The tourniquet has done a complete 180 in my lifetime. When I was a kid, every reputable source of information recommended the tourniquet only as a last resort. When I started deploying to the GWOT tourniquets were coming back in military circles. I would be another decade before civilian EMS okay’d tourniquets. Now they are the darling of the “tactical community” and emergency medicine seems to begin and end with them. Unfortunately, tourniquets suck as a general-purpose medical intervention.
Warning: Graphic Medical Photo Below!
I’m constantly curious about the widespread adoption of tourniquets in the “concealed carry lifestyle” and EDC spaces, to the exclusion of all other medical gear. While they are great at what they do, tourniquets ONLY DO ONE THING! I don’t think a tourniquet should be the first thing you think of when you think of trauma medicine. Why?
Because tourniquets suck at treating most injuries!
While I think carrying a tourniquet is a good idea, I also think carrying ONLY a tourniquet is a terrible idea. Tourniquets have gotten this reputation is the all-star medical tool but this reputation is undeserved. Let’s delve a bit deeper into why I don’t carry a tourniquet in my day-to-day, personal life, and why I think tourniquets suck as an EDC medical item.
Why I Don’t EDC a Tourniquet:
I have written about my complaints with the tourniquet before. The tourniquet stops hemorrhage from extremities quickly, easily, and effectively. So why am I unhappy with the tourniquet? I’m glad you asked. While it does one job exceptionally well, it leaves literally every other base uncovered.
Indications For Tourniquet Application
Real quick, let’s quickly cover the indications for a tourniquet: massive (generally arterial) bleeding from an extremity that is unlikely to be controlled by other means, amputations above the wrist or ankle, or multiple injuries on the extremity that exceed your ability to treat individually. The only time deviation from this is acceptable is when the tactical situation makes direct pressure impossible…
And this is where we’ve gotten tourniquets wrong. The TCCC/TECC curriculum is wonderful at what it does: teaching the use of hemostatic agents, wound packing, pressure dressings, and yes, tourniquets, in a CARE UNDER FIRE situation. Tourinquet application to “any bleeding” is ONLY applicable in Care Under Fire/Direct Threat Care medicine. Once the threat has been eliminated (or even a temporary lull has been created (reducing the care phase to Tactical Field Care/Indirect Threat Care) other interventions should be considered.
The TCCC/TECC doctrine is sound, but only in context. Slapping tourniquets “high and tight” is applicable to the battlefield (foreign or domestic), but outside of those narrow confines is usually not what is in the patient’s best interest. Let’s be real: you’re many times more likely to need a tourniquet for any other cause than as a result of hostile action.
Now, let’s talk about why tourniquets suck and I don’t carry one.
Tourniquets Don’t Treat 50+ Percent of your Body
Tourniquets do absolutely nothing for your head, neck, chest, abdomen, or groin. Yes, you can be severely injured in the head and not die; I have treated an arterial bleed from a head wound that a tourniquet would have done absolutely nothing for. I’ve also packed stab wounds in junctional spaces, and treated penetrating trauma to the chest and abdomen that again, a tourniquet would have been worthless against.
Hell, tourniquets don’t even cover all of your extremities. Yes, you read that right: portions of your extremities are too high for a tourniquet to effectively encircle. The last non-fatal, officer-involved GSW in my area was on a leg (well below the inguinal fold for you medics out there) but was too high for effective tourniquet application and required wound packing. If you are only going to carry one intervention, shouldn’t it be something that covers more than 50% of your total body mass?
Tourniquets just aren’t that useful. If you’re going to carry some other stuff and a tourniquet, cool. If you’re ONLY carrying a tourniquet, you’re choosing to forgo most of your medical capability for one very specific tool. The fact is, tourniquets are single-purpose items that lack versatility; tourniquets suck as a general-purpose, EDC item!
Tourniquets Suck at Body Parts Most Likely to be Injured
Your torso is the largest target on your body. A 2018 study from Johns Hopkins University looking at 437,398 patients found that 57.4 percent of gunshot wounds in the civilian setting are to the thorax and abdomen. That’s a huge percentage of wounds completely unaddressed by a tourniquet. When you factor in the tiny percentage of extremity wounds that actually require a tourniquet, we’re probably down to single-digit percentages of wounds that actually need one.
Would you carry a gun that only worked 50% of the time you pulled it out?
I know you’re probably thinking that if you get shot anywhere other than an extremity, there isn’t much you can do about it. That’s not necessarily true. Wounds to the neck can be exceptionally dangerous for obvious reasons. They can also often be treated with a pressure dressing and occlusive dressing. Wounds to the chest can benefit greatly from an occlusive dressing. Wounds to junctional spaces can be just as deadly, as rapidly, as arterial bleeding from an arm or leg, but require wound packing to treat. These wounds can be treated…but not with a tourniquet.
Tourniquets Usually Aren’t Necessary for Extremity Bleeds
Most bleeding – even bleeding from arms and legs – can be controlled by means other than a tourniquet. Most bleeding can be controlled by direct pressure. Much bleeding that can’t be controlled by direct pressure can be controlled by wound packing or a pressure dressing. I’ve treated all sorts of injuries, and the need to a use a tourniquet is exceptionally few and far between.
Let’s put this into some real-world terms: in five years of working on a 911 ambulance, I’ve only had to resort to a tourniquet one time. Yes, just once. Out of countless motor vehicle collisions, falls, stabbings, gunshot wounds, workplace accidents, etc., I have been able to control bleeding (including arterial bleeding) using direct pressure, pressure dressings, and wound packing, except in one case. In that one case, a woman’s leg had literally been torn from her body by a piece of machinery. For everything else, including extremity hemorrhage, a tourniquet was unnecessary.
Tourniquets Are Not Complication-Free
As I mentioned earlier, we’ve gotten over the “last resort” mentality of tourniquets that was so common in the 80s and 90s. When a tourniquet is indicated, it’s indicated and should be used immediately! Like any medical intervention however, the tourniquet should NOT be used when contraindicated. Why? First, tourniquets are not totally benign instruments, free of medical complications.
When you apply a tourniquet to an arm or leg, the tissue in that extremity can no longer get oxygen or offload carbon dioxide. This creates a profound metabolic imbalance. If the tourniquet is suddenly removed (intentionally or accidentally), the patient may go into sudden cardiac arrest. Is it worth creating this small but potentially fatal risk for anything short of an uncontrollable, arterial bleed? No, but I’ve seen tourniquets applied to wounds that could have been handled with a roll of gauze, needlessly risking this complication.
If bleeding can be controlled by other, lesser means, then other, lesser means should be utilized. We should strive to use the least invasive, least damaging method possible. Using a tourniquet on a minor wound is like pulling a pistol on someone who is merely flipping us off, or starting CPR on someone with a head cold: it is grossly out of proportion!
Tourniquets Impose Significant Financial Burden
Tourniquets also carry a huge financial cost. A trauma center will categorize any patient with a tourniquet applied as a “Code Trauma.” This is going to active a huge team of doctors, PAs, nurses, anesthesiologists, respiratory therapists, etc. The bill for a code trauma will probably start in the neighborhood of $10,000 (in my area it’s about $30K).
I know what you’re thinking: “I’d rather be alive to worry about money problems than dead with money in the bank!” True, but that misses the point. This isn’t zero-sum; if they patient doesn’t need a tourniquet, we don’t need to take it upon ourselves to double or triple the cost of his (or our own!) healthcare. If the wound will be adequately treated with some direct pressure, we don’t need to activate a trauma team, which is also a misallocation of precious medical resources…but that’s a discussion for another time.
Medically, we should always be operating with the mindset of “doing what is in the best interest of the patient.” Causing the patient to incur huge medical bills when a trip to urgent care and a couple stitches would have fixed them up is probably not in their best interest. Again, the tourniquet should only be applied when indicated. But if it’s all you go, then every medical problem starts to look like a tourniquet problem.
Tourniquet Do Not Suck at What They Do
I admit the title is a bit of clickbait…but only a bit. Tourniquets are really, really good at what they do. When the patient has a massive hemorrhage, a mangled limb, or a traumatic amputation, it’s the tool you want. A tourniquet will get the job done quickly, intuitively, and effectively. Unfortunately, if you have a wound to the head, neck, chest, abdomen, or groin, your tourniquet does absolutely nothing.
And if even the wound is to an extremity, in the absence of uncontrollable bleeding, we don’t need to risk compartment syndrome and a CODE TRAUMA activation by thoughtlessly slapping on a tourniquet. If direct pressure will do, don’t overdo with a tourniquet.
When all you carry is a tourniquet, it’s the only thing you have to fall back on. As a result, it will probably be overused and misused. In fact, I know it will because I have reduced tourniquets that were misapplied by law enforcement, firefighters, and yes, the average citizen.
What I Recommend for Medical EDC
I hate to complain about problems without offering solutions. So, here’s my recommendation. I have written before that I carry a triangular bandage. I called it the “medical multitool” because it does so many jobs. It can be an improvised tourniquet (it is probably the best improvised TQ), even though we recognize that the likelihood of truly needing a tourniquet is minuscule. The triangular bandage can also be a pressure dressing for a neck wound, a dressing for a head wound, padding for a splint, a sling, wound packing material… The list goes on and on.
But the $5 triangular bandage isn’t very sexy. So, instead, I offer you the OLAES Modular Bandage! It’s cool, its inexpensive, and it is a military medical product. You’ll get all the cool-guy points for carrying a “special ops-approved” medical intervention, but it will be far more useful than a tourniquet! Ok, serious again…let’s talk about why I recommend the OLAES Modular Bandage, and why I carry one in my cargo pocket on every patrol shift.
Better Than a Tourniquet for EDC: The 4″ OLAES Modular Bandage
The OLAES Modular Bandage is amazingly versatile! It functions as a standard pressure dressing and does so extremely effectively. The elastic band has a velcro strip every 10 inches to prevent the whole roll from spilling everywhere when the bandage is opened. Instead of a hook that must book looped through, there is a rigid cup that provides pressure over the wound. But that’s not all.
The OLAES Modular Bandage is, as the name implies, meant for quick, easy disassembly. The gauze comes out of the dressing for fast wound packing. The dressing compartment also contains a purpose-made occlusive dressing. The packaging also makes excellent occlusive dressing (or two), and is a great surface for putting a couple strips of Gorilla Tape to hold them down.
The OLAES Modular Bandage covers down on many more injuries than the tourniquet. These include extremity bleeds not requiring a tourniquet, head wounds, neck wounds, junctional wounds, and wounds to the chest and abdomen. If you are only carrying a tourniquet and want something a bit more capable, check out the OLAES Modular Bandage. There is even a version with hemostatic gauze if spending less than $40 doesn’t appeal to you.
Okay, Tourniquets Don’t Suck
Tourniquets don’t suck. They are great – better than anything else – at what they do. Tourniquets are absolutely wonderful when used within their narrow set of indications. Unfortunately, tourniquets are used on a lot of wounds they shouldn’t be used on.
Much worse, tourniquets do absolutely nothing from a plethora of other wounds. Many of these wounds which are more likely than an arterial hemorrhage from an arm or leg.
You’re not wrong if you’re carrying a tourniquet. But if it’s all your carrying, you might want to reexamine your medical capability. If you’re only carrying one thing, I’d much rather it be an OLAES Modular Bandage.
