(UPDATED 01/23/23) “Who put this tourniquet on him?” asked the trauma doctor in the Emergency Room. “Brad. It was Brad.” replied the female ranch hand who had driven the patient to the hospital. “Well, you can tell him that he did a good job and that he saved his life.” the doctor assured the young woman.

Student of the Gun has been teaching the Beyond the Boo Boo traumatic medical training class since 2011 and we have received innumerable reports from our graduates who had to use their training. However, we have never had someone use the skill and gear from the class to save a life as quickly as we did last summer. It was only eight days after the class that Brad was called upon to save a life.

During the after action report from the above incident, we learned that the patient had been knocked down and stepped on by a steer on the ranch. The steer’s hoof cut deep into his arm and severed the brachial artery. Our graduate was there and applied a tourniquet. The ER doctor further elaborated, “If he (the patient) had bled for another minute, he would not be here today.”

When I attended USMC Infantry School, our first aid training mirrored that of the Red Cross civilian program. While battlefield trauma was talked about, little emphasis was put on self-aid and buddy-aid. The primary care giver on the battlefield was the Navy Corpsman and your first aid kit was carried merely to give the Corpsman some extra gear with which to work. Ways to improvise a tourniquet were mentioned but only with the caveat … “as a last resort, after all other means have failed.”

During the Cold War Era with few exceptions, the powers that be were more concerned with winning the next conflict with B-52 bombers and nuclear-powered submarines than infantry troops. Ground troops were considered an ancillary component to warfare, not the prime focus. As such the budgets for training and gear were sparse at best. Live-fire was limited and combat focused training was rather stagnant.

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Fast forward to the year 2011 and we have been in an active shooting war for ten years. This is a war where the man on the ground is now a critical player. Our nation has done an excellent job developing body armor and thus protecting our troops’ core; their torso. However, grievous life-threatening injuries in the form traumatic arm and legs wounds were taking our troopers lives too often. These were considered life-threatening but preventable injuries. By preventable, it was meant that appropriate battlefield care could save their lives.

Embracing Tourniquet Use

A dedicated Tactical Combat Casualty Care program was developed and taught to the combat troops. Rather than simply scream for the medic or corpsman, troops were taught to treat themselves and their buddies and to stem the flow of blood while waiting for professional medical aid. Pre-made tourniquets of many designs were purchased by all branches of the U.S. Military and the troops were taught how to use them properly.

On the battlefield overseas the tourniquet training battle has been won and innumerable U.S. servicemen have had their lives and limbs saved by the rapid and effective use of a tourniquet. However, here at home the only folks who seem to understand the life-saving value of the tourniquet are the vets.

It’s not just citizens who fear the tourniquet as the shadowy boogeyman; it’s also emergency medical professionals and first responders. I’ve had trained EMT’s argue that we can’t teach just anyone to use a tourniquet. Furthermore, they had argued that risks outweigh the possible benefits. Empirical battlefield evidence aside, allow me to quote from the Prehospital Trauma Life Support 6th Edition. This medical manual is the bible for SOF medics and the reference guide they use.

On page 181 of PHTLS 6th Edition the manual states… “If external bleeding from an extremity cannot be controlled by pressure, application of a tourniquet is the reasonable next step for hemorrhage control.” It continues… “Although there is a small risk that all or part of the limb may be sacrificed, given the choice of losing a limb or saving the patient’s life, the obvious decision is to preserve life.” Naturally the recommended method for patient assessment and the application of a tourniquet, if necessary, are explained in great detail in the PHTLS.

Gear Training

All gear, and that includes medical gear, requires proper training to be used effectively. Those who are serious about saving their own lives with a firearm are best served by professional training and then practice. Simply put, if an 18 year old Army private can be taught to save his buddy’s life with a trauma kit, so can any trained gun carrier.

Beyond the Boo Boo - Arm Injury Demonstration
Beyond the Boo Boo – Arm Injury Demonstration

An arterial hemorrhage on the streets of Houston, Texas or the rocky soil of Afghanistan both have the same result. In other words, the patient dies. Arterial bleeding in the arm or leg must be controlled in mere minutes (1 to 2 minutes) or the patient will exsanguinate (bleed to unconsciousness) and reach irreversible shock. Two minutes is precious little time to exhaust “all other means” and then start looking for the material to make an improvised tourniquet.

The tourniquet is not some sinister boogeyman waiting in the shadows to force amputation; it is merely a tool that can save a patient’s life and limb in the unhappy event of the traumatic injury to the arms or legs. Training and gear are available to all. The decision is yours, make an informed decision, not one based on myth or misunderstanding.

[Original Publish Date: 06/18/2014]

Have you thought about what you would do if a loved one was bleeding out right next to you? What action would you take? Let us know in the comments below.

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Paul G. Markel has worn many hats during his lifetime. He has been a U.S. Marine, Police Officer, Professional Bodyguard, and Small Arms and Tactics Instructor. Mr. Markel has been writing professionally for law enforcement and firearms periodicals for nearly twenty years with hundreds and hundreds of articles in print. Paul is a regular guest on nationally syndicated radio talk shows and subject matter expert in firearms training and use of force. Mr. Markel has been teaching safe and effective firearms handling to students young and old for decades and has worked actively with the 4-H Shooting Sports program. Paul holds numerous instructor certifications in multiple disciplines and a Bachelor’s degree in conflict resolution; nonetheless, he is and will remain a dedicated Student of the Gun.

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