Debunking Tourniquet Myths: What You Need to Know
(warning: this article contains graphic images)
We recently posted a training video from our friends at North American Rescue, that caused quite a stir on social media. The clip was from a worksite training scenario where a worker is bleeding heavily from his trapped leg. His workmates, following their first aid training, quickly apply a tourniquet to control the 'catastrophic bleeding'. It's a textbook response that could save a life in a real emergency. Here's that vid:
But, some of the comments on this video tell a concerning story:
"Gonna lose that leg"
"Quick, get the tourny off before he loses his leg for real"
“Is there a reason why the pants weren't cut away? How do you know you couldn’t pack the wound rather then using a tourniquet?”
“Tourniquets are usually only used if you’re expecting to lose that limb"
"You just gave him even more workman's comp for losing his whole leg"
These responses highlight a serious problem: dangerous misconceptions about tourniquet use are still widespread, and they're putting lives at risk.
At TacMed Australia, we're committed to debunking these myths with facts, so let's tackle the five most dangerous tourniquet myths we've encountered.
Myth 1: "Tourniquets Should Only Be Used as a Last Resort"
The Truth: In cases of life-threatening extremity bleeding, tourniquets should be your first-line treatment, not your last resort. The old "last resort" thinking has been thoroughly debunked by decades of military and civilian trauma experience.
Why? Because when someone is experiencing catastrophic bleeding:
- Every second counts! Blood loss from a severed artery can be catastrophically rapid. Life-threatening bleeding can lead to death within minutes if not controlled quickly. With major vessels like the femoral artery pumping out massive amounts of blood per minute, time is literally measured in heartbeats, not minutes and even a short delay in controlling the bleed can mean the difference between life and death.
- In the case of catastrophic blood loss, trying other methods first (holding pressure, wound packing etc) just wastes precious time. Each failed attempt means more blood loss, increased shock risk, and a rapidly deteriorating casualty.
- Research consistently shows that immediate tourniquet application has significantly better survival rates than delayed application. When tourniquets are applied before the casualty goes into shock, survival rates are dramatically higher.
Both our C-A-T and SOF Tourniquets are designed for rapid application specifically because speed saves lives. When you see bright red blood spurting from a limb, don't waste time - get that tourniquet on immediately!!
Myth 2: "Tourniquets Always Lead to Amputation"
The Truth: Modern studies have thoroughly debunked this myth. Proper tourniquet use rarely leads to amputation.
Why?
- A comprehensive 2021 systematic review titled 'Systematic Review of Prehospital Tourniquet Use in Civilian Limb Trauma' [2] examined nearly 3,000 cases of civilian tourniquet use and delivered compelling evidence about tourniquet safety. The research showed that when tourniquets were applied correctly, complications were remarkably rare - occurring in less than 2% of cases. Even more significantly, the review found that reported tissue damage from tourniquets was temporary, with no cases of amputation caused by tourniquet use alone. When limb loss did occur, it was invariably due to the severity of the original injury rather than tourniquet application. This large-scale civilian study reinforces what military medicine has known for years: properly applied tourniquets are safe and effective life-saving tools.
- Surgeons routinely use tourniquets during limb surgeries, particularly orthopaedic procedures. These controlled surgical environments have provided extensive evidence about tourniquet safety - surgeons carefully monitor duration and pressure, typically keeping tourniquet times under 2 hours to minimise any risk of tissue damage. If tourniquets inherently led to amputations, they wouldn't be a standard tool in modern surgical practice.
- This PubMed study, 'Tourniquet use for civilian extremity' [3] found that "tourniquet use in the civilian sector is associated with a low rate of complications. With the low complication rate and high potential for benefit, aggressive use of this potentially lifesaving intervention is justified."
Both the C-A-T and SOF Tourniquets are specifically engineered to apply the minimum pressure needed to stop bleeding while maximising tissue safety. They feature:
C-A-T Tourniquet:
- Single Routing Buckle for effective pressure control
- Patented free-moving internal band for even circumferential pressure
- Stabilisation plate with bevelled contact bar to prevent tissue damage
SOF Tourniquet:
- Precise pressure control through the "Rugged Buckle" system
- 1.5" reinforced webbing to distribute pressure effectively
- Slack Indicator Wedge for optimal pressure application
Myth 3: "Time Documentation Isn't Important"
The Truth: Writing the time of application on a tourniquet is absolutely important and both the C-A-T and SOF Tourniquets include a time-strip for documenting application time. This isn't just a nice-to-have feature - it's a critical component of proper tourniquet use that can impact patient care decisions. ANZCOR States: "The time of tourniquet application must be noted and communicated to emergency/paramedic personnel" [1]
Why? While it's true that tourniquets can safely remain in place for several hours, medical teams need this information to:
- Make time-critical clinical decisions about surgical intervention. Research suggests that while tourniquets can be safely applied for extended periods, different surgical protocols are required based on precise timing.
- Monitor and manage physiological complications. Timing is crucial for medical teams to manage potential complications from prolonged tissue compression and to plan appropriate interventions. A tourniquet applied for an extended period requires specific medical management protocols, particularly when it comes to removal and managing potential reperfusion effects.
- Enable effective clinical handover across treating teams. Writing the time of application is critical for continuity of care across multiple treating teams. Consider a casualty on a remote beach in rural Australia who requires a tourniquet - they might be initially treated by a surf lifesaver or first responder, then handed over to ambulance paramedics, transferred to a regional hospital, and then transported to a major trauma centre via helicopter for definitive care. Throughout this journey, which could take several hours, multiple medical teams need to know exactly how long that tourniquet has been in place. Having the time accurately documented on the tourniquet itself ensures that critical information travels with the patient and enables each treating team to make informed clinical decisions about ongoing care.
Myth 4: "Improvised Tourniquets Are Just as Good"
The Truth: Despite what you might have seen in movies, improvised tourniquets using belts, ropes, or other household items without a windlass, are generally ineffective.
Why?
- Improvised tourniquets like belts, ropes, or clothing lack the mechanical advantage needed to generate the minimum pressure required to occlude arterial blood flow. ANZCOR guidelines state that a tourniquet should be tightened until the bleeding stops and the distal pulse is no longer palpable. The exact pressure needed will vary depending on the size of the limb and the location of the injury, and the key indicator of proper application is the complete cessation of bleeding. Without sufficient pressure, blood can continue to pump past the improvised device, leading to ongoing blood loss.
- The narrow width and inconsistent pressure distribution of improvised materials like ropes or cords can cause significant neurovascular damage. Commercial tourniquets are specifically engineered with optimal width and pressure distribution systems to minimise tissue trauma while maintaining effective occlusion.
- Under the extreme pressures needed for arterial occlusion, improvised materials frequently break, slip, or lose tension. When dealing with life-threatening bleeding, this kind of failure isn't just disappointing - it's potentially fatal.
- The windlass system used in proper tourniquets like the C-A-T and SOF-T isn't just about tightening but maintaining the precise pressure needed to stop arterial blood flow until surgical intervention. Even if adequate pressure is somehow achieved with an improvised tourniquet, they lack the locking mechanisms needed to maintain that pressure during patient movement and transport.
An Important Note on Improvised Tourniquets:
While we've emphasised the clear superiority of purpose-built tourniquets like the C-A-T or SOF Tourniquet for treating catastrophic haemorrhage - and we strongly advocate that every Australian should have immediate access to these proven life-saving tools - we also acknowledge the reality of unexpected trauma situations. If you find yourself in the extremely rare situation where catastrophic limb bleeding is present and a commercial tourniquet is not available, an improvised tourniquet may be your only option.
In these scenarios, your improvised tourniquet should include:
- A wide piece of material (like a t-shirt or triangular bandage) to evenly distribute pressure and minimise tissue damage
- A strong, rigid improvised windlass (such as a screwdriver, wrench, or sturdy stick)
- A way to secure the windlass once tension is applied
While ANZCOR [1] acknowledges that improvised tourniquets may be necessary in extreme circumstances where no commercial tourniquet is available, they emphasise the importance of having proper tourniquets available in first aid kits, particularly in high-risk environments.
Myth 5: "A Knock-Off Tourniquet Does The Same Job."
The Truth: Counterfeit tourniquets pose a critical risk in emergency situations. While they may look similar to genuine models, these imitations frequently fail when lives are on the line. The difference between an authentic and counterfeit tourniquet isn't just about brand protection - it's about proven reliability when, quite literally, lives are on the line.
Why? Authentic tourniquets undergo rigorous testing and must meet strict quality control standards that knock-offs simply don't match. Here's a few of the reported failings that we have heard about:
- Windlass rods snapping under pressure
- Stitching failing when tension is applied
- Velcro that won't hold under pressure
- Buckles and clips breaking during application
- Material stretching or tearing when tightened
We did an entire blog article about the dangers of counterfeit tourniquets. You can find that [ HERE ]
In yet another example of why it's important not to believe everything you read on social media, the evidence is clear: when it comes to life-threatening limb bleeding, properly applied commercial tourniquets save lives. Modern research has thoroughly debunked old myths about tourniquet's doing more harm than good, and we need your help to get the word out! What can you do?
- Share this article with your mates
- Offer evidence based facts and ANZCOR guidelines with anyone spreading the common misconceptions about tourniquet use
- Make sure you have immediate access to a genuine tourniquet in your first aid kit, vehicle, or workspace - don't wait until you need one to get one
Stay safe,
Team TacMed
*Note: Always follow current ANZCOR guidelines and seek immediate emergency medical care in any trauma situation. This information supplements but does not replace proper first aid training.*
References:
[1] ANZCOR Guideline 9.1.1 - First Aid Management of Bleeding (January 2023):
[4] Eilertsen KA, Winberg M, Jeppesen E, Hval G, Wisborg T. Prehospital Tourniquets in Civilians: A Systematic Review. Prehosp Disaster Med. 2021 Feb;36(1):86-94. doi: 10.1017/S1049023X20001284. Epub 2020 Nov 3. PMID: 33138876; PMCID: PMC7844612.