The experience with limb tourniquets was largely responsible for the adoption of TCCC throughout the US military.21 Tourniquets were a high-visibility issue for two reasons. First, tourniquet use was a radical departure from prehospital trauma care practice. Second, ubiquitous tourniquet use has clearly been the single most important lifesaving battlefield trauma care advance achieved during the wars in Iraq and Afghanistan.22,23

The strategic messaging on tourniquets that drove the spread of TCCC from the Special Operations community to the conventional forces included reports of preventable death from extremity hemorrhage and documentation of improved survival as the use of extremity tourniquets became more prevalent. Now, in addition to evidence-based tourniquet guidance, many other TCCC advances have been adopted, such as hemostatic agents, needle decompression of the chest (NDC), advanced/surgical airways, resuscitation with blood products, and hypothermia prevention. These have not only had positive impacts on military prehospital trauma care but also have been widely adopted in the civilian community.24