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One-Third Two-Thirds Tourniquet: One Cravat

An improvised tourniquet alternate begins by knotting the windlass at the ⅓ point of the tournqiuet
Mike Shertz MD/18D

Researched and written by Mike Shertz, MD/18D, not AI

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Why the first step feels backwards for this improvised tourniquet

I was shown a new technique for an improvised tourniquet. Unlike the traditional military cravat improvised tourniquet that requires two cravats, this new technique only requires one. However, we have some concerns that the first step is the least intuitive.  By tying your windlass into the tourniquet before applying it, you leave yourself extra tails which can help in securing the windlass. 

How to build the one-third two-thirds tourniquet

  1. Lay out your cravat or piece of material and divide it into thirds.
  2. Preset your twist stick, or windlass, at the ⅓ mark and tye it in place with an overhand knot.
  3. Place the long, running end of the tourniquet (the ⅔ side) behind the limb, with the windlass outboard.
  4. Take the tails and tie a square knot.
  5. Tighten the windlass. As with all improvised tourniquet techniques, pull off the body rather than into it. It is less painful for your casualty.
  6. Tie the windlass in place with the tails you have left. No second cravat required.

Assets and Liabilities

  • Asset: you only need one piece of material. There is no second cravat needed to secure the windlass.

  • Liability: the first step is a little unique. You have to lay out your material, find the one-third two-thirds mark, place your rod there, and overhand knot it in place. This requires you to pause before beginning to treat the casualty

Knowing how to make one improvised tourniquet is not the same as knowing when to reach for one or how best to build them.

The Crisis Medicine Improvised TECC/TCCC course covers optimal improvised tourniquet construction, what the effectiveness data actually shows, and how best to improvise when commercial, proven, off the shelf equipment isn’t available. We run the MARCH mnemonic using only improvised techniques which have medical literature to support their use. 
Improvised TECC/TCCC
Picture of Mike Shertz MD/18D

Mike Shertz MD/18D

Dr. Mike Shertz is the Owner and Lead Instructor at Crisis Medicine. Dr. Shertz is a dual-boarded Emergency Medicine and EMS physician, having spent over 30 years gaining the experience and insight to create and provide his comprehensive, science-informed, training to better prepare everyday citizens, law enforcement, EMS, and the military to manage casualties and wounded in high-risk environments. Drawing on his prior experience as an Army Special Forces medic (18D), two decades as an armed, embedded tactical medic on a regional SWAT team, and as a Fire Service and EMS medical director. Using a combination of current and historical events, Dr. Shertz’s lectures include relevant, illustrative photos, as well as hands-on demonstrations to demystify the how, why, when to use each emergency medical procedure you need to become a Force Multiplier for Good.