For much of the last century the use of tourniquets to control bleeding in the prehospital setting was discouraged as they were viewed as doing “more harm than good.” Recent studies have called into question this understanding. The results of one such study appeared in the Summer 2015 edition of the Journal of Special Operations Medicine.

The study, Prehospital Use of Hemostatic Bandages and Tourniquets: Translation From Military Experience to Implementation in Civilian Trauma Care was conducted using data collected from the Mayo Clinic’s prehospital EMS providers Gold Cross Ambulance and Mayo One Medical Transport. The sample size of the study was 125 which included 73 tourniquet and 52 hemostatic bandage applications. The tourniquets and hemostatic bandages deployed by the EMS providers were the Combat Application Tourniquet (CAT®) and QuickClot Combat Gauze®.

The study concluded that both methods were highly effective in controlling bleeding: a 99% success rate for tourniquets and a 95% success rate for hemostatic bandages. In no instance was a hemostatic bandage deployed prior to the arrival of EMS. In 22% of the instances tourniquets were deployed prior to EMS arriving, although it is unclear from the study the level of training, if any, the individuals making the applications received. Interestingly, in all three instances in which an improvised tourniquet was deployed, in every case a belt, effective bleeding control was not achieved.  Presumably, such improvised applications were made by bystanders that lacked access to proper equipment and/or training.

The study also concluded that: “Civilian prehospital use of tourniquets and hemostatic gauze is feasible and effective at achieving hemostasis [bleeding control].” The study also found a fairly high retention rate for training and proficiency of skills even with just occasional use of either bleeding control method. (It should be noted that the study participants were all EMS professionals and as such much more likely to encounter uncontrolled bleeds on a regular basis than the general public.)

Bottom line: the use of tourniquets and hemostatic bandages by properly trained civilians are effective means of bleeding control in the prehospital setting. All of Excelsior’s bleeding control and trauma response courses include instruction in the proper use of tourniquets and hemostatic bandages.