Tourniquet & Wound Packing — Quick Card

Uncontrolled bleeding is the leading cause of preventable death from trauma. A tourniquet or wound packing applied correctly in the first few minutes can save a life before emergency services arrive.

⚠️ Do not hesitate to apply a tourniquet to save a life. The risk of limb loss from a properly applied tourniquet is far lower than the risk of death from uncontrolled bleeding.

When to Use What

Situation	Correct Intervention
Bleeding from arm or leg — soaking through dressings	Tourniquet
Bleeding from arm or leg — moderate, not yet life-threatening	Direct pressure first; tourniquet if soaking through
Wound in groin, armpit, or neck (junctional)	Wound packing + pressure — tourniquet cannot be placed here
Wound on torso/chest/abdomen	Direct pressure only — no tourniquet, no packing
Amputation	Tourniquet immediately — do not attempt direct pressure first

Tourniquet Application — Step by Step

A commercial tourniquet (CAT, SOFTT-W) is ideal. An improvised tourniquet from a belt or strip of fabric works if nothing else is available.

Step	Action
1. Expose the wound	Cut away clothing — you must see the injury
2. Position	Apply 5–7 cm (2–3 inches) above the wound — never over a joint
3. Route the strap	Thread through the buckle and pull tight
4. Tighten with windlass	Twist the rod until bleeding stops — this will be painful; continue until bleeding stops
5. Secure the windlass	Lock into the clip; do not allow it to unwind
6. Note the time	Write the time of application on the tourniquet or the casualty's forehead with a marker
7. Do not cover	Leave the tourniquet visible at all times
8. Do not remove	Only a physician removes a tourniquet — once applied, leave it on

The tourniquet is working when: Active bleeding has stopped. If bleeding continues, tighten further or apply a second tourniquet immediately above the first.

Wound Packing — Step by Step

Use for deep wounds in areas where a tourniquet cannot be placed: neck, groin, armpit, shoulder.

Step	Action
1. Apply gloves if available	Protect yourself from bloodborne pathogens
2. Pack the wound	Push haemostatic gauze (or any clean cloth) firmly into the wound cavity — do not just cover the surface
3. Pack tightly	Use your fingers to push gauze deep into the wound, filling the cavity completely
4. Apply direct pressure	Lean your full body weight onto the packed wound — maintain for a minimum of 3 minutes (5 minutes for haemostatic gauze)
5. Do not lift to check	Lifting releases the pressure and disrupts clotting
6. If bleeding soaks through	Add more gauze on top; do not remove original packing

Improvised Tourniquet

If no commercial tourniquet is available:

1. Fold a strip of fabric (belt, torn shirt) to at least 4 cm wide — narrow material cuts into skin without stopping blood flow
2. Wrap twice around the limb, 5–7 cm above the wound
3. Tie a half-knot; place a stick, pen, or rigid object on top; tie another half-knot over it
4. Twist the object until bleeding stops
5. Secure the object so it cannot unwind (tie, tape, or tuck)
6. Note the time

Common Errors

Error	Consequence	Correct Approach
Too loose	Causes venous tourniquet — worsens bleeding	Tighten until bleeding stops entirely
Applied over a joint	Ineffective and potentially harmful	Apply mid-limb, 5–7 cm above wound
Narrow material	Cuts skin; distributes pressure poorly	Minimum 4 cm wide
Covering with bandage	Prevents monitoring	Leave visible at all times
Removing in the field	Re-bleeding; reversal of clot	Leave on — hospital removal only
Packing the surface only	Blood continues beneath	Pack deep into the wound cavity

Post-Application Care

• Monitor for continued bleeding above or below the tourniquet
• Treat for shock: lay the casualty flat, elevate the uninjured leg, keep warm
• Reassure and keep the casualty still
• Ensure emergency services know tourniquet time when handing over

Quick Reference

Scenario	Action
Limb bleeding, soaking through	Tourniquet — 5–7 cm above wound; tighten until bleeding stops; note time
Groin, armpit, or neck wound	Pack wound deep with gauze; apply firm continuous pressure 3–5 min
Tourniquet not stopping bleed	Apply second tourniquet directly above first
No commercial tourniquet	Belt/torn strip ≥4 cm wide; windlass technique
Remove tourniquet?	Never in the field — hospital only
How long can tourniquet stay on?	Up to 2 hours safely; beyond that, risk of damage — but life > limb