Tourniquets that were placed in CUF should be reassessed for effectiveness if the casualty reaches TFC. Also, tourniquets placed in CUF are often placed hastily, out of necessity, over clothing, and “high and tight” if the site of bleeding is not immediately obvious.  

In TFC, there is more time to expose the wound and determine the actual site of bleeding. Tourniquets should be applied more deliberately in the TFC setting, 2 to 3 inches above the wound and directly on the skin to maximize effectiveness and minimize the amount of healthy tissue that might be impacted by a tourniquet placed too high on the limb.  

If bleeding is not controlled and the distal pulse absent after the first tourniquet has been placed in either CUF or TFC, you may need to tighten the tourniquet and/or apply a second tourniquet side-by-side and proximal on the limb to the first.

Remember: Do not put tourniquets over the knee, elbow, a holster or other equipment, or a cargo pocket containing bulky items.