I was interested to read an article about the use of tourniquets in Ukraine, particularly because it contrasts between their use in a rapid-evacuation situation (such as US troops mostly encounter) versus taking hours or even days to reach anyone more advanced than a field medic.
The tourniquet has saved many thousands of lives and limbs in war zones around the world, but misuse of the device is causing huge numbers of excess amputations and deaths in Ukraine, say top military surgeons.
Captain Rom A Stevens, a retired senior US medical navy officer who has served in Iraq, Afghanistan, and East Africa, estimates that of the roughly 100,000 amputations performed on Ukrainian soldiers since Russia’s full-scale invasion in 2022, as many as 75,000 were caused by improper use of tourniquets.
“I’ve seen tourniquets that have been left on for days, often for injuries that could have been stopped by other methods. Then [the patient] has to have their limb amputated because the tissue has died,” Captain Stevens told The Telegraph.
Tourniquets are strong bands used to stop catastrophic bleeding by cutting off blood flow, and are standard issue for most modern armies.
But if left on over two hours, they can cause tissue death, meaning the arm or leg which has the tourniquet on is no longer viable and requires amputation.
The device became standard-issue in the 2000s wars in Iraq and Afghanistan, where rapid air evacuation to military surgical teams was possible in under 60 minutes. If the tourniquet was unnecessary it was removed, and no harm was done.
But in Ukraine, where the skies are infested with drones, injured soldiers are evacuated by land, often far exceeding the safe time window for tourniquet use.
This critical delay has caused tens of thousands of amputations, say experts, many of which were unnecessary because the injuries didn’t require a tourniquet in the first place.
There's more at the link.
I remember our field first aid training in the South African military. We didn't carry IFAKs (Individual First Aid Kits) - just a single field dressing, a bandage that could be tied in place over an injury to absorb at least some of the bleeding and keep contaminants away from the wound. Field medics carried a relatively comprehensive kit, with more supplies available aboard our transports: but none of them were at the level of a medical station or field hospital. If we were lucky, helicopter evacuation might be available, but not always - our air support was frequently hundreds of miles away, and had to thread its way through the most comprehensive Soviet air defense system outside the Warsaw Pact. It might take hours to arrive. For that reason, if a medic applied a tourniquet, he would usually try to note down exactly when it was tightened, and make sure that a record of every time it was tightened and loosened accompanied the patient whenever possible. That way, permanent damage to the limb might be avoided. It didn't always work.
It worries me that I see so many "civilian" IFAKs being marketed today. I have no problem with as many people as possible carrying them; it's far better to have them available on the spot rather than miles away. However, relatively few of those carrying them have had any first aid training at all, let alone how to deal with serious blood loss. The use of blood-clotting powder or bandages is a case in point: another is the use of a tourniquet. Neither is as easy as it looks, and one can inflict a lot of damage by doing the wrong thing. For untrained users, I think of individual IFAKs as being useful supplemental kit for a paramedic or EMT (Emergency Medical Technician) or firefighter or police officer (both of the latter are usually trained in first aid to at least some extent). If he/she runs out of their own supplies (not impossible where more than one or two casualties are involved), they can offer your IFAKs to provide additional essential gear.
The entire article is worth reading to show how a battlefield situation affects what gear may be useful, and what might not. A tourniquet is very valuable indeed under certain circumstances, but as noted in the article, might lead to a much greater injury through cutting off the blood supply to a limb for too long. I hope it motivates those who carry a tourniquet without undergoing training to at least watch a video or two on the subject, or perhaps motivate them to get proper training from local instructors. One could even attend evening classes for a semester or two and graduate with a basic EMT qualification (like, for example, this course), which puts one head and shoulders above those less well trained.
Peter