3 Things Movies Get Wrong About Tourniquets

When faced with an unknown, stressful situation, the typical first reaction is to do what you have seen other people do.  In cases where those people have reacted correctly, this can be great.  However, in situations where that person’s response was incorrect, the results could be catastrophic.

Unfortunately, how Hollywood approaches the presentation of life-saving medical interventions on screen is often wrong; but nevertheless, these flawed methods get repeated… and repeated…. and repeated until they have been shown so many times that the audience (you) remembers what they have seen and accepts it as fact.  It takes facing a life-threatening situation to finally realize what you’ve seen simply will not work, and at that point, it will be too late.  Perhaps the most common misinterpretation by Hollywood is effectively applying a tourniquet to yourself or an injured person.

What is a tourniquet?

A tourniquet is a device or object (commercially-made tourniquet, shirt, belt, triangular bandage, etc.) that is placed around the injured extremity between the wound and the heart and tightened.  As it is tightened, it generates a “cone of pressure” underneath the tourniquet material.  This cone of pressure compresses the underlying muscle, which then compresses the arteries and veins.  Once these blood vessels have been closed off, blood flow to the extremity stops.

Sounds like a simple concept, right?  Yet an amazing amount of science supports the hows and whys of proper tourniquet material selection, usage, and application.  Research and testing is done at the United State Army Institute for Surgical Research.  This is the research lab whose mission is to provide combat casualty care medical solutions and products for wounded warriors. In other words, they do the research and testing of life-saving interventions that may be used for battlefield wounds.

With that background knowledge, let’s look at some of the most common tourniquet mistakes.

3 Common Tourniquet Mistakes

Myth #1 How often have we seen the hero rip the phone cord (or electrical cord) out of the wall and tie it tightly around an arm or leg to stop the bleeding and save the day?

This improvised method of applying a tourniquet has a 100% failure rate.

The cone of pressure is specifically related to the width of the material used for the tourniquet.  A narrow piece of material (bungee cord, phone cord, etc.), when tightened, generates a very narrow and shallow cone of pressure which fails to penetrate deeply enough into the arm/leg to compress the muscles.  If the muscles are inadequately compressed, then the blood vessels will remain open and the bleeding continues.

Myth #2 Another popular method of improvising a tourniquet is to tie a shirt around the injured extremity or use a belt.  Unfortunately, while these are wider, simply pulling the belt as tightly as possible, or tying the shirt also has a 100% failure rate.  While the belt and shirt may be wider than the phone cord when generating the cone of pressure, they are ineffective because simply pulling the material or the belt tight will not generate a cone of pressure that is deep enough to compress the blood vessels.  Instead, a wide shallow cone of pressure is generated. Again, the result is failure to stop the bleeding!

Clothing material is too “stretchy” to be effective and belts are often too rigid to allow satisfactory tightening.  Either way, this has a 100% failure rate!

In reality, it takes time, knowledge, and practice to create an improvised tourniquet that works.  While this is being done, the victim continues to lose blood.  The Institute of Surgical Research has shown that under the best of conditions, an improvised tourniquet with a rigid rod (windlass) for tightening still has a 70% failure rate.  Far better to be familiar with, carry, and understand how to successfully use a commercially-made tourniquet such as the CAT (Combat Application Tourniquet).

Myth #3 Once the bleeding stops, that means the tourniquet is working.

How often have we seen a tourniquet applied, but nothing else is done to the injured extremity?

With massive arterial bleeds, it is critical to determine whether the tourniquet application has been successful.  Simply placing the tourniquet or looking at the wound to see if the bleeding has decreased is not the correct method to determine success.

The only way to tell if a tourniquet has been successfully applied is to check for the pulse.  If there is a pulse in the injured arm/leg below the tourniquet, then the tourniquet is not working, and this situation needs to be immediately corrected.

When using tourniquets, it is critical that the person applying the tourniquet knows where to check for the presence or absence of a pulse.  Otherwise, it is impossible to determine the success of tourniquet application.

Learn how to check for a pulse and how to properly apply a tourniquet in First Aid for Gunshot Wounds,  the educational course and guidebook, developed by U.S. LawShield. The course teaches the basic life-saving interventions that are necessary in any traumatic life-threatening situation (gunshot wounds, motor vehicle accidents, industrial accidents, etc.).  Learn how to treat the 3 potentially preventable causes of death—massive arterial bleeding, airway obstruction, and chest wounds.

Find a course in your area at gunlawseminar.com or sign up for the online course at 2ainstitute.com.

It is far better to have the knowledge and not need it, than to need it and not have it!

—Dr. Rick Hammesfahr, U.S. LawShield Medical Director

Comment section

7 comments on “3 Things Movies Get Wrong About Tourniquets

  1. The gunshot wound class is the one first aid class everyone should take. Especially the tourniquet procedure. I took a first aid class many years ago and this totally dispelled what I was taught previously. They teach the why’s and wherefor’s about placement, feeling for pulse, and marking the time so EMTs know how long it has been since the tourniquet was in place. And you NEVER loosen it. This is not your typical first aid course. It is a must for everyone. Gunshot wounds to the torso, extremities, and head are treated differently, and each method is explained and practiced. Again, I say this class is a MUST for anyone. This is for the critical minutes until the EMTs arrive.

  2. Great article! I learned how to properly apply a tourniquet several years ago. As an avid action-movie watcher, I can say it is completely different than how it appears on screen. You need real strength to make the tourniquet tight!

    This is such important knowledge to know in the day of frequent mass-shootings. Whether you’re trying to save your life, or another’s, it NEVER hurts to learn the proper medical skills to do so.

  3. I have marveled at this for years – how can so many movies can get gunfights (and subsequent emergency care) so wrong? I’m amazed we haven’t heard more about folks who specifically failed to survive (or help another survive) an emergency situation because of trying what they saw in a movie and it failing. Very interesting and fresh take on a topically relevant point. Great post!

  4. Very interesting article. If I hadn’t read this, I would’ve believed that a telephone cord would work as a tourniquet. Thanks for the information! Keep it coming!

  5. Never put a tourniquet on a limb that you don’t plan on losing below the tourniquet. In other words, if NOTHING else has worked, apply the tourniquet as close to the wound as possible to allow the surgeons to make a better stump for prosthetic use later on.

    • We teach people to apply the tourniquet at least 2-3 inches above the wound, or as high as practical. In the case of a wound below the knee, always apply the tourniquet at mid-thigh or higher. The chances of damage to the limb from the tourniquet application are minimal if you get help at a hospital within two hours. You can find all this and more in our revolutionary book, First Aid for Gunshot Wounds, written by Rick Hammesfahr, MD at https://www.2ainstitute.com/gunshot-wound-guidebook.php and our online course based on the book.

  6. Proper application of a tourniquet is the standard of care for life threatening bleeding from extremity injuries as determined by the Institute of Surgical Research (US Army), the Committee on Tactical Combat Casualty Care, the Committee of Tactical Emergency Casualty Care, and the Stop the Bleed program endorsed by the American College of Surgeons and the Department of Homeland Security. Studies have shown that tourniquets DO NOT lead to an increased rate of amputation. Obviously, if the limb cannot be saved due to he nature of the original injury, it may need to be amputated. But the necessity for amputation is due to the original injury, not the tourniquet use which was life saving.

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