover him/her to prevent him/her from freezing. Under no circumstances should the injured person be allowed to unbuckle or remove the tourniquet, even in severe pain.

Yes, a tourniquet must be used in all cases, including for children, if the bleeding is life-threatening and cannot be stopped by other means.

Yes, a tourniquet is designed to cease life-threatening bleeding and must be used immediately, without waiting for medical services to arrive, similarly as witnesses of sudden death must start resuscitation as soon as possible. Likewise, a fire extinguisher in the event of fire can and should be used without waiting for the arrival of the fire brigade or a lawfully held firearm used in case of self-defence without waiting for the police.

No, if the tourniquet was applied due to a life-threatening bleeding or amputation, it cannotbe released (even for short periods of time) with false aims to “renew the blood flow to the extremity”, “allow the limb to recuperate” or to relieve pain. If the tourniquet is released, the clot that was forming is washed out, causing the renewal of bleeding and leading to further blood loss. It is followed by the release of tissue decomposition products into the general bloodstream, shock and death.

If the tourniquet was applied due to life-threatening bleeding or amputation, it can only be removed by the medical staff after the evaluation of the extent of the injury, the possibility of stopping the bleeding by other means, while monitoring the casualty’s vital signs.