TOURNIQUET APPLICATION

Purpose: The purpose of this policy is to assist paramedics with the indications for, and application and management of a prehospital tourniquet.

UTSW/BioTel paramedics may apply any EMS agency-approved tourniquet to control blood loss under certain conditions. Once applied, these patients require transport to a Trauma Center.

  1. Indications for tourniquet application
    1. Potentially life-threatening extremity hemorrhage AND
    2. Hemorrhage cannot be controlled by direct pressure.
  2. Contraindications for tourniquet application
    1. Non-extremity hemorrhage OR
    2. Site of extremity hemorrhage precludes the ability to appropriately apply a tourniquet.
  3. Procedures for tourniquet application:
    1. UTSW/BioTel paramedics shall be familiar with safe tourniquet application technique.
    2. The tourniquet and bleeding site should be left uncovered or with minimal bandaging to facilitate frequent wound site re-evaluation.
    3. If the application of a tourniquet fails to control bleeding a second tourniquet may be applied.
    4. It is essential to document the time that a tourniquet was applied.
      1. Time of application should be written directly on the tourniquet
      2. Time of application should be documented in the patient care report
    5. Once placed, the tourniquet should not be removed until the patient is transferred to a higher level of care (see special circumstance below)
    6. Notify BioTel or the receiving hospital en route that the patient has had a tourniquet applied. Communicate whether bleeding has been controlled or not, as well as time of tourniquet application.
    7. Continue to monitor the patient’s vital signs and the wound for recurrent bleeding.

Special circumstances:

Improvised tourniquets applied by bystanders and non-medical personnel prior to EMS arrival are not a substitute for a commercial device properly applied by UTSW/BioTel EMS providers.

  1. In such cases, a BioTel agency-approved commercial tourniquet should be applied (but not secured) proximal to the improvised device prior to its removal, if possible. If hemorrhage uncontrolled by direct pressure reoccurs after removal of the improvised device, the commercial tourniquet shall be deployed using the procedure described in this Policy.

Rarely, a patient who has had a tourniquet placed by a first-responding law enforcement officer or citizen prior to EMS arrival may decline an offer of transport to the hospital by ambulance. This should be strongly discouraged.
However, should paramedics be unsuccessful in convincing the patient to accept ambulance transport, the following steps shall be taken:

  1. Explain to the patient that the tourniquet cannot remain in place if the patient is not being transported by ambulance, and that removal of the tourniquet may result in uncontrolled bleeding and possibly death.
  2. Contact BioTel requesting that the Medical Command Physician speak directly with the patient to try to convince the patient to accept transport.
  3. If the Medical Command Physician fails to convince the patient to accept ambulance transport, and upon acknowledgment of the warnings, the tourniquet should be slowly released over 3 to 5 minutes.
  4. If bleeding recurs, apply direct pressure/pressure bandaging and observe the patient for 10 minutes. If bleeding remains uncontrolled, re-apply the tourniquet and contact BioTel for further assistance.
  5. If bleeding is controlled with direct pressure/pressure bandage, document this, as well as the presence of distal pulses and capillary refill. Then, have the patient sign the refusal, and encourage them to seek immediate emergency medical care by whatever means they choose.