Petit-type tourniquet, London, England, 1823-1829.

History of the life-saving Tourniquet

During World War I, the medical profession responded with mobile X-Ray machines, the use of the Thomas Splint, use of vaccines, and new emphasis on continuing care and rehabilitation. Many of the medical innovations that were seen in the Great War proved itself as an instrument to save lives. These innovations were modified and improved over time and are still used. The tourniquet was criticized due to the loss of limbs and increased nerve damage and its’ use affected widespread use in the future. It is not seen as an effective device to control bleeding until the wars in Iraq and Afghanistan.

Prior to the 1900s, the use of the tourniquet was used in amputation surgery. The advantage of the tourniquet are that it can be easily applied with the patient himself being able to manage it properly; it ensures a more reliable and permanent pressure; it compresses all the branches of the artery. The device will never tire like the fingers of an individual to controlling bleeding. As a disadvantage it interferes with venous circulation and cuts off arterial blood.

Petit-type tourniquet, London, England, 1823-1829.
Petit-type tourniquet, London, England, 1823-1829. (Credits: Wellcome)

The first use of a tourniquet to control massive bleeding is not exactly known however; the existence of similar devices has been described to date back to ancient Rome. With the millions of casualties that doctors would see during the Great War it seemed that a device that is easy to apply and has been used on patients in the past would be ripe for it’s time to prove itself as an effective device to save lives.

The opportunity for the tourniquet to prove itself as a lifesaving device was present during WWI due to the countless extremity wounds. Military surgeons like Dr. Lorenz Bohler felt that there were circumstances that contributed to failed use of the tourniquet such as rapid evacuation of the wounded was often not possible, tourniquets were applied and left on for long periods of time, and unnecessary application of a tourniquet which lead to ischemic disturbances, necrosis of the extremity if it remained in place more than 3 hours. Furthermore, when applied tourniquets could be covered and unseen under splints, clothing, or blankets. Dr. Bohler worked at the end of the casualty evacuation chain and noted that that limbs were needlessly constricted, which were frozen during transport of use of the tourniquet, and which had to be amputated. The original injury itself in certain instances may have been minor and would not have caused fatal hemorrhage. The minor injury was made worse by the improper application of a tourniquet. Bohler suggested to Commanding Medical Officers that the practice of tourniquet use be discontinued.

Varieties of tourniquet.
Varieties of tourniquet. (Credits: Wellcome)

A Consulting Surgeon to the French Armies Dr. Theodore Tuffier did not have a favorable opinion of tourniquets as well and wrote in an article that his doctors were skilled at stopping bleeding with sutures. Tuffier then declared that the tourniquet is sometimes utilized under circumstances where it is actually impossible to apply a ligature and it has caused disasters. As soon as a tourniquet is seen in an ambulance it should be taken away. The Official British Manual, republished by the U.S. Government in 1918 titled Injuries and Diseases of War contained negative statements about tourniquets and an individual that would apply one. In the Manual it states: The employment of the tourniquet, except as a temporary measure during an operation, usually indicates that the person employing it is quite ignorant both of how to stop bleeding properly and also of the danger to life and limb caused by the tourniquet… If an orderly has applied a tourniquet, it is the duty of the medical officer who first sees that patient to remove it at once. English doctors also had concerns over tourniquet use. Major Blackwood of the Royal Army Medical Corps, thought of the tourniquet as an invention of the Evil One and felt that many limbs were lost due to the indiscriminate use of them.

After WWI, Tuttle wrote Handbook for the Medical Soldier. In the book, he emphasized using pressure points to stop bleeding. He discussed tourniquets and how they should be deployed and mentioned the use of the Spanish windlass as a way to apply and maintain pressure from a tourniquet. Tuttle’s rules for using a tourniquet still hold true to today:

  1. Never cover over a bandage or tourniquet.
  2. Write on the medical tag ‘tourniquet’.
  3. If the injured is conscious they should be instructed to tell every medical professional they encounter that he has a tourniquet on.
  4. If a tourniquet is left on a wound for 6 hours or more the limb will surely die.

These rules would have been helpful to the medics and hospital corpsman that were serving on
the frontline.

During WWI, the Allied Expeditionary Force recognized the need of combat medical technicians to treat casualties during the battle rather than wait for conditions to become safer to treat patients. The most common cause of death on any battlefield is massive hemorrhage. Since bleeding can be easily treated the goal was to have treatment begin at once. Litter Bearers used by the French and the British were not present at the height of the battle. When both services saw that lives can be saved by placing someone responsible for providing care on the onset of injury they began to make that shift. The U.S. Navy began to transfer corpsmen from the ambulance evacuation companies to the forward units of the U.S. Marine Corp regiments so they were present at the height of the battle. Hospital corpsman had received advanced first aid training and carried pressure dressings, but there is no record of corpsman using tourniquets.

Training for medics and corpsman in combat situations was brief and not as extensive as it is today. As the war progressed, doctors realized that training those closest to casualties such as ambulance drivers, medics, and corpsman helped to improve patient care. It is unclear how extensive tourniquet training was for battlefield technicians.

Army Sgt. 1st Class Greg Deleon, a two-tour Iraq War combat veteran and an instructor/writer at the Department of Combat Medic Training demonstrates the proper way to use a combat action tourniquet, Nov. 6, 2008. Once taught to be used as the last resort, now the new tourniquet is many times the first item out of the medic bag. (Credits: Fred W. Baker III / DoD)

The use of tourniquets during WWI was tainted due to the lack of training on the proper application of tourniquets along with Medical Professionals that had their negative experience with tourniquet use published. Use of the tourniquet was used in wars after WWI and over time the tourniquet’s reputation has improved due to the decreased time it takes to get a casualty to surgical care, improved training, and research to support tourniquet use.

In the wars in Afghanistan and Iraq, there has been an increase in explosive injuries mostly from Improvised Explosive Devices. The overwhelming amount of explosive injuries forced troops on the ground to turn to tourniquets to control massive bleeding. Eighty-six years after the Great War our nation’s military has used tourniquets with much better results.

TQ North American Rescue
A tourniquet (there are many producers out there) that is used by military forces around the world.

A Tourniquet is a life-saving tool that can be properly used with a minimum of training by everyone to stop a severe bleeding in one of the extremities. Follow a TCCC course and purchase yourself a Tourniquet that can save either your life or one of your loved ones. North American Rescue has a great TQ for sale for $21.25.