Tourniquets 101
The Importance of Tourniquets in Hemorrhage Control: A Historical and Practical Overview
The Long History of Tourniquets
Tourniquets have been used to control bleeding for centuries. According to Taylor et al. (2011), the concept of using a tourniquet to manage hemorrhage dates back to the ancient Greeks. Military surgeons in Roman times also used tourniquets during amputations. Ambrose Pare (1510-1590), often credited with popularizing the term "tourniquet," was one of the first to recommend its use during surgical procedures. Pare even improved the design by adding a screw to tighten the constricting band.
By the 17th century, figures like William Fabry and Etienne Morel had developed new techniques, including the use of a windlass, a tool that twists a stick to tighten a band further. This windlass mechanism is still in use today, particularly in the widely recognized CAT (Combat Application Tourniquet) system, which is designed for quick and effective hemorrhage control.
Petit’s screw Tourniquet
Originally fashioned with a wooden buckle and screw, it quickly adopted the more durable brass. This model dates from the 1820s. Its resemblance to modern tourniquets such as the CAT highlights the persisting influence of this technology. Owen Wangensteen believed 'it was certainly one of the most important surgical discoveries before the advent of anesthesia.' 64
Modern Use of Tourniquets: A Controversial Tool
Despite their long history, tourniquets were not universally accepted for use outside military contexts until recently. The lack of direct evidence in prehospital environments made EMS systems in North America hesitant to include them as part of standard hemorrhage control. However, in the early 2000s, studies from military settings—specifically from the wars in Iraq and Afghanistan—began to highlight the benefits of tourniquets. Research revealed that complications from tourniquet use were relatively low and that early application could significantly improve survival rates in patients with severe extremity trauma.
Kragh et al. (2009) found that the survival rate for patients receiving tourniquet treatment before shock set in was as high as 90%, compared to just 10% for those who went into shock before the tourniquet was applied. These findings have reshaped how healthcare providers approach hemorrhage control in emergencies.
Tourniquets in Trauma Care: Preventing Deaths from Extremity Hemorrhage
Studies examining trauma in U.S. hospitals have further reinforced the importance of tourniquet use. A review of trauma cases at two U.S. trauma centers showed that death from isolated extremity hemorrhage is rare (only 0.02% of trauma cases), but over 50% of these deaths were potentially preventable with the early use of a tourniquet. Extrapolating this data to Alberta suggests that including tourniquets in our emergency response toolkit could save lives, especially in situations where transport times are long or resources are limited.
A study* highlighted that while commercial tourniquets are available, their proper application is hindered by a lack of training and awareness. This underscores the critical need for comprehensive training programs to improve the efficacy of tourniquet use in civilian populations.
*Ismail, S. A. The Effectiveness of Tourniquets in First Aid for Emergency Situations: A Scoping Review
The Role of Tourniquets in Peak 2 Peak Safety’s Courses
At Peak 2 Peak Safety, we believe in providing comprehensive, practical training to our participants. All of our courses—whether for workplace safety, emergency medical response, or CPR training—include detailed instruction on the application of a tourniquet. Understanding when and how to apply a tourniquet can be the difference between life and death in emergency situations, and we ensure that every participant is equipped with the skills to perform this life-saving procedure.
How Tourniquets Work: The Mechanics of Hemorrhage Control
A tourniquet works by occluding both arterial and venous circulation to a limb, stopping the flow of blood and preventing further blood loss. When a tourniquet is applied, it compresses the muscles and tissues around the blood vessels, causing the vessels to collapse and cutting off circulation below the tourniquet. The amount of pressure required to stop bleeding depends on the size of the extremity and the width of the tourniquet. Wider tourniquets tend to be more effective because they can apply more even pressure, requiring less force to stop arterial blood flow compared to narrower bands.
Check out this quick video on the world's leading prehospital field tourniquet, the C-A-T® Tourniquet from North American Rescue. NAR Doc gives an anatomy lesson and shows why it's important to understand the best locations for applying tourniquets.
Why Tourniquet Training Matters
Mastering tourniquet application is crucial for anyone involved in first aid or emergency response, whether in a workplace setting, during outdoor activities, or in healthcare environments. At Peak 2 Peak Safety, we emphasize the importance of practical, hands-on training that covers the most effective techniques for hemorrhage control, including proper tourniquet use.
Saving Lives with Early Intervention
Tourniquets have come a long way from their ancient origins, and modern research supports their effectiveness in saving lives during trauma. The evidence shows that early application of a tourniquet can dramatically improve survival outcomes in cases of severe extremity hemorrhage. At Peak 2 Peak Safety, we are committed to providing the highest-quality training to ensure that individuals are ready to respond effectively in emergency situations. Whether you are in a remote area, working in a hazardous environment, or providing care at a public event, knowing how to use a tourniquet can make all the difference in saving lives.