First Aid Kits: Bleeding Control & Tourniquets

Should you put a tourniquet in your first aid kit? Maybe, but you should know some things before you do:

• Training is more important than any piece of gear. Most bleeds can be stopped with direct pressure and/or proper wound packing — and both can be done with your hands and any old piece of fabric you have lying around. If you don’t know what “direct pressure” or “wound packing” means, or if you want to practice, take a course! A Stop The Bleed course is an excellent investment, and will go into all forms of bleeding control (including how to properly apply a tourniquet.) Most basic first aid courses will also cover bleeding control to some extent, though wilderness-oriented courses (for example, Wilderness First Aid) will typically go into more depth.

  (These are US-oriented suggestions; readers from other areas, I’d love for you to get in touch and let me know the equivalents in your country.)

• Once you do take that training, you’ll learn that the most important supplies for bleeding control are gloves, a stretchy bandage and plenty of gauze. Get those first, then think about other supplies.

• You probably don’t need a tourniquet in your first aid kit. Major bleeds that require tourniquets and aren’t immediately fatal — are rare outside of some specific circumstances (see below). Most people will never encounter one of these circumstances. While there’s nothing wrong with having one (if you’re trained to use it), they’re expensive and don’t last forever. If you’ve got disposable income, and the training, sure, go ahead; but for most people, your money is better spent on something else. (Narcan, for example: you’ve got a much higher chance of saving a life with Narcan than with a tourniquet.)

• You probably do need a tourniquet if you:

  • work with highly dangerous power tools (e.g. table saws, chainsaws),
  • use firearms (e.g. target shooting, hunting) or are likely to be shot (e.g. military), or
  • ride a motorcycle.

  This isn’t an exhaustive list; you may be able to think of other situations. The common factor is exposing yourself to a risk of sudden massive hemorrhage. If you’re in one of those situations, you should have a tourniquet and know how to use it.

• If you do decide to have a tourniquet, you need to know how to use it. They’re not intuitive to use, especially if you’re stressed, and putting one on yourself can be tricky. Most people, without training, don’t make the tourniquet nearly tight enough — they need to be shockingly tight.

  Take a course, and buy a trainer tourniquet to practice. You don’t want to practice with your real tourniquet, because they’re single use. Tightening them correctly can weaken the strap to the point that they may not work a second time; hence the need for the trainer. (This is another reason why I say that tourniquets are expensive.) Practice applying a tourniquet to yourself and to someone else, and crank it down correctly. It should cut off circulation (that’s the point), and will hurt. Practicing like this is safe as long as you don’t leave the tourniquet tightened for longer than a few minutes.

• Buy a windlass-style tourniquet- that’s the kind with a velcro band and tightening stick. Other styles (like the stretchy strap you might see when you get blood drawn for lab work) don’t work as well, and improvised tourniquets (e.g. a belt or climbing rope or whatever) don’t work at all. Get it from a reputable source: places like Amazon often sell fakes that’ll break under proper tension. They should be expensive (around $40 each).

  The gold standard are C-A-T tourniquets; I get mine from North American Rescue.

• An alternative to a tourniquet that’s nearly as effective and easier to use is an Israeli Bandage. They’re much cheaper (typically less than $10 each), and are easy to apply (but still practice). They’re great, you should have one in your FAK even if you also have a tourniquet.

• Some people put clotting agents or bandages (e.g. QuikClot) in their bleeding control kits. Opinion on these is split: they do work, but they leave gunk in the wound that your ER doc is going to need to cut out. This’ll prolong recovery and cause worse cosmetic outcomes. They also can’t stop the big bleeds that you’d need wound packing or a tourniquet to stop. Many ER doctors and nurses I’ve talked to don’t like clotting agents, and recommend against them; but on the other hand, several remote/austere medicine practitioners I’ve spoken to make compelling cases for them. So: think about the tradeoffs.

• Tourniquets expire — the nylon weakens over time, to the point that tightening an old tourniquet might break it. So that tourniquet your friend kept when he left the army should go in the trash, and you need to check your kit yearly-ish and replace any past their expiration date.

So what do I do?

I have tourniquets in two places:

1. In my shop. I have a table saw in there, and several other things that spin sharp metal at high speed.
2. In a small first aid pouch that I wear on my belt when I’m using my chainsaw.

Both of those bleeding control kits also have an Israeli bandage, vetwrap, and gauze. I probably ought to have gloves but I don’t; the person doing the bleeding is going to be me or a loved one, and I can’t be bothered to keep replacing them as they get all gross and sticky from the heat.

None of my other first aid kits have tourniquets. My backcountry kits don’t need them; I’m not going to encounter a situation in the wilderness that requires a tourniquet. (I would add one if I went on a hunting trip.)

There’s an argument to be made that I should carry one in the kit in my car — because I have emergency medical training, I’d want to stop and help if I witnessed a traffic accident, and those are situations where perhaps a tourniquet could make a difference. However, I’m concerned that the heat of the car will degrade the tourniquet faster than I’d expect, and so if I did apply it, it could fail. And I’m confident enough in my ability to control bleeding with pressure until EMS arrives.

Was this helpful? I’ve been thinking about writing a longer series about first aid kits (how I think about building them, and what goes in mine), of which this could become a part. If that’s something you’d like to read, get in touch.