The number one cause of preventable death on the battlefield is exsanguination from extremity hemorrhage. Hemorrhage from extremity wounds was the cause of death in more than 2,500 casualties in Vietnam who had no other injuries. These deaths could have been prevented through the use of a tourniquet. The tourniquet was first used on the battlefield in 1674 by a French military surgeon. Since then, it has been routinely used to control bleeding during surgery and following extremity trauma resulting in severe bleeding.

Because of the US experience in Iraq and Afghanistan, there has been new interest in finding a safe reliable tourniquet that can be used by soldiers. In 2005, the US Army Institute of Surgical Research conducted a study of available tourniquets. Experiments were conducted on human volunteers to test tourniquet performance in stopping blood flow to both the arms and legs. The experiments found that the previous tourniquet used by the United States Military did not work properly when applied to the legs. This is a major concern since studies show the majority of wounds needing a tourniquet occur in the legs, not arms.

In order to work properly, tourniquets must be able to stop arterial blood flow into the extremities. Tourniquets designed for use in administering IVs will not work for this purpose. They are designed to prevent venous return to the body but allow arterial flow. This causes blood to pool in the limbs and raise the veins. This is the opposite of what is needed to stop massive bleeding. In order to work properly, the tourniquet must be able to reliably stop arterial flow.

In Thailand, the use of surgical tubing for battlefield tourniquets is common. The Canadian military studied the use of surgical tubing for tourniquets in 2006. They found it can be used in an emergency to stop arterial flow into the legs but recommended the use of a properly designed tourniquet to replace the surgical tubing as soon as possible. The Canadian study also found the use of surgical tubing to cause unnecessary pain to the wounded soldier and also a high potential for local tissue damage under the tourniquet. They recommended against leaving the tubing in place.

SOF Tactical Tourniquets. The black and orange versions are the same design but the orange is designed for civilian use.

The pressure needed to stop arterial flow is directly related to the width of the tourniquet. The narrower the tourniquet, the more pressure that is needed. The higher the pressure, the more chance of permanent injury to the limb. To occlude arterial flow, surgical tubing must be wrapped around the limb multiple times. If it is going to be used, the Canadian study recommends carrying a minimum of 5 feet (1.5 meters) of surgical tubing. The United States military instead requires a purpose designed tourniquet that is a minimum of one inch wide.

Combat Application Tourniquet (CAT)

Two tourniquets were chosen by the United States Army for use by soldiers. These are the Combat Application Tourniquet (CAT) and SOF Tactical Tourniquet. Although very effective, the CAT Tourniquet is designed as a single use tourniquet. Repeated use of the tourniquet in training can cause the tourniquet to break. Because of this problem, the CAT Tourniquet is now available in a blue 'training' version to ensure that training tourniquets are not used on live patients. In Thailand, budgets are not available for separate sets of training and operational equipment so Sea Air Thai recommends the use of the SOF Tactical Tourniquet. The SOF Tactical Tourniquet is a much stronger design and the same tourniquet can be used for both training and for operational use without having to worry about the tourniquet breaking.

Whichever tourniquet is used, the tourniquet should be left in place until a trained medic can assess the injury. The tourniquet should not be loosed every 15 minutes. Numerous studies have shown tourniquets can be safely left in place for two hours or more without causing the limb to be amputated. Even in the case of extreme bleeding, it is rare that a tourniquet is required for more than an hour. A tourniquet helps to allow the blood in the effected limb to begin the clotting process and most tourniquets can be completely removed after a short period of time. Even if bleeding continues, the wound can be packed with gauze and bandaged allowing the tourniquet to be removed. Again, this should only be done by a medic who has been trained in this procedure.

Tourniquets are life saving tools but must be respected. A tourniquet design must be properly tested to ensure that it works properly when it is needed. Do not wait until you are dying to find out your equipment does not work.

Please contact Sea Air Thai for additional information.