Equipment 8-882 - Tourniquet

CMH EMS & MIH Protocols

Scope of Practice:

Emergency Medical Dispatcher

Emergency Medical Responder

Emergency Medical Technician

Advanced Emergency Medical Technician

Registered Nurse

Paramedic

Indications:

Contraindications:

None.

Precautions:

Prolonged Tourniquet application may result in nerve damage, rhabdomyolysis, compartment syndrome, ischemia, and re-profusion injury.

Time of Tourniquet application MUST be reported to accepting ER.

Do not apply Tourniquet over a joint.

Procedure:

May use cloth, blood pressure cuff, or commercial device. Constricting band should be at least 1 inch wide.

Apply Tourniquet proximal to bleeding site.

HIGHLY preferred to place tourniquets on the upper arms or leg to compress one bone instead of two in distal limbs.

Tighten Tourniquet until bright red bleeding has stopped.

Secure Tourniquet from loosening.

Note the time of Tourniquet application.

Advanced Life Support:

Application of Tourniquets typically results in severe Pain. Consider referring to Protocol 2-660 - Pain Control after bleeding control, fluid administration, and TXA administration (if given).
If prolonged transport time, consider Tourniquet removal if ALL of the following are met:

Not in circulatory shock,
Stable vitals,
Enough personnel and resources, AND
Not an amputated Extremity.

Contact MEDICAL CONTROL to request orders to loosen tourniquet, if applicable:

Apply pressure dressing and loosen Tourniquet (leave in place).
Re-tighten Tourniquet if significant bleeding returns.

Citations:

Protocol 9-010 - References
Cain, 2008.
Composite Resources, Inc.
Doyle & Taillac, 2008.
Flores, 2012.
Kragh, et al., 2008.
Richey, 2007.
Schreckengaust, Littlejohn, & Zarow, 2014.

Change Log:

Date	Link to previous version	Description of change
11/29/13	pdf	Added indications for use. Added precautionary statement about re-profusion injury. Added ALS analgesics and Tourniquet removal instructions. Added Combat Application Tourniquet instructional graphic.
12/15/13		Added EMT scope of practice statement.
06/01/15	pdf	Added indication for Protocol 6-085 - High-Threat Response.
08/24/18	pdf	Added scope of practice to all levels.
07/04/20		Renumbered the section to allow for future additions.
08/08/20	pdf	Added content (without substantive modification) from old Section 8-390 - Tourniquet.
06/15/21	pdf	Moved to emsprotocols.online
12/01/21		Updated link to TXA.

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