Tourniquet Placement Changes - July 2017 Guidelines

In July 2017 the Faculty Of Pre-hospital Care at Royal College of Surgeons Of Edinburgh published a statement on the application of tourniquets. 

This statement recommends the placement of the tourniquet mid-shaft on a single bone to be changed to placing it as distally as possible above the wound. We would not place it over the wound or on a joint but these recommendations would mean it could be placed on a lower leg or arm. The reason for this change in recommendations is to reduce the tissue damage and to help salvage the limb.

They still recommend applying it as soon as possible directly to the skin and applied tightly enough to arrest the haemorrhage. If the first tourniquet does not stop the bleeding a second one can be applied above the first. It was also reiterated that tourniquets must be used correctly or not at all as an inappropriately applied tourniquet can be harmful and make the situation worse. Tourniquets must be applied tight enough to stop arterial bleeding and not just venous bleeding.

Where a tourniquet cannot be applied close to the wound. This may be where the limb is trapped and in these cases, it can still be applied proximally up the limb where previously advised. When freed, another tourniquet can be applied closer to the wound first, then the higher one removed.

Tourniquets should still be left in place until advanced medical treatment is available.