Severe Bleeding, STOP the Bleed – Tourniquets©

 

Author’s note – If you do not like gore, be warned due to the subject matter, some of the photos in this article are graphic, in fact they are purposefully gory, because emergency scenes are gruesome and you must be prepared for it.  I hope that you enjoy learning from this resource!  

To help me to continue to provide valuable free content, please consider showing your appreciation by leaving a donation HERE.  Thank you and Happy Trails!

 

Hate to say it, but the way things are going, no one is ever safe all the time, everywhere.  YOU HAVE TO BE PREPARED! 

 

Maybe you’re a first responder at a mass casualty event, a serious accident, or any other situation where there is severe bleeding, or maybe you’re the victim and there isn’t one around that can save you.  Do you know how to save yourself and others?  

 

Controlling severe bleeding from injuries to the arms and legs with a tourniquet can prevent a victim from bleeding out, but do you know when and how to use them? 

 

Today there are many commercially available tourniquets designed to control bleeding, such as windlass, elastic, ratchet, and pneumatic tourniquets.  

 

However, the windlass C-A-T® (Combat Application Tourniquet), is the fastest, safest, and most effective, it is a true one-handed, prehospital field tourniquet.  It was adopted as the official tourniquet of the U.S. Army and was proven to be 100% effective by the U.S. Army’s Institute of Surgical Research at stopping severe extremity bleeding in the event of a traumatic wound and is frequently used by first responders and emergency medical services.

 

Using a C-A-T^® Tourniquet

Step 1: Assess the Scene

Always assess the scene.  Is it safe for the rescuer to enter?  You are no help to anyone if you rush into an unsafe situation, just become another victim.

 

Once you have assessed the situation and decided it is safe, here are the steps to follow while assessing the victim, follow these priorities:

C-Catastrophic bleeding

A- Airway, ensure it is clear

B-Breathing, check for normal breathing

C-Circulation, pulse and all other bleeding

 

Expose the wound and apply direct pressure, while assessing if the bleeding is catastrophic and immediately life-threatening.  If immediate direct pressure and packing fails to control the bleeding, a tourniquet will be needed. 

 

Gather emergency supplies and contact emergency services or ask someone nearby to call for medical help and gather supplies, while doing the basic assessment and applying immediate direct pressure. 

 

DO NOT STOP applying immediate pressure to the wound hunt for supplies or call for help. 

You will want...

•       Windlass rod tourniquet

•       Gloves

•       Scissors (for cutting clothing away if necessary)

•       Pen or marker (to note the time the tourniquet is applied)

 

Step 2: Applying the Windlass Rod Tourniquet

Follow these steps to correctly apply the C-A-T® windlass rod tourniquet:

A)            Position and Adjust the Tourniquet

Wrap the tourniquet around the bleeding arm or leg approximately 2 to 3 inches above the bleeding wound.  DO NOT place the tourniquet directly over a joint.  If necessary, place the tourniquet above the joint to ensure effectiveness.

 

B)     Position Manually tighten the Tourniquet

Pull the free end of the strap to make it as tight as possible.  Once the tourniquet is as tight as possible, secure the free end in place.

 

C)    Twist the Windlass Rod

Using the windlass rod, twist and wind it until the bleeding stops.  This action will further tighten the tourniquet and will apply the necessary pressure to the wound to effectively stop the bleeding.

 

D)    Secure the Windlass Rod

To keep the tourniquet tight and maintain the pressure on the bleeding injury, you must secure the windlass rod in place with the windlass clip and velcro strap if available.  

 

E)    Note the Time

It is important to record the time the tourniquet was applied. 

The standard first aid practice to alert later medical professionals is to write a “T” or “TQ”, the time, and the location, such as “RA” for right arm or “LL” for left leg, on the patient's forehead.  

 

Also write it on the tourniquet.  This prevents missed tourniquets, because in chaotic situations, it’s easy to overlook one on a patient with multiple injuries.  It helps to guide future treatment, as tourniquets left on  for a prolonged time, over 2-6 hours, can cause permanent tissue damage, knowing the time is crucial for safe removal or conversion.  Use a pen or marker to write the time on the tourniquet or on the victim.  

A properly applied tourniquet IS painful; a casualty may require significant pain relief to apply the tourniquet to the appropriate pressure.  DO NOT hesitate or be shy, pain can be treated death due to bleeding out, cannot!

 

Don’t forget to come back next week and read “Severe Bleeding, STOP the Bleed – Improvised Tourniquets  Part Five©”.

 

Disclaimer: All content and media on The Woodsman’s Journal Online is created and published for informational/educational purposes only.  It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice.  Use of the information on this site is AT YOUR OWN RISK, intended solely for self-help, in times of emergency, when medical help is not available, and does not create a doctor-patient relationship.  Always consult with a medical professional for proper diagnosis and treatment of injuries.

 

I hope that you enjoy learning from this resource!  To help me to continue to provide valuable free content, please consider showing your appreciation by leaving a donation HERE.  Thank you and Happy Trails!

 

I hope that you continue to enjoy The Woodsman’s Journal Online and look for me on YouTube at BandanaMan Productions for other related videos, HERE.  Don’t forget to follow me on both The Woodsman’s Journal Online, HERE, and subscribe to BandanaMan Productions on YouTube.  If you have questions, as always, feel free to leave a comment on either site.  I announce new articles on Facebook at Eric Reynolds, on Instagram at bandanamanaproductions, and on VK at Eric Reynolds, so watch for me.

 

That is all for now, and as always, until next time, Happy Trails!

 

 

Notes

 

Sources

 

Covey, D.C. and Gentchos, Christopher E. ; “Field tourniquets in an austere military environment: A prospective case series”, Injury, Volume 53, Issue 10, October 2022, Pages 3240 to 3247, https://www.sciencedirect.com/science/article/pii/S0020138322005204, accessed January 17, 2026

 

Salchner, Hannah, MD, Et al.; “Arterial Occlusion Effectiveness of Space Blanket‒Improvised Tourniquets for the Remote Setting”, Wilderness & Environmental Medicine, 2023; Vol. 34, No. 3., pages 269 to 276, https://www.sciencedirect.com/science/article/pii/S1080603223000431?ref=pdf_download&fr=RR-2&rr=9bf1180be96941bb, accessed January 17, 2026

 

John F. Kragh, Jr., MD, Et al.; “Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma”, The Journal of TRAUMA Injury, Infection, and Critical Care, February Supplement, 2008, pages S38 to S50, https://learning-media.allogy.com/api/v1/pdf/9533415c-0a79-41ea-a624-a1e08ba56afe/contents, accessed January 17, 2026