11 advanced tips for hands-on tourniquet training
Challenge LEOs to go beyond the basics and demonstrate tourniquet competency in a variety of challenging environments and scenarios
This is the third article in a three-part series on tourniquet application to stop severe bleeding written by a SWAT team leader and a paramedic. Part 1 addresses basic tourniquet selection considerations and tips for success. Part 2 covers training with tourniquets. Part 3 addresses the real-world use of tourniquets
By Jason Williams and Brian G. Anderson
Once students have basic tourniquet application proficiency, increase the challenge with these additional hands-on training tips to prepare LEOs for real-world applications.
1. Left, right, or both hands. Applying a tourniquet with both hands in training makes sense when building basic skills, but once the basics are engrained, it’s time to learn to use a single hand to deploy and apply the tourniquet. There may be situations when one hand is out of commission due to an injury or when it’s necessary to keep a weapon in the dominant hand and the non-dominant hand must be used to apply the tourniquet. Application variations include self-application to both the left and right arms along with the left and right legs and the application to a victim’s arm or leg.
2. Time pressure. One method of instilling the need for speed is to ask class participants to estimate how long it will take to apply a tourniquet. With the estimates established and the group starting at the same time, start a stopwatch. Participants will most likely try to beat their own estimates and their buddies' estimates, causing them to work quickly.
When confronted with life-threatening bleeding, seconds, not minutes make a difference. A severed artery in an arm or leg can result in death in a few minutes. Speed is of the essence and speed is achieved with practice and mental preparation.
3. Dim the lights. When it’s time to use a tourniquet in the field, there’s a good chance that the lighting won’t be as good as in the training room. Even when training in the classroom, higher fidelity can be achieved by turning off the lights and closing the window shades.
4. I can’t see. When conducting initial or refresher training, participants will demonstrate competency in the application of the tourniquet with the lights on and eyes open. Once this competency is demonstrated, the participants can be tasked with applying the tourniquets with their eyes closed. This is an important skill when considering the possibility of decreased vision due to pepper spray or other contaminants, blunt force trauma to the head or eyes, or working in darkness by chance or tactical necessity. For complete darkness and an opportunity to train in a confining environment, a storage closet or similar area works well. This is a good time to discuss the problems with using weapon-mounted lights to illuminate a victim.
5. Light it up. Dark rooms provide a realistic training environment, but more realism can be achieved with the addition of flashing red/blue lights. Old dashboard lights that have been removed from vehicles can add realism to a training session and the shop that performs the installations may have old lights that can be acquired just for training. Given that the modern warning lights are constructed with LEDs and draw little energy, compact rechargeable 12-volt batteries can be used in the training exercises.
6. Crank up the volume. Dark rooms and flashing lights are great, and now the only thing missing is the sounds of an incident scene. Putting out great sound during training is easy with the use of a little bit of simple technology. For hardware, MP3 players, smartphones, or laptops are easy to use and they can often be coupled to large speakers via Bluetooth. Public Education offices may have large speakers that are used for school demos and other public events that may be perfect for the classroom. When it’s time to add sound to the training, there are several choices. Good audio content includes radio traffic from an earlier dynamic incident, crowd noise, a K-9 barking, and sound effects of sirens, air horns and helicopters. These can be found and downloaded from internet special effects websites or recordings can be made on-site. Other choices for audio include club music, up-tempo foreign language music and heavy metal music.
7. Smoke detectors. The discharge of firearms in enclosed spaces may activate smoke detectors, adding to the audible distractions. This effect can be added to training with an inexpensive battery-powered smoke detector. To activate the smoke detector on demand, a spring clamp can be used to depress the smoke detector’s test button to activate the alarm.
8. Get down! If training is restricted to a classroom, training participants should get out of the chairs and get on the floor or under the classroom tables to provide more realistic conditions in which to assess a victim and apply a tourniquet.
9. Get gear out of the way. Drop-leg holsters, gas mask pouches, arm protection, spare magazine pouches and smartphones in pockets can prevent a tourniquet from applying the circumferential pressure needed to function properly. Unbuckle and swing this equipment out of the way or out of the pockets before applying a tourniquet. Should the limb be impaled with an object, the running end of the tourniquet may have to be removed from the buckle, and the limb encircled with a strap and reconnected to the buckle.
10. Officer trapped in a vehicle. With a good foundation of basic skills established, consider the real-world challenges that officers may face in the field. One example is a car crash with a jammed door that can’t be opened and the driver needs a tourniquet on the leg. Leaning through the driver’s side window and applying a tourniquet to the driver’s leg will probably mean that the tourniquet cannot be applied in the loop configuration, so the strap will have to be removed from the buckle, slid under the driver’s leg and then reattached before tightening.
11. Work with a partner. When it’s obvious that a tourniquet is needed for a victim, one officer can apply direct pressure to slow the bleeding while another officer is applying a tourniquet. The amount of bleeding that is prevented with direct pressure may make a difference in the victim’s survival.
Another scenario is applying a tourniquet to the leg of the driver while working from the passenger side of the vehicle. Working from the kneeling position, over the center console and laptop can put the basic skills to the test.
Finally, it is our duty to respect the warfighters. The invention and widespread use of tactical tourniquets is the direct result of a need that was identified by warfighters, medics and trauma surgeons in Iraq and Afghanistan. Learning and practicing tourniquet skills honors their sacrifice and commitment to saving lives.
About the authors
Jason Williams is a 20-year veteran of the Aventura Police Department in Miami-Dade County, Florida. Jason has been a member of the multi-agency SWAT team for 16 years, as well as a team leader for the past 12 years. He is currently certified in several instructor areas including Active Shooter Response, less lethal, ballistic shield, mechanical/ballistic breacher and several more. Jason served as a K-9 handler for 12 years working two dual-purpose canines. His experience as a SWAT team leader/member and K-9 handler has pushed him to become a better tactician and to share his expertise.
Brian G. Anderson is a retired battalion chief and paramedic from Miami-Dade (Fla.) Fire Rescue. Prior to retirement, he focused on fire-rescue active shooter procedure development and inter-agency active shooter exercises. He is an instructor at Palm Beach State College and is also a volunteer instructor with Trauma Training Group, Inc., an organization that provides no-cost Stop the Bleed training in South Florida. He has delivered bleeding control training to private, public and charter school personnel and members of city and county law enforcement agencies.