The Life-Saving Evolution of Tourniquet Use: From Battlefield to EMS

The use of tourniquets has transformed trauma care, moving from a once-feared intervention to a cornerstone of life-saving strategies, both on the battlefield and in civilian emergency response.

Navy Captain (Ret.) Dr. Frank Butler, the architect of Tactical Combat Casualty Care (TCCC), helped shift the perception of tourniquets in the 1990s.

Earlier trauma care teachings viewed tourniquets as dangerous due to the risk of limb loss. However, research from past conflicts, and practical experience, revealed that failure to control extremity bleeding was a leading cause of preventable death.

With the rise of TCCC in military settings, particularly during the wars in Afghanistan and Iraq, the widespread adoption of tourniquets helped save thousands of lives by controlling life-threatening hemorrhage early.

This success led to updated guidelines emphasizing tourniquet conversion, replacing the tourniquet with other bleeding control methods within two hours to avoid complications when possible.

Despite its military success, civilian EMS was initially slow to adopt tourniquet use. That changed following the Hartford Consensus and the creation of the Stop the Bleed campaign after the Sandy Hook tragedy.

These efforts brought battlefield lessons to the civilian sector, empowering both the public and EMS providers to take swift action in bleeding emergencies.

The key takeaway for EMS providers is clear:

👉 Uncontrolled bleeding is a time-sensitive emergency

👉 Tourniquets, when used correctly, are a safe and essential tool in prehospital care

👉 Every EMS provider should be trained, equipped, and ready to use a tourniquet when needed

For a deeper dive into the history, science, and best practices behind tourniquet use, you can read the full article here: 

The Evolution of Tourniquet Use in Trauma Care by Public Safety Group, 2025

EMS Medication Administration - Intravenous (IV) Catheter Placement

IV catheter placement is a critical skill for EMS Providers who are at the level of AEMT or above, in most states. Proper technique ensures effective treatment and minimizes complications.

Here are the recommended steps for IV catheter placement:

Preparation

Gather Supplies:

• IV catheter (appropriate gauge)
• Tourniquet
• Antiseptic wipes (e.g., alcohol, chlorhexidine)
• Sterile gauze
• Adhesive dressing or securement device
• IV extension set or saline lock
• Saline flush
• Tape

Gloves and other personal protective equipment (PPE)

Patient Assessment:

Identify a suitable vein: Look for a prominent, straight vein.

Consider patient-specific factors: Age, condition, hydration status, and vein quality.

Explain Procedure:

Inform the patient about the procedure to gain their cooperation and reduce anxiety.

Insertion

Prepare the Site:

Apply the tourniquet above the chosen site to engorge the vein.

Palpate the vein to confirm its location and direction.

Cleanse the site thoroughly with antiseptic wipes in a circular motion, starting from the center and moving outward. Allow the site to dry.

Insert the Catheter:

Don gloves.

Hold the catheter at a 10-30 degree angle to the skin, bevel up.

Insert the needle into the vein, looking for a flashback of blood in the catheter chamber.

Advance the needle slightly to ensure the catheter tip is in the vein.

Advance the Catheter:

Slide the catheter off the needle into the vein while holding the needle stationary.

Release the tourniquet once the catheter is fully advanced.

Securing and Flushing

Remove the Needle:

Retract the needle completely, and dispose of it in a sharps container.

Secure the Catheter:

Connect the IV extension set or saline lock.

Flush the catheter with saline to ensure patency.

Secure the catheter with an adhesive dressing or a securement device to prevent dislodgement.

Tape the IV tubing in place if connected to a fluid bag.

Monitoring and Documentation

Monitor the Site:

Check for signs of infiltration, phlebitis, or infection.

Monitor the patient's response to the IV.

Documentation:

Record the size of the catheter, insertion site, time, date, and any complications or observations.

Troubleshooting

If Initial Attempt Fails:

Reassess vein selection and technique.

Try another site or use a smaller gauge catheter.

Consider alternative access methods, such as intraosseous (IO), if IV access remains difficult and is urgently needed.

Post-Insertion Care

Patient Comfort:

Ensure the patient is comfortable and the IV site is not causing pain or discomfort.

Educate the patient on how to care for the IV site if it will remain in place for an extended period.

By following these steps, EMS Providers at the appropriate level can effectively and safely place IV catheters, ensuring optimal patient care and minimizing potential complications.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Hantke, J (2022) IV Placement and Management. Appropedia. Accessed May 22, 2024.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Trauma Emergencies - Stop The Bleed

 

The "Stop the Bleed" campaign, initiated by the American College of Surgeons, is a national program aimed at training individuals in basic bleeding control techniques to save lives in emergencies. These guidelines focus on empowering bystanders to take immediate action in case of severe bleeding. 

The following are the key steps recommended by the American College of Surgeons for "Stop the Bleed":

Ensure Personal Safety:

Always prioritize your own safety. Ensure that the scene is safe for you to approach and provide assistance.

Call 911:

In any severe bleeding emergency, it is essential to call 911 or emergency services to ensure that professional medical assistance is on the way.

Identify the Source of Bleeding:

Quickly identify the source of bleeding. Look for wounds or areas where blood is actively flowing or pooling.

Apply Direct Pressure:

Use your hands or a cloth to apply firm, direct pressure to the wound. If possible, use a clean cloth, bandage, or gauze to prevent direct contact with the blood.

Use Dressings and Bandages:

If direct pressure alone doesn't stop the bleeding, use dressings or bandages to cover the wound and apply additional pressure. Maintain consistent pressure until the bleeding is under control.

Apply Tourniquet:

If the bleeding is severe and not responding to direct pressure or dressings, consider using a tourniquet as a last resort. Place the tourniquet above the bleeding site, if possible. Ensure it is tight enough to stop the blood flow but not so tight that it causes other problems. Document the time the tourniquet was applied.

Continue to Monitor:

Continue to monitor the injured person's condition, especially if a tourniquet has been applied. Make sure the tourniquet remains effective, and do not remove it.

Provide Emotional Support:

Stay with the injured person and provide reassurance and emotional support. Severe bleeding can be traumatic, and your presence can help keep the individual calm.

The "Stop the Bleed" program emphasizes the importance of early intervention by bystanders, as controlling severe bleeding within the first few minutes after an injury can significantly improve a person's chances of survival. The program also offers hands-on training and resources to help individuals become more confident in their ability to assist in emergency situations involving severe bleeding.

#EMS #StopTheBleed #PersonalSafety #Call911 #Tourniquets