By: Rob Orgel, Emergency Response Tactical

Let's talk about tourniquets. Tourniquet application is a very deep rabbit hole and it's hard not to bleed over into several other topics (get it, bleed...) when discussing them. Let's prioritize a few topics. First, how many tourniquets do I need? Next, when would I apply a tourniquet and how long do I have to deploy a one? Where should it be located in my kit? What do I need to do to evaluate my tourniquet and make sure it's still working correctly?

How Many Tourniquets Do I Need?

Let’s first consider the needs of the operation. If I’m operating individually then I would only need as many tourniquets as I’m capable of applying to myself. If there’s anyone else involved in the operation, they may be able to aid me in tactical medicine or I may be aiding them as well as myself in tactical medicine. As the team grows so do the needs. An individual with a serious wound and arterial bleed will need at least one tourniquet. If the tourniquet is applied correctly they will only need one tourniquet. If something goes wrong and the tourniquet is applied incorrectly and it does not stop the bleed, we do not remove that tourniquet!

That tourniquet is helping to some degree or another. We will apply an additional tourniquet to the same appendage. This means for one serious wound I have now applied two tourniquets. If this individual has two appendages that are seriously bleeding, I might double that number. Now you can see that that number will continue to grow. The likelihood of four tourniquets for all four appendages is relatively unlikely. There have been cases where this has happened and the patient has survived, however, most of the time the patient will bleed out too fast for us to do useful things. Again, I don’t want to say it’s not possible, let’s just plan for the most realistic scenarios. If I do my part right tourniquets should cover most of my needs as an individual or within a team of two. Again, you’re limited to your imagination, I'll just state that more is better in this instance.

When Do I Apply A Tourniquet?

As we dissect emergency medicine, we have to understand that this falls under the category of tactical medicine. In gun fighting, the priority is gun fighting. This means you don’t add additional casualties by treating a casualty when it’s not safe. If there is a need to administer treatment during a gun fight, the most important thing you can do is stop the person who is projecting bullets in your direction (and has already caused one casualty). This isn’t much different when you look at ambulatory care. When EMS hop off of an ambulance, they don’t run straight over to the casualty. They look for the mechanism of injury. If your arm has been sawed off via a bandsaw, EMS is going to look at the bandsaw and make sure it’s unplugged before they put their hands near that casualty and that bandsaw. Just like them, we need to make sure we don’t get hurt in the process of treating someone who is hurt. The best medicine on the battlefield is bullets. Only after the gunfight has come to an end can the tactical medical effort begin. When there’s a massive bleed taking place, it can be so time-sensitive that we can prioritize it over lack of oxygen. This is where we use the acronym M.A.R.C.H. (Massive bleeding, Airway, Respiratory, Circulation, Head injury, and Hypothermia). Here we can see that massive bleeding is the priority. In my experience, massive bleeding is quite obvious. Don’t be alarmed! In treating casualties it’s very easy to get overwhelmed. A little bit of blood can seem like a lot of blood. But when we see squirting and or pooling blood, it’s time for a tourniquet. If we apply a tourniquet on a tourniquet, it’s not a problem at all. The old misnomer that you will lose the limb wherever the tourniquet is applied and the further away from the heart is 100% incorrect. Very often under stress, when a little bit of blood can seem like a lot of blood, people tend to over tourniquet. Again, this is not an issue. Let’s keep in mind that tourniquets are for appendages, you have only four. Let me be clear for those who know what Windex tastes like, don’t tourniquet the head. This will cause the casualty to stop complaining which might seem like a benefit, but typically you lose that patient. Finally on the application side of tourniquets, without going into a class in tactical medicine, I’ll simply add: high and tight. If you’re going to apply a tourniquet, go as high on the appendage as you can. This gives you access to a more exposed artery. Always go as high as possible or in other words closest to the heart on the appendage.

Where Do I Keep Tourniquets?

On my kit, my tourniquet is on my non-pistol side where I have rapid access to it. Additional tourniquets can be found on my vest and in my individual first aid kit. Off-body tourniquets are kept in my tactical medicine kit and my range bag. Be sure you have your tourniquets ready for use by taking all plastic wrapping off. This will save precious time if you find yourself in a critical emergency. As mentioned in the paragraph above, in gunfighting the priority is winning the gunfight. Only after that is tackled can we begin with administering treatment. This can mean I may not apply it to myself during a massive bleed, I might continue to gunfight instead. It’s silly to apply a tourniquet when receiving additional rounds. This is also why I keep my tourniquet out of the way of my gunfighting gear. It’s important that it still be rapidly accessible. I never want to put my tourniquet in a place where I could get mixed up with an additional magazine. This might seem like a funny concept, but plenty of times I have seen people try to stuff a Leatherman or cell phone in their pistol magazine pouch. Keep in mind that gunfighting, shooting, competition, and qualification can be very stressful.

Check your equipment. We’re all guilty of feeling better because we have a tourniquet or an emergency medical medicine kit nearby. However, we have to go through and prep our equipment as well as maintain our equipment. In some states, we are dealing with extreme hot or cold which can cause degradation to our equipment. It’s a good idea to pull out your tourniquet and apply it to yourself and ensure that it’s able to stop blood flow to an appendage. Do this on both your arm and your leg. The leg is much more difficult to tourniquet because of the amount of muscle and we are usually wearing pants with things in our pockets. This is a good standard to maintain often, as the plastic pieces on our tourniquet can break. It also doesn’t hurt to get in the extra practice so that in a real emergency you have a degree of muscle-memory and are well-versed in what you need to do. Also, it feels good knowing that you’re prepared for such an emergency.

About the Author:

Rob joined the USMC in 2004 with a military occupational specialty of 0311 (Infantry Rifleman). Assigned to 3rd Bn 1st Marines, Rob participated in a deployment to Iraq (OIF-3) as a point man followed by an assignment as Team Leader for the 13th MEU Special Operations Capable to Iraq (OIF-6). In 2007, he joined 1st Marine Regiment and reenlisted to deploy to Afghanistan. InJanuary 2010, Rob was promoted to the rank of Sergeant & continued to serve 1st Marine Regiment for a year-long deployment in Afghanistan. On return from Afghanistan, Rob was assigned to School Of Infantry West to work as a Combat Instructor (CI) for the USMC where he trained thousands of Marines to gain the skills necessary to survive. Rob exited the USMC in 2014 & was immediately picked up by Securing our Country (SOC). As a private military contractor, Rob was responsible for training the specialty teams of operators at the American Embassy in Iraq. Shortly after leaving Contract in 2018, Rob became the Chief Instructor of GPS Defense Sniper School. Rob now gives 100% of his attention to Emergency Response Tactical training all levels over 320 days a year as his passion & full-time job.

You can read his full bio here.