Proper Use of Tourniquets – 2018


Proper Use of Tourniquets – 2018

By Jeff DeBellis

Illustrations by T.B.R. Walsh

SOLO recently updated its tourniquet curriculum to incorporate the latest evidence. A growing trove of research in recent decades has confirmed that tourniquets are extremely effective at stopping massive bleeds. When used appropriately, they have minimal complications. Tourniquets have been a contentious piece of the pre-hospital medical kit for thousands of years. The emergency medical community has swung back and forth on their merits and drawbacks during that time. The era of evidence-based medicine itself is relatively new. It’s only since the war in Vietnam that researchers have begun to study tourniquets systematically. This research has led to improved education and much greater success.

A tourniquet is still a last resort to stop severe extremity bleeding in the wilderness setting. Only use one if there is a traumatic amputation, obvious arterial bleeding, or if direct pressure will not stop the bleeding. They should never be used on minor bleeds. Using a tourniquet on minor bleeds or shoddy improvisation by inadequately trained caregivers are some of the reasons that many surgeons vilified tourniquets for so long.

The major change in the curriculum is that tourniquets are no longer just for life-over-limb situations. They are a life-saving technique that should be used without hesitation. So long as the tourniquet can be removed within a couple of hours, patients are unlikely to lose the limb. One recent study looked at 232 patients who had tourniquets applied to 309 limbs. Not a single limb was lost to amputation because of the use of tourniquets.

How to Apply a Tourniquet:

There are a number of commercial tourniquet models available. The two that the US Army Institute of Surgical Research identifies as being 100% effective are the Combat Application Tourniquet (CAT) and the SOF Tactical Tourniquet (SOFTT). A properly improvised and placed tourniquet can work just as well as a commercial model.

Evidenced-based medical research has shown that the proper position for the tourniquet is two to three inches above the site of bleeding. It is important to take a few seconds and locate the site of bleeding and then place the tourniquet. You cannot place a tourniquet over a joint, the knee or the elbow. If necessary, move just proximal to the joint and place the tourniquet.

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How to Apply a Tourniquet in the Wilderness Setting:

January/February 2011  ISSN-1059-6518  Volume 24 Number 1

How to Apply a Tourniquet in the Wilderness Setting:

Brad L. Bennett, PhD, NREMT-P, WEMT, FAWM

Captain, US Navy (Ret.)

Member, Committee on Tactical Combat Casualty Care

SOLO Wilderness Medicine Instructor

Tidewater Search & Rescue, Virginia

Member, Committee on Tactical Combat Casualty Care


“The new concept of Tactical Combat Casualty Care (TCCC)

has revolutionized the management of combat

Casualties in the prehospital tactical setting.”

R. Mabry, MD and J. McManus, MD

Critical Care Medicine, 2008


Is there a place for a tourniquet in your backcountry jump kit? Well, possibly, but does everyone in the backcountry need to carry them?  Does wilderness epidemiology provide evidence for the frequency of severe bleeding? Does shock result in the same outcome no matter the mechanism of injury? Are all tourniquets effective? Should we use them? It is not that simple! The answer is not yes or no, but, when, where, why, how and which ones? The following discussion is the most up-to-date information from the Department of Defense tourniquet use on thousands of casualties over the past 10 years. The answers to these questions should become clear as you read this article.

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