How to put on a tourniquet and prevent someone from bleeding to death

It doesn’t take a medical professional to save the life of someone bleeding profusely from a gunshot wound or other traumatic injury. Any bystander can undertake a series of crucial first steps until an expert arrives on the scene.

These may include the use of a low-tech tool that has been around since the early days of medicine: a tourniquet.

Experts recommend an in-person training session before using one of the strap-like devices, which must be wrapped so tightly around an arm or leg that it cuts off blood flow. But for those who haven’t had an object lesson, the American College of Surgeons offers an online version of its “Stop the Bleed” curriculum at stopthebleed.org.

» READ MORE: Why the tourniquet, a relic of the early days of medicine, is back amid the gun violence epidemic

Here are the highlights, with the help of Thomas Jefferson University Hospital RN Nora Kramer, who has trained hundreds of adults and teens in the Philadelphia area:

Make sure you are not risking injury to the person you are trying to help, whether it be from gunshots, vehicular traffic, or some other source of blood loss.

Once you determine that it is safe to begin first aid, wear a pair of gloves, if you have them, to reduce the risk of contracting bloodborne diseases.

Above all, call 911. If there are two rescuers on the scene, one can call for help while the other works to stop the bleeding.

Some wounds do not require immediate treatment.

To know when the bleeding is severe enough to be life-threatening, look for these three signs: continuous bleeding, large volume of blood, and pooling.

Be aware that these types of serious injuries may be hidden under clothing.

Press directly on the wound with gauze or cloth.

If that stops the bleeding, continue to do so until emergency medical professionals arrive. If bleeding continues from deep within the wound, cover it with a gauze pad and then reapply pressure.

If that fails, apply a tourniquet.

A tourniquet is an option when the wound is on the arm or leg, not the neck or torso.

The device consists of a strap and a stick-like accessory called a windlass.

Place the tourniquet on the limb 2 to 3 inches above the wound (but not above the elbow or knee). Twist the windlass to tighten the tourniquet until the bleeding stops and secure it in place, says Jefferson’s Kramer. If applied correctly, it will hurt.

“If someone is still conscious and complaining, that’s a good sign,” he said.

Don’t worry if it’s too tight, said Lewis J. Kaplan, a professor of surgery at the University of Pennsylvania Perelman School of Medicine.

“This is a life-on-limb situation,” he said.

Never remove a tourniquet, leave it to the experts. If bleeding continues, apply a second tourniquet.

Many first aid kits contain a commercial tourniquet. When one is not available, rescuers can improvise a field tourniquet from a piece of cloth and a rigid object, such as a pen or stick, to serve as a windlass.

But be careful, says Elinore Kaufman, a trauma surgeon at Penn Presbyterian Medical Center. If a makeshift tourniquet isn’t tight enough, it can speed up bleeding rather than cut it off.

“Partially on is worse than not at all,” he said.

A commercial turnstile has a locking mechanism to secure the turnstile in place. With a field tourniquet, instead, the windlass must be tied.

When a tourniquet is applied correctly, tight enough to cut off blood flow, it may appear as if blood would pool above that location.

Not really, Kaplan said.

When you cut off blood flow to a vessel, the blood already inside it effectively blocks the entry of more blood.

“The drawbridge is up,” he said. “You can not pass”.

Instead, blood flow continues above the wound and continues to supply other areas of the body until it returns to the heart.

For babies and young children, typical tourniquets are too large. Stick with the application of direct pressure.

If the bleeding is caused by an impaled object, leave it in place. These should only be removed by a professional.

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