The Myth of the Tourniquet

The use of tourniquets, tight straps around an arm or leg and tightened with a windlass to stop bleeding, have been around for nearly 400 years. The first documented case of a tourniquet used on the battlefield was in 1674. Discussions of constricting bands (but without the use of a windlass) date back much further than that.

Tourniquets are absolutely essential on the battlefield. They provide a hands-free way to stop bleeding, which gives the soldier freedom to keep fighting and prevents death from hemorrhage. From 2001-2010, tourniquet use by combatants increased, along with survivability. At the same time, injuries got worse. Tourniquet use became the gold standard and every US Army soldier was taught to use them. Every US military person was issued a tourniquet when they entered a combat area.

Over the years, tourniquets became inextricably tied to extremity amputations. The assumption was that the use of a tourniquet would lead to the loss of the limb to which it was applied. It's not clear where this belief originated. It could be a direct result of the early use of tourniquets to facilitate amputation. Let's face it; it's easier to surgically remove a limb if you can stop bleeding during the surgery.

Since the tourniquet and the amputation became married to one another in ancient medical lore, it evolved to be the opinion of paramedics and rescuers that the use of a tourniquet would lead to an amputation. Supporting theories were created, including the idea that the loss of blood flow in the limb would kill all the tissue, necessitating an amputation. It was considered a necessary evil, however, to save the patient's life.

This being emergency medical services, we never let a lack of evidence dissuade us from our beliefs. After military evidence from combat in Iraq and Afghanistan began to pile up saying tourniquets were safe and effective, civilian paramedics sat up and took notice.

Tissue damage—usually localized to the area where the tourniquet is applied and not the entire limb—does happen. But it's not a one-for-one swap, life for limb. There is very little evidence that emergency use of a tourniquet causes any significant damage to the usually already injured extremity. Let's face it, you won't be putting a tourniquet on an arm or leg unless that arm or leg is already severely damaged. In that case, there's almost no way to know for sure if the tourniquet made anything worse.

That's not a good reason to use a tourniquet—um, we can't tell if the damage is from the treatment, so go ahead—but tourniquets definitely save lives. Saving lives is a good reason to use them.

Sources:

Kragh JF Jr, Dubick MA, Aden JK, McKeague AL, Rasmussen TE, Baer DG, Blackbourne LH. U.S. Military use of tourniquets from 2001 to 2010. Prehosp Emerg Care. 2015 Apr-Jun;19(2):184-90. doi: 10.3109/10903127.2014.964892.

Ode G, Studnek J, Seymour R, Bosse MJ, Hsu JR. Emergency tourniquets for civilians: Can military lessons in extremity hemorrhage be translated? J Trauma Acute Care Surg. 2015 Oct;79(4):586-91. doi: 10.1097/TA.0000000000000815.

Saied, A., Ayatollahi Mousavi, A., Arabnejad, F., & Ahmadzadeh Heshmati, A. (2015). Tourniquet in Surgery of the Limbs: A Review of History, Types and Complications. Iranian Red Crescent Medical Journal, 17(2). doi:10.5812/ircmj.9588