Stopping of an external bleeding with an Esmarch type haemostatic tourniquet

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Equipment for the practical skill:

• simulator;
• vehicle first aid kit.

Clinical situation:      

• While walking down the street you witnessed an accident. A car hit a pedestrian crossing the road. The victim was thrown to the side of the road. The victim lies with his eyes closed. There is a gaping wound on the right thigh from which blood is ejected in a pulsating stream. Stop the bleeding.

The procedure for performing a practical skill:

• Call for help:
  • ask an eyewitness to call an ambulance and report an accident with a victim;
  • ask a bystander to assist you in providing first aid.
• Make sure the scene is safe.
• Identify a type of the external bleeding:
  • visualize the wound;
  • verify the bleeding;
  • choose a way to stop the bleeding.
• Use finger pressure points for stop (reduce) severe bleeding
  • choose the place of pressure on the artery: the femoral artery is pressed under the inguinal ligament to the pubic bone;
  • clench your hand into a fist and place it on the selected point;
  • place the palm of your other hand on your fist;
  • apply pressure with your fist at the selected point using your body weight;

• • increase the pressure gradually;
  • achieve the cessation of significant reduction in bleeding.
• Ask the bystander to assist you in providing first aid:
  • to bring the vehicle first aid kit;
  • to change you in pressure to the point where bleeding stops;
  • to replace you in applying pressure to the point to stop bleeding.
• Take from the first aid kit protective gloves and put on it.
• Stop bleeding with a Esmarch type haemostatic tourniquet:
  • select the exact place for the tourniquet: 5-10 centimeters proximally from the wound
  • prepare the place for the tourniquet: put some clothes or some bandage rounds on this place;
  • Use the tourniquet:
    • take the tourniquet with one hand (left) so that the short end of the tourniquet is 10 cm;

• • • with your other hand, put a tourniquet above the surface of the limb at the selected place;
    • stretch the tourniquet with both hands;
    • form the first turn around the limb;
    • increase gradually the effort of the stretch until the bleeding stop;
    • hold down the first turn of the tourniquet with the other turns applying them without the additional stretch amd with  overlaping of lower ones about 50%;
    • fasten two ends of the tourniquet with locking elements (buckles) or tie ends of the tourniquet.

• Check for bleeding (no bleeding from the wound).
• Note the time of a tourniquet application (write the note with the marked and put it under the upper tourniquet turn).
• Apply an aseptic bandage on the wound, without any covering the tourniquet.
• Immobilize the damaged area
• In the cold season, protect the damaged limb from cold.