Marines with Echo Company, Battalion Landing Team, 2nd Battalion, 5th Marine Regiment, practice applying tourniquets during a Combat Life Saver class aboard the USS Green Bay (LPD 20), at sea, Mar. 30, 2017.U.S. Marine Corps photo by Lance Cpl. Jorge Rosales/Released.
Current medical guidelines regard the tourniquet as a primary lifesaving measure for controlling severe bleeding from an extremity. Tourniquets have become the standard of care because they are easy to use, can be applied quickly, and effectively stop blood loss completely.
Since its inception, the Committee on Tactical Combat Casualty Care (CoTCCC) has continually updated its recommendations on tourniquet application, reflecting advancements in battlefield medicine and insights gained from various conflicts.
The CoTCCC, part of the DoD’s Joint Trauma System (JTS), is instrumental in developing evidence-based trauma care guidelines for tactical and combat scenarios. They conduct extensive research and testing on various tourniquets to evaluate their effectiveness in combat situations.
CoTCCC has emphasized the need for clear tourniquet guidelines due to the high incidence of preventable deaths from extremity hemorrhage. The early advice was to apply the tourniquet high and tight on the limb, close to the trunk if necessary, prioritizing speed over precision to quickly control bleeding.
Field experiences during the Afghanistan and Iraq Wars reinforced the importance of tourniquet use in preventing deaths from extremity hemorrhage. The “high and tight” approach remained crucial, especially in chaotic situations or when the wound’s exact location was unclear.
Over time, CoTCCC refined its guidance to include more precise recommendations. While the “high and tight” rule was still applicable for immediate bleeding control, a more targeted approach—placing the tourniquet 2-3 inches above the bleeding site—was recognized as optimal when conditions allowed. This method helped reduce tissue damage and nerve injury from prolonged tourniquet use.
CoTCCC’s current guidance balances the “high and tight” placement for emergencies with a preference for more targeted placement when the bleeding source is identifiable. The focus remains on rapid and effective bleeding control, followed by swift evacuation and medical care.
A tourniquet should never be applied over a joint, such as an elbow or knee, because joints protect blood passageways and prevent the necessary pressure needed to stop an arterial bleed. Applying a tourniquet over a joint can also cause permanent nerve, joint, or blood vessel injury.
CoTCCC has consistently highlighted the vital role of tourniquets, refining its guidance to balance speed and precision, aiming to save lives while minimizing potential complications.
Training and practice are essential for effective and appropriate use of any tourniquet. The time to learn is not during an emergency. The best tourniquet is the one that you have trained on. The American College of Surgeons (ACS) STOP THE BLEED® program is an excellent resource that can direct you to training in your area.
Resource
STOP THE BLEED
STOP THE BLEED.org
Disclaimer: This article is not intended as medical advice or to replace appropriate training in the selection, safe use and application of a tourniquet or any other medical device.