Medical Technology in War: The Unwavering Resilience of Tourniquets

Jun 30, 2023

Written By Marc De Pasquale, U.S. Army (ret.)

In the ever-evolving landscape of modern warfare, technological advancements have propelled us into a realm of sophistication that would leave even our recent past soldiers awestruck. From drones armed with thermal sensors to laser aiming modules enhancing rifle precision, the battleground has become a high-tech theater of combat. As a Special Forces medic, I have witnessed firsthand the incredible strides made in medical capacity, from groundbreaking surgical techniques to post-surgical strategies and the marvels of prosthetic limbs. However, amidst this whirlwind of progress, one unsung hero stands resolute, a time-tested and steadfast companion of medics since the days of ancient warriors – the tourniquet.

A tourniquet, a seemingly simple band of fabric, has been used in warfare for centuries, tracing its roots back to the time of the valiant Spartans at the Hot Gates of Thermopylae. It is a lightweight, portable device capable of stopping severe bleeding by compressing vessels against the bone, overcoming peak arterial pressure, and temporarily ceasing hemorrhage. This critical intervention grants medics precious time to transport the wounded to higher echelons of care, where more comprehensive medical protocols can be deployed, paving the way to recovery.

While the technological landscape of warfare has witnessed a staggering transformation, the humble tourniquet remains unchanged in its basic design and principle. A comparison between the tourniquets used by the Spartans and those employed by today’s Special Forces medics would reveal striking similarities. The essence of its function has persevered across civilizations, unaffected by the relentless march of time.

Some may wonder why, in an age of unprecedented medical advancements, we still rely on a seemingly rudimentary device like the tourniquet. The answer lies in its unmatched efficacy and life-saving potential on the battlefield. Time and again, data has borne witness to the critical role tourniquets play in preserving lives during combat.

In the aftermath of the conflicts in Iraq and Afghanistan, a landmark study published in the Journal of Trauma and Acute Care Surgery revealed that tourniquets were responsible for saving numerous lives. The study found that among soldiers who experienced severe extremity bleeding, the application of tourniquets led to a remarkable 92% survival rate. It was a staggering testament to the power of this simple tool.

The tourniquet’s prominence in modern combat medicine can also be attributed to the advent of tactical combat casualty care (TCCC) – a system tailored to the realities of the battlefield. TCCC emphasizes the rapid and judicious use of tourniquets as a first-line intervention to control severe bleeding. As a result, combat medics now undergo rigorous training in tourniquet application, ensuring they possess the skills necessary to wield this life-saving tool effectively.

In recent years, the technology behind tourniquet design has experienced incremental improvements. From innovative buckle mechanisms to ratcheting systems, these enhancements have made tourniquet application more straightforward and efficient. Furthermore, modern tourniquets often incorporate time indicators, allowing medics to monitor the duration of tourniquet application to minimize potential complications.

It’s important to emphasize that not all modern tourniquets are created equal. Counterfeits and cheaply made tourniquets available on the internet have contributed to devastating losses as their lack of quality lead to failure and the inability to maintain occlusion. These types of tourniquets should be avoided as it can literally become a matter of life or death. It is always best to purchase tourniquets from the original equipment manufacturer or a reputable U.S.-based distributor with a reputation in the tactical medical space. Remember, tourniquets aren’t complicated, but they are medical devices and, as such, are regulated by the FDA. The price is one of the best markers to determine if you are purchasing a reliable tourniquet. A U.S.-made and U.S. Army Council on Tactical Combat Casualty Care (CoTCCC) recognized tourniquet typically retails around the $30 range.

Cheap internet tourniquets typically have plastic windlasses and inferior bands and are not recommended, as they may compromise patient safety. Unfortunately, there have been many recent reports of these “fake” tourniquets” catastrophically failing in an emergency. Quality tourniquets like the SOF-T® from TacMed™ Solutions or the CAT® from North American Rescue™ have been battle-proven and are trusted by professionals.

Despite these incremental improvements, the core principle and simplicity of the tourniquet have remained unchanged. Its reliability in the field is unmatched, offering a swift and effective solution to the life-threatening challenge of hemorrhage control. While high-tech gadgets may grab the headlines, the tourniquet quietly stands tall as the tried-and-true hero on the battlefield.

As a Special Forces medic, I have borne witness to the life-saving power of the tourniquet. It is a tool that transcends time and technology, remaining steadfast in its mission to preserve lives on the battlefield. While our soldiers wield the most sophisticated weaponry and benefit from cutting-edge medical advancements, the tourniquet is a constant, a beacon of hope in the darkest moments.

So, let us not forget the quiet heroism of the tourniquet, the unchanging ally of warriors since antiquity. Amidst the whirlwind of technological change, it remains an indispensable tool, a simple band of fabric that holds within it the power to tip the scales between life and death. As we honor the strides made in medical technology, let us also pay tribute to the enduring resilience of the tourniquet, forever etched in the annals of warfare as a beacon of hope.

About the Author, Marc De Pasquale: Marc is an educator with over 30 years of experience in the Pre-Hospital trauma care field – initially as an EMT Basic and culminating as a U.S. Army Special Forces Medic. Marc has been sought after as a consultant, educator, and trainer of numerous highly-tiered organizations in the pre-hospital space.