August 10, 2020
By Todd Stubblebine
It is impossible to say how many lives have been saved, or could have been saved by the use of tourniquets. Although dating back centuries, the first recorded battlefield use of a tourniquet was in 1674 by Etienne J. Morel, a French Army surgeon. Dr. Morel placed a stick into a bandage on the patient’s upper leg, and twisted until the bleeding stopped.
The Civil War was the first time that American troops were encouraged to carry tourniquets. These were of a very rudimentary design, often a belt and stick. Due to lack of training and the excitement of battle, the tourniquets were not very widely used, and were not credited with saving many lives.
Between the Civil War and modern day, there have been great improvements in the design of tourniquets, as well as training in their use. Proper use of tourniquets has become a core component of the military’s Tactical Combat Casualty Care (TCCC) and Combat Life Saver (CLS) courses, which are given to most soldiers and Marines deployed to combat zones. And the benefits of that training have become readily apparent. In a study conducted at an Army combat support hospital in Baghdad, Iraq, 87% of patients with major limb trauma that had a tourniquet in place survived.
There are two broad types of emergency tourniquet: improvised and manufactured. Improvised tourniquets are just that: using whatever you have with you to make the bleeding stop. Ideally, it should be a strap or piece of webbing wider than one inch, to help prevent unnecessary nerve damage. Inserted into that would be a sturdy stick, or something else of that size that you can use as a windlass to apply increasing pressure until the bleeding stops.
Manufactured tourniquets come in a variety of different designs. The ideal qualities you want in a tourniquet is: ease of use, ability to apply sufficient pressure, and cost effectiveness. You will want a tourniquet that you can easily apply in the dark, in a confined space, one-handed, and under stress. Unfortunately if you do have to apply a tourniquet to yourself or your buddy, it is a guarantee that one or more of those conditions will apply. The tourniquet should be greater than one inch wide, and able to compress a limb with sufficient tension to stop major bleeding. And, finally, the tourniquet should be cost effective, because it is a disposable piece of gear. The most common type of tourniquet used by the military is the windlass Combat Application Tourniquet® (CAT) made by Composite Resources. It utilizes an adjustable Velcro band to fit a variety of limb sizes, the windlass rod for tension, and then windlass clips to lock the rod into position once appropriate tension has been achieved.
Tourniquet application is relatively easy and straight-forward, which is lucky because it is a time critical event. The average adult has about five liters of blood, and can completely bleed out from a major extremity wound in less than five minutes. You want to place the tourniquet above the knee or elbow, or if the wound is above the knee or elbow, about 4-6 inches above the wound. Then, start applying tension to the windlass device until the major bleeding stops. There will probably still be a slow trickle of blood coming from the wound, but you should be most concerned with the heavy bleeding. Once the major bleeding has stopped, lock off the windlass device. And then reassess the wound every 3-5 minutes. If major bleeding reoccurs, tighten the windlass device the least amount that you can to stop it. Also, if you are able, note the time that the tourniquet was applied, to tell the hospital staff. Tourniquets are not appropriate for every situation. Their use should be confined primarily to major extremity wounds such as complete/partial amputations, or penetrating injuries with severe bleeding.
A tourniquet is one piece of gear that you should always have with you. Whether you are military, law enforcement, or just an avid outdoorsman, potentially life threatening events can and do occur. Just remember though, you need to practice with it. Practice in the dark, with one hand and learn how to apply it quickly and properly. Having a relatively small, inexpensive piece of equipment like a tourniquet could mean the difference between life and death.