Save Lives. Learn When and How to Properly Use Tourniquets
February 25, 2025
Proper tourniquet application is a priority as evidenced by the popular Stop the Bleed campaign which brought awareness of tourniquets to local responders, communities and schools.
Extremity tourniquets were extremely effective at preventing death from extremity hemorrhage during the conflicts in Afghanistan and Iraq without causing any significant morbidity from tourniquet-induced limb ischemia. This was largely because evacuation times in those conflicts were short, typically one to two hours or less.
Casualty evacuation times in the current Russo-Ukrainian War, however, are much longer, sometimes taking as long as 12 to 24 hours. Tourniquets applied to injured extremities in this conflict often remain in place throughout these prolonged evacuations, resulting in many amputations.
With tourniquet application times of this length, Prolonged Tourniquet Application Syndrome emerged as a major cause of morbidity in the Ukrainian military, resulting in many casualties suffering limb amputation, compartment syndromes, electrolyte abnormalities, and acute kidney injury. "Ukraine has taught us that we need to do a better job of training combatants on how to use tourniquets properly," said retired Navy Capt. Frank Butler, MD.
The tourniquet overuse evidence from both the civilian and the Ukrainian combat settings, combined with the Ukrainian tourniquet morbidity experience, shows there is a clear opportunity, and a pressing need, for first responder training to better prepare students to differentiate life-threatening extremity bleeding, which requires a tourniquet, from minor or minimal bleeding, which does not.1
An historical warning about the use of tourniquets illustrates the complexities and provide a cautionary tale. Training documents issued before the Allied invasion of Normandy warned that if a soldier required a tourniquet, it was likely that the limb would require amputation. Case in Point: Marine Fatality in Iraq – 2005
- Marine shot in the leg in Iraq
- Femoral bleeding
- Corpsman arrived 10 minutes later
- Attempted to use hemostatic agent - failed
- IV attempted – failed
- Tourniquet finally applied - but too late
- Marine died
Click here to learn when NOT to use a tourniquet. The presentation, Who Does Not Need a Tourniquet, is a valuable supplement to the current TCCC training material.
Deployedmedicine.com features tourniquet training: Tourniquets in TCCC Guidelines (Jan 2024)
- Butler F, Holcomb JB, Dorlac W, et al. Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war. Journal of Trauma and Acute Care Surgery 97(2S):p S45-S54, August 2024.
- Holcomb JB, Dorlac WC, Drew BG, et al. Rethinking limb tourniquet conversion in the prehospital environment. J Trauma Acute Care Surg. 2023 Dec 1;95(6):e54-e60.