When Tourniquets Don't Work - Applying a Second
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What to Do If Bleeding Continues After a Tourniquet Is Applied
If you have applied a tourniquet and the casualty is still bleeding, do not panic. There are several clear, logical steps you can take to improve bleeding control. Severe haemorrhage can be challenging, and it is not uncommon to need more than one intervention.
Step 1: Tighten the Tourniquet
The first and simplest action is to tighten the tourniquet further.
When a tourniquet is first applied, it may initially slow or stop the bleeding. However, as the soft tissue compresses and blood is forced out, the tourniquet can loosen slightly.
- Re-tighten the tourniquet
- Apply additional pressure using the windlass or tightening mechanism
In many cases, this alone will be enough to fully control the bleed.
Step 2: Reassess Direct Pressure
If tightening does not fully stop the bleeding, reassess whether direct pressure will now be effective.
Earlier, direct pressure may not have worked because of heavy blood flow. However, once a tourniquet has reduced circulation to the limb, direct pressure can often become effective.
- Apply firm direct pressure directly over the wound
- Maintain pressure and reassess bleeding
This combination can sometimes resolve the problem without further escalation.
Step 3: Use a Haemostatic Dressing
If direct pressure alone is still not enough, consider using a haemostatic dressing.
Before the tourniquet was applied, the wound may have appeared too severe for haemostatic agents to be effective. However, now that blood flow has been reduced, haemostatic dressings may work very well.
- Apply the haemostatic dressing directly to the wound
- Cover it with a trauma dressing
- Apply firm pressure
This layered approach can significantly improve clot formation and bleeding control.
Step 4: Apply a Second Tourniquet
If bleeding continues despite these measures, you may need to apply a second tourniquet.
Correct Placement of a Second Tourniquet
- Place the second tourniquet above the first one
- Always position it closer to the body
- Never place a tourniquet over a joint
Placing a tourniquet over a joint will not work, causes extreme pain, and can lead to serious tissue damage.
Once applied, tighten the second tourniquet fully and reassess bleeding.
Step 5: Improvised Tourniquet (If Needed)
If your bleed control kit contains only one commercial tourniquet and bleeding still cannot be controlled, you may need to use an improvised tourniquet.
An improvised tourniquet should:
- Be placed above the existing tourniquet
- Use a strong band such as a triangular bandage or robust material
- Include a solid object (such as a piece of wood) to act as a windlass
Twist the windlass to tighten the improvised tourniquet until bleeding is controlled, then secure it in place.
Extreme Circumstances
In very rare and extreme cases, it may be necessary to apply a third tourniquet. This is uncommon, but catastrophic bleeding requires decisive action.
At this stage, saving life takes priority over limb preservation.
Key Points to Remember
- Always tighten a tourniquet first if bleeding continues
- Reassess direct pressure once blood flow is reduced
- Use haemostatic dressings and trauma dressings together
- Apply a second tourniquet above the first if needed
- Never place a tourniquet over a joint
- Improvised tourniquets are a last resort but can save lives
Severe bleeding can be difficult to control, but using a structured, step-by-step approach gives the casualty the best possible chance of survival.
- IPOSi Unit three LO3.1, 3.2, 3.3 & 3.4
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