Two Letters Re: Tourniquet Pros and Cons

I’m afraid you’re out of date on tourniquet use. It’s been a couple years since we were in the Army, and the world in general has shifted gears on tourniquets. In Iraq and Afghanistan, [we read] “no iatrogenic injury has been reported, even with tourniquet times up to 8 hours.” (Royal Australasian College of Surgeons, 76th annual scientific congress.) US Army literature on the subject has indicated that if the limb can be saved, it can still be saved three hours after a tourniquet is applied (U.S. Medicine, May 2005)
Tourniquets got a bad rap, probably deservedly, in WWII. This was mainly due to the long casevac times, and the mass number of casualties, and state of medical science at the time. The mantra of “use a tourniquet=lose the limb” stems from this. Like many things from WWII, good and bad, it became ingrained in the training of the military even though subsequent studies indicated that tourniquet’s could be useful, especially with the reduced casevac time. It’s estimated that 8-10% of the deaths in Vietnam could have been prevented by using a tourniquet.
Recent actions in Somalia and in Afghanistan and Iraq have shown that tourniquets are effective time-savers, and it’s all about time with a casualty. The WWII notion of loss of limb being automatic is simply false. What’s not false is the notion that you’ll bleed to death pretty fast if you don’t stop the bleeding. Current figures from Iraq indicate that 50% of the combat fatalities before evacuation are due to bleeding out. (Guardian News and Media) Much of this is due to the wound pattern being different than previous wars.
Advanced body armor has saved many lives, but shifted the percentage of injuries to the limbs. Combine that with IEDs and you have many traumatic amputations (in the event of which obviously anyone would use a tourniquet) and other wounds in the same body parts. Obviously a tourniquet isn’t for everything. The old joke about [using a tourniquet on the neck for] a head wound still applies of course;)

Forget writing the short story [“L. Leg Tourn.@0845Z”] in magic marker. Just put a “T” on his forehead in blood, which you will have plenty of. Don’t cover the tourniquet–so it’s seen–but even if it gets covered the doctors will find it pretty easily. This is common sense stuff. If you’re bleeding from your arm, the doctor will look at your arm. If there’s a tourniquet there, then he’ll see it.
The “T” helps out in Triage, etc. but modern battlefield medical care is competent enough to deal with a tourniquet.
Now as I’ve said before, things that apply to the military may not apply to Joe Survivalist. You may have to go “Civil War” on his arm and take it off yourself if that’s the situation, but the application of a tourniquet will not alter that. Don’t loosen the tourniquet until you have the bleeding controlled in some fashion. What that fashion is will depend greatly on your resources. – “Doug Carlton”


I’m a 30-year military vet and Reservist, combat lifesaver qualified, three tours in Iraq, two in Afghanistan, and one in Grenada <grin>; I also was a military / civilian law enforcement SWAT trainer for about 10 years and still attend training annually on subjects like survival, weapons work and medical topics. (“Emptying the teacup” on a regular basis, so to speak)
Like yourself, I held — for years — that the word tourniquet was synonymous with amputation but it is a “last resort” that still beats bleeding to death in a combat situation.

During recent pre-deployment training for a combat tour, I was exposed to the idea of tourniquet usage as a “necessary evil” but I still held — perhaps only within my own mind — that tourniquets were still just a “final option” reserved for times when all other “stopping blood flow” methods failed. (And, implied here, is the associated time lost — and blood loss — with trying all those other methods first.)

At a recent twp-day Wilderness Medical Survival class taught by an emergency room surgeon (who is also on a multi-jurisdiction police SWAT team), the topic of tourniquets arose — and he heartily endorsed their usage sooner versus later, citing not only their employment during the current Global War on Terror but noting that, during microsurgery (the reattachment of a severed hand was the example he cited), tourniquets are routinely applied for 2 to 4 hours without the “guarantee” of follow-on amputation that I naturally expected.

After class, I personally tied — under a paramedic’s supervision — a one-hand-application tourniquet on my upper left arm (I’m left-handed) and left it there for 15 minutes without any distal artery pulse detected in the arm…and with no ill effects and without the arm turning brown and falling off. It hurt / burned immensely, “fell asleep” and was cold to the touch (and bluish) — and I did have a temporary bruise on the skin where the tourniquet strap was twisted and tightened — but that was the extent of the “damage.” (FYI, I am 48)

I don’t advocate trying this on yourself — for many safety reasons, and it was probably very foolish for me to have experimented with my own primary upper appendage — but I had always held an image that the application of a tourniquet would almost immediately transform my extremity into a dried and twisted piece of useless, vestigial flesh within seconds…and it simply wasn’t true. (and, FYI, 15 minutes is an eternity-and-a-half in a firefight)

As such, I’ve had a “paradigm shift” and no longer consider tourniquet usage a “last resort” or “fall-back position” — but now hold tourniquets in the same regard as any other specialized tool, technique, or skill in my toolkit. It has its place, .and not just as a blood stopper of last resort. Hope this helps. – StealthNeighbor