3-42. In the absence of a specially designed tourniquet, you can make one from any strong, pliable material such as gauze or muslin bandages, clothing, or cravats. Use your improvised tourniquet with a rigid, stick-like object. To minimize skin damage, the improvised tourniquet must be at least 2 inches wide.
The tourniquet must be easily identified or easily seen. Do not use wire, shoestring, or anything else that could cut into flesh, for a tourniquet band.
3-43. To position the makeshift tourniquet, place it around the limb, between the wound and the body trunk, or between the wound and the heart. Never place it directly over a wound, a fracture, or joint. For maximum effectiveness, place it on the upper arm or above the knee on the thigh (Figure 3-36).
3-44. Pad the tourniquet well. If possible, place it over a smoothed sleeve or trouser leg to keep the skin from being pinched or twisted. If the tourniquet is long enough, wrap it around the limb several times, keeping the material as flat as possible. Damaging the skin may deprive the surgeon of skin required to cover an amputation. Protecting the skin also reduces the casualty’s pain.
3-45. To apply the tourniquet, tie a half knot, which is the same as the first part of tying a shoe lace. Place a stick, or other rigid object, on top of the half knot (Figure 3-37).
3-46. Tie a full-knot over the stick, and twist the stick until the tourniquet tightens around the limb or the bright red bleeding stops (Figure 3-38). In the case of amputation, dark oozing blood may continue for a short time. This is the blood trapped in the area between the wound and tourniquet.
3-47. To fasten the tourniquet to the limb, loop the free ends of the tourniquet over the ends of the stick. Bring the ends around the limb to keep the stick from loosening. Tie the ends together on the side of the limb (Figure 3-39).
3-48. You can use other means to secure the stick. Just make sure the material remains wound around the stick, and that no further injury is possible. If possible, save and transport any severed (amputated) limbs or body parts with (but out of sight of) the casualty. Never cover the tourniquet. Leave it in full view. If the limb is missing (total amputation), apply a dressing to the stump. All wounds should have a dressing to protect the wound from contamination. Mark the casualty’s forehead with a “T” and the time to show that he has a tourniquet. If necessary, use the casualty’s blood to make this mark. Check and treat for shock, and then seek medical aid.
Do not remove a tourniquet yourself. Only trained medical personnel may adjust or otherwise remove or release the tourniquet, and then only in the appropriate setting.
3-49. The term shock means various things. In medicine, it means a collapse of the body’s cardiovascular system, including an inadequate supply of blood to the body’s tissues. Shock stuns and weakens the body. When the normal blood flow in the body is upset, death can result. Early recognition and proper first aid may save the casualty’s life.
Causes and Effects of Shock
3-50. The three basic effects of shock are–
Heart is damaged and fails to pump.
Blood loss (heavy bleeding) depletes fluids in vascular system.
Blood vessels dilate (open wider), dropping blood pressure to dangerous level.
3-51. Shock might be caused by–
Allergic reaction to foods, drugs, insect stings, and snakebites.
Significant loss of blood.
Reaction to sight of wound, blood, or other traumatic scene.
Traumatic injuries. — Burns. –Gunshot or shrapnel wounds. — Crush injuries. –Blows to the body, which can break bones or damage internal organs. — Head injuries. –Penetrating wounds such as from knife, bayonet, or missile.
Signs and Symptoms of Shock
3-52. Examine the casualty to see if he has any of the following signs and symptoms:
Sweaty but cool (clammy) skin.
Weak and rapid pulse.
(Too) rapid breathing.
Pale or chalky skin tone.
Cyanosis (blue) or blotchy skin, especially around the mouth and lips.
Restlessness or nervousness.
Significant loss of blood.
Confusion or disorientation.
Nausea, vomiting, or both.
First-Aid Measures for Shock