Understanding Proper Use of Tourniquets

When and Where Tourniquets are Acceptable to Use

Midwife taking blood sample from arm of pregnant woman. Credit: Adam Gault/SPL / Getty Images

Tourniquets are tight bands used to control bleeding by completely stopping the blood flow to a wound. Tourniquets work only on arm and leg injuries. Tourniquets are usually reserved for the worst bleeding to keep the victim from developing shock. The use of tourniquets was first documented on the battlefield in 1674.

The Tourniquet Controversy

Tourniquets have a bad rap in the field of emergency first aid.

Complications of tourniquet use have led to severe tissue damage. Victims treated with tourniquets have had amputations of limbs attributed to the use of the tourniquet.

That doesn't mean tourniquets don't work. On the contrary, tourniquets can arrest bleeding quite well and are certainly useful in cases of severe bleeding that cannot be stopped any other way. They're popular on the battlefield because they can be applied quickly and do not need to be constantly monitored once they are in place, allowing even injured soldiers to remain conscious and protect themselves.

When a gunman attacked the Virginia Tech campus on April 16, 2007, at least one victim managed to stop his own bleeding by using a makeshift tourniquet. Kevin Sterne, an Eagle Scout trained in first aid, applied a tourniquet made from an electrical cord to his leg, which stopped the bleeding from his wounded femoral artery.

Correct Tourniquet Use

Tourniquets only work if they are tight enough to stop arterial blood flow. Arterial blood is under significantly more pressure than venous blood, and it takes more pressure to stop it. Tourniquets should not be too narrow, or they will cut into skin as pressure is applied. Unfortunately, the wider the tourniquet, the more pressure that is required to stop blood flow.

Generally speaking, for best results, tourniquets should be between 1 and 2 inches wide. Tourniquets on the leg will need to be narrower than those on the arm, due to the increased pressure necessary to stop blood flow in the leg.

Tourniquets should always be a last resort. They are to be used only when there is no other way to stop bleeding. That can be either because other methods to control bleeding do not work, or because other methods to control bleeding cannot be safely undertaken or are not available. 

Common Tourniquet Mistakes

Tourniquets can be life-saving devices if used properly. But tourniquets that are applied too loosely can actually worsen bleeding. If the tourniquet only stops venous blood return, but does not stop blood flow in the artery, bleeding gets more severe below the tourniquet.

In addition to avoiding improper use of tourniquets, tourniquets should not be removed by rescuers without training. While leaving a tourniquet in place too long may lead to tissue damage, removal may lead to more severe bleeding.

In most cases, the potential for loss of a limb is outweighed by the potential for loss of life.


Beebe, Richard, and Deborah Funk. Fundamentals of Emergency Care. 2001. Delmar.

Mabry, Robert L. "Tourniquet use on the battlefield." Military Medicine. May 2006.

Walters, Thomas J, and Mabry, Robert L. "Issues Related to the Use of Tourniquets on the Battlefield." Military Medicine. Sep 2005.

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