AMU Emergency Management Original Public Safety

Lessons from the Battlefield: Tourniquets Can Save Lives

By Allison G. S. Knox
Contributor, EDM Digest

Active shooter situations present a wide variety of issues for emergency managers and public safety officials. Not only are these situations frightening experiences for everyone involved, they also raise issues of resource management.

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The unfortunate reality is while mass shootings have devastating social impacts, they allow public safety teams across the country to review how they would handle such incidents. They also offer opportunities to incorporate lessons learned into general public safety practice. One of these lessons is the proper use of tourniquets.

According to an article published in, “Up to 9% of casualties killed in action during the Vietnam War died from exsanguination [blood loss] from extremity injuries. Retrospective reviews of prehospital tourniquet use in World War II and by the Israeli Defense Forces revealed improvements in extremity hemorrhage control and very few adverse limb outcomes when tourniquet times are less than 6 hours.”

The reality is the tourniquet is a lesson learned from the battlefield that has been applied to active shooter incidents. It is a lesson that has allowed for appropriate resource management during a major mass casualty incident. Rethinking the use of this important device has saved lives.

Afghanistan and Iraq Wars Gave Medics a Chance to Rethink Use of Tourniquets

Prior to the wars in Afghanistan and Iraq, the use of tourniquets was not advocated. But during  the wars, their use became an important factor in treating significant bleeding emergencies. This created the unfortunate opportunity for medics, doctors and other medical personnel to rethink how they would treat certain trauma cases. In doing so, they shifted many old methods of medicine, like the use of a tourniquet, back to the forefront of the protocol discussion.

During active shooter incidents, many people are left bleeding profusely from their wounds and will die on scene if they are not treated promptly. From a resource management standpoint, the tourniquet is also particularly effective for helping first responders manage multiple patients.

It has taken some “out of the box thinking” to manage such domestic incidents. Before the rise of active shooter incidents, law enforcement needed to clear the scene before Emergency Medical Services could enter the zone to treat the wounded. Now, there are new protocols in place that allow law enforcement to manage the scene effectively while patients are treated promptly.

Rethinking Patient Management to Include Tourniquet Use

Since it can take a little while for the injured to receive care, one of the most effective means of managing bleeding emergencies is the tourniquet. Advocated by the Stop the Bleed program and protocols around the country, the tourniquet provides medical care that will prevent severely wounded victims from bleeding out and dying.

Because of the nature of active shooter incidents, it is particularly important for public safety personnel to rethink how they will handle mass casualty incidents. Ultimately, looking to the military and how they have handled combat-related injuries have drastically helped to rethink emergency medicine in the field. Prehospital care has tightened considerably because of the use of the tourniquet and what we understand about hemorrhage control.

Using the tourniquet is an important piece of managing mass casualty incidents. But training the general public in the use of tourniquets — as strongly advocated by the Stop the Bleed program — is also important because it helps manage scarce resources. The more people that understand how to use tourniquets, the better the outcomes for victims of active shooter incidents.

Allison G. S. Knox teaches in the fire science and emergency management departments at American Military University and American Public University. Focusing on emergency management and emergency medical services policy, she often writes and advocates about these issues. Allison serves as an Intermittent Emergency Management Specialist with the Department of Health and Human Services, as At-Large Director of the National Association of Emergency Medical Technicians and as Chancellor of the Southeast Region on the Board of Trustees with Pi Gamma Mu International Honor Society in Social Sciences. She is also chair of Pi Gamma Mu’s Leadership Development Program. Prior to teaching, Allison worked for a member of Congress in Washington, D.C. and in a Level One trauma center emergency department. She is an emergency medical technician and holds multiple graduate degrees.

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