Massive hemorrhage control interventions performed in Care Under Fire should be reassessed. Previously applied tourniquets should be assessed for effectiveness (bleeding has stopped and distal pulses are absent). If the tourniquet is not effective, apply direct pressure and tighten the original tourniquet and/or apply a second tourniquet. Depending on the situation, this could be placed side-by-side and proximal to the first one, but might also be placed directly on the skin 2 inches above the wound as we will discuss shortly.

Tourniquets are a temporary measure allowing effective hemorrhage control and should be applied before shock to save lives.

# Why tourniquets instead of pressure dressings?

### Rapid control of severe (life-threatening) bleeding

Tourniquets allow for quick and direct occlusion of blood flow to the injured limb, which can be critical in cases of severe bleeding that cannot be controlled by traditional pressure dressings alone. Tourniquets can rapidly stop blood loss and provide valuable time for further medical interventions.

### Effective in arterial bleeding

Tourniquets are particularly effective in managing high-pressure arterial bleeding, which can be challenging to control with pressure dressings alone. By completely stopping blood flow to the affected limb, tourniquets can effectively halt severe arterial bleeding until more definitive medical care can be provided.

### Simple and easy application

Tourniquets are designed to be simple and quick to apply, even in high-stress situations. They typically consist of a strap or band and a mechanical or windlass mechanism that can be easily tightened to achieve sufficient pressure and occlusion of blood flow.

### Enhanced stability and compression

Tourniquets provide stable and consistent compression to the injured limb, reducing the risk of rebleeding or blood loss when compared to pressure dressings, which may shift or become dislodged over time.

### Prolonged effectiveness

Tourniquets can maintain effective hemorrhage control for an extended period, allowing for safe transport of the injured person to a medical facility. This can be particularly important in situations where medical help may be delayed or difficult to access, such as in remote or austere environments.