You keep twisting the windlass on your tourniquet, 5,6,7…11 times and you’re still bleeding… What is going on during the worst day of your life?!
A portion of literature on tourniquets has recognized failure with slack. This means operators are twisting the windlass before pulling as much slack as they can through the friction adapter/buckle, which causes the TQ to not be as tight as possible.
How do I address and prevent this?
I incorporate a “Slack Drill” into my TCCC classes before standard tourniquet drills. Before I let my students touch the windlass, I tell them “make it as tight as possible by just pulling the slack out, every centimeter, as if windlass doesn’t exist and that is all you have to stop the bleed.”
I then walk around the room and get at least a few centimeters, if not inches, out of some students slack to show them the standard.
THEN I tell them to turn the windlass and they can strongly get a feel for themselves that when a tourniquet is tight enough, the “patient” your student is practicing on grimaces halfway through the first turn and does NOT want to experience twisting until total arterial occlusion. That is a huge difference from not being aggressive when pulling slack and ending up rotating that windlass all day frivolously and causing blood loss and/or compartment syndrome.
In addition, teach your students how to “reset” a training tourniquet by grabbing the ends and pulling to lengthen out the internal band when doing drills. A tourniquet still “tight” from the last training application won’t go on as realistically and will therefore cause possible training scars and windlass emphasis.
*Training tourniquets should never be used on real casualties.
Consider addressing this in your class by emphasizing getting the slack out so we can lower operator induced tourniquet failure.
Here’s just a couple studies I easily grabbed off google, there are more:
* Confidence-Competence Mismatch and Reasons for Failure of Non-Medical Tourniquet Users. Baruch EN, et al. Prehosp Emerg Care. 2017 Jan-Feb.
* No Slackers in TQ Use to stop bleeding: https://www.jsomonline.org/SharedScience/2013212Polston.pdf Thanks to , Journal of Special Operations Medicine