Introduction:
The tourniquet, a simple yet powerful tool, has been instrumental in saving lives in battlefield and pre-hospital trauma scenarios throughout history. This article delves into the history of its invention, its effectiveness based on the latest battlefield research, its notable usage, including its quiet and effective role during the American Civil War, and its modern incarnations approved by the Tactical Combat Casualty Care (TCCC) committee.
Section 1 – The Birth of the Tourniquet:
The tourniquet has ancient roots, with early references dating back to the Roman Empire, where they were used to staunch bleeding during surgical procedures[^1^]. However, “tourniquet” originated in the 17th century from the French word “tourner,” meaning to turn. The concept was formalized by Dr. Jean Louis Petit, who invented a screw device to stop blood flow during surgery[^2^].
Section 2 – Tourniquet in the American Civil War:
During the American Civil War, tourniquets played a crucial yet subdued role. The Esmarch tourniquet, a simple rubber bandage rolled tightly around a limb, was a lifesaver. Despite its simplicity, it effectively reduced battlefield fatalities by controlling haemorrhage [^3^].
Section 3 – Effectiveness of Tourniquets:
Modern research and battlefield experience underscores the pivotal role of tourniquets in controlling life-threatening haemorrhages, especially in pre-hospital environments. A study involving 862 tourniquet uses on 651 extremity wounds in the Afghan and Iraq wars found a survival rate of 87% when a tourniquet was applied before the onset of shock, and a 0% mortality rate in casualties without shock or prehospital arrest[^4^]. Another study indicated a dramatic decrease in mortality rates from 23.3% in World War II to 7.8% in recent conflicts, attributed mainly to the widespread use of tourniquets and improved haemorrhage control practices[^5^].
Section 4 – TCCC-Approved Tourniquets:
The Tactical Combat Casualty Care (TCCC) committee currently endorses three types of tourniquets:
- CAT (Combat Application Tourniquet)
- SOFTT-W (Special Operation Forces Tactical Tourniquet-Wide)
- EMT (Emergency and Military Tourniquet)
These tourniquets are lauded for their effectiveness, ease of use, and ability to be applied with a single hand, making them crucial tools in pre-hospital trauma scenarios.
Section 5 – Concluding Remarks:
As the tourniquet continues to evolve, so does our understanding of its vital role in lifesaving haemorrhage control. Its story is one of innovation and adaptation in pursuing a singular, invaluable goal: saving lives.
Citations:
[^1^]: McEwen, J.A. (2008). Tourniquet History, Facts and Myths. BCMJ, 50(5), 275.
[^2^]: Petit, J.L. (1718). A treatise of chirurgical operations according to the mechanism of the parts of the humane body. T. Payne.
[^3
^]: Bollet, A. J. (2002). Civil War Medicine: Challenges and Triumphs. Galen Press Ltd.
[^4^]: Kragh, J. F., Walters, T. J., Baer, D. G., Fox, C. J., Wade, C. E., Salinas, J., & Holcomb, J. B. (2009). Survival with emergency tourniquet used to stop bleeding in major limb trauma. Annals of surgery, 249(1), 1–7.
[^5^]: Eastridge BJ, Mabry RL, Seguin P, et al. (2012). Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 73(6 Suppl 5):S431-7.
