CoTCCC-recommended limb tourniquets should be used whenever possible. However, there may be occasions when your supply has been exhausted or you find yourself in a situation without one, and you might consider improvising a tourniquet. That said, improvised tourniquets should only be used as a last resort when there is no other available option to control life-threatening extremity hemorrhage.

If an improvised tourniquet must be utilized, use materials at least 2 inches in width for the strap to avoid excess tissue damage, and make sure that there isn’t too much elasticity in the strapping materials. The windlass materials need to be strong enough to turn the strap and something to secure the windlass and keep it from unwinding once control has been established is needed.

Continue to reassess improvised tourniquets after placement as they are prone to loosening and apply a CoTCCC-recommended tourniquet as soon as one becomes available.

Of 66 injured patients, 29 patients had recognized extremity exsanguination at the scene. In total, 27 tourniquets were applied: 16 of 17 traumatic amputations, 5 of 12 lower extremities with major vascular injuries, and 6 additional limbs with major soft tissue injury. All tourniquets were improvised, and no commercial, purpose-designed tourniquets were identified. Among all 243 patients, mortality was 0%.