Tourniquets function by compressing blood vessels (arterial and venous) and stopping blood flow to the injured extremity. As arteries and larger veins follow the course of the skeletal system, the compression against bones is part of their mechanism of action; and also explains why it is sometimes difficult to control bleeding in lower leg and forearm injuries, where the arteries and large veins transit between the two bones and it is more difficult to attain or maintain adequate compression.

Because of their effectiveness at hemorrhage control, the speed with which they can be applied, and the lack of a requirement to hold sustained direct pressure on the bleeding site, tourniquets are the best option for temporary control of life-threatening extremity hemorrhage in the tactical environment.

The Committee on Tactical Combat Casualty Care routinely reviews tourniquets to help guide the selection of tourniquets with a proven track record of effectiveness. So, a CoTCCC-recommended limb tourniquet (TQ) should be applied quickly to all wounds that are amenable when ongoing severe bleeding is noted. 3,421 is a staggering number when all these deaths were potentially preventable.

“The striking feature was to see healthy young Americans with a single injury of the distal extremity arrive at the magnificently equipped field hospital, usually within hours, but dead on arrival. In fact there were 193 deaths due to wounds of the upper and lower extremities, …… of the 2600.” (Maughon JS)

Be sure to use the casualty’s TQ from their JFAK first (every Service member should have a new TQ in their JFAK). But if that is not possible, or more than one tourniquet is needed, then use the next available option, such as a TQ from unit mission equipment.

Also, remember that a tourniquet is designed as a one-time use device. Service members should never deploy with a tourniquet that has been used previously in training, as there is an increased risk of device failure.