The Benefits of Commercial
Tourniquets
“The fate of the wounded lies in the hands of one
who apply the first dressing”
Nicholas Senn, MD
Bleeding from the Arms and Legs
• Bleeding from wounds to the extremities can
be controlled by direct pressure and/or a
commercial tourniquet
Stop the Bleeding
• A victim who is bleeding from an artery can
die in as little as 3 minutes
• Serious bleeding from an extremity is the
most frequents cause of preventable death
from injury.
• If you can do only ONE thing for the injured
patient: stop him or her from bleeding to
death.
The Commercial Tourniquet
• A commercial tourniquet is a device that stops
the flow of blood.
• If applied correctly, the tourniquet stops
arterial blood flow
Tourniquet Pain
• Tourniquets HURT when applied effectively
• Does not necessarily indicate a mistake in
application
• Does not mean you should take it off!
• Manage pain prehospital with analgesics
when the situation allows.
5
Tourniquet Mistakes
to Avoid!
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Not using one when you should
Using a tourniquet for minimal bleeding
Putting it on too proximally
Taking it off when the casualty is in shock or
has only a short transport time to the hospital
Not making it tight enough to eliminate the
distal pulse
Not using a second tourniquet if needed
Waiting too long to put the tourniquet on
Periodically loosening the tourniquet to allow
blood flow to the injured extremity
* These lessons learned have been written in blood. *
6
Tourniquets in Action
• Fort Hood Shooting
– 12 dead; 31 wound
– Officer Kim Munley
• The hero of the Ft. Hood shooting, she was shot in both
legs and had major bleeding. Her colleagues applied
pressure to the wound to try to stop the bleeding, but
it was not effective. Ultimately, an Army medic used a
combat application tourniquet (C-A-T) to stop the
bleeding and save her life.
Commercial Tourniquet Types
Studied by the U.S. Military and have shown to be efficient and effective
Other Tourniquets
The SOF® Tactical Tourniquet (SOF®TT) by Tactical
Medical Solutions, Inc.
Photo courtesy TMS, Inc.
Parts of the Tourniquet
The Combat Application Tourniquet (C-A-T) (Patient Pending) is a small
and lightweight one-handed tourniquets that can completely occlude
atrial blood flow in an extremity
Vietnam
• Over 2500
deaths occurred
in Vietnam
secondary to
hemorrhage
from extremity
wounds. These
casualties had
no other injuries.
Tourniquets in U.S Military
Mid-1990s
• Old strap-and-buckle tourniquets were still
being issued.
• Medics and corpsmen were being trained in
courses where they were taught not to use
them.
Causes of Death in Combat
• Viet Nam:
– Casualties suffered in ground combat
• 9% died from bleeding from extremity wounds
• 5% died from tension pneumothorax
• 1% died from airway obstruction
Tourniquets – Beekley et al
Journal of Trauma 2008
• 31st Combat Support Hospital in 2004
• 165 casualties with severe extremity trauma
• 67 had prehospital tourniquets placed; 98 did
not
• 7 deaths
• 4 of the 7 deaths were potentially
preventable if a commercial tourniquet had
been placed.
Safety of Tourniquet Use
Kragh - Journal of Trauma 2008
15
• Combat Support Hospital in Baghdad
• 232 patients with tourniquets on 309 limbs
• CAT was best field tourniquet
• No amputations caused by tourniquet use
• Approximately 3% transient nerve palsies
Impact of Tourniquet Use
Kragh - Annals of Surgery 2009
• Ibn Sina Hospital, Baghdad, 2006
• 31 lives saved in this study by applying
tourniquets prehospital rather than in the ED
• Better survival when tourniquets were applied
BEFORE casualties went into shock
• Survival if applied before shock develops – 96%
• Survival if applied after shock develops – 4%
16
Deaths in the
Global War On Terror
Factors That Might Have Changed Outcomes
• Study evaluated 82 fatalities
– 12 were potentially survivable
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Commercial Tourniquets (3)
Hemostatic dressings/direct pressure (2)
Airway management (1)
Needle Thoracostomy (1)
CAT Tourniquet Application to the Arm
CAT Tourniquet Application to the Leg
Thank you!
Felix J. Marquez, PMD, BA
Tactical Combat Causality Care
State Coordinator