Raven EMS Education Program ManualTrauma Tourniquet Evaluation Form
Date:
Student name:
Evaluator name:
Steps:
Take BSI precautions.
Apply direct pressure to the wound.
Explain the procedure to the patient (if conscious).
If direct pressure does not control the bleeding, apply the tourniquet to the extremity 2 inches above the wound (tourniquet should be 1.5–4 inches wide).
Position the tourniquet with the tail to the inside for self-application, or the tail to the outside for application to the patient.
Position the windlass rod on top of the extremity.
Remove all slack.
Twist the windlass rod between three-fourths and two turns or until bleeding has stopped.
Secure the windlass rod under the clip buckle or triangle.
Ensure the distal pulse is absent; tighten the windlass rod further if needed.
Document the date and time of application.
Apply a pressure bandage over the wound and secure it in place.
Place the patient in the supine position.
Administer high-flow oxygen.
Keep the patient warm.
Provide rapid transport.
Accepts evaluation and criticism professionally.
Shows willingness to learn/asks appropriate questions.
Interacts with simulated patient and other personnel in a professional manner (ie, uses appropriate name, explains procedures, maintains modesty, is courteous to crew, etc).
Passing criteria:
Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
Fail.
Does not take or verbalize BSI precautions.
Did not explain and reassure the patient to allow informed consent.
Does not apply a high concentration of oxygen.
Does not control the hemorrhage using correct procedures in a timely manner.
Does not indicate the need for immediate transportation.
