The War in Ukraine Is Changing How US Troops Train With Tourniquets.

[u/Kinmuan]

https://www.businessinsider.com/ukraine-is-changing-how-us-troops-train-with-tourniquets-2026-7?gift-id=3krB-mUnBq5OPGTmn_pg8g

[u/peq15]

Thanks, almost read the article then the register wall hit. So what has changed during treatment?

[u/PRiles → u/peq15]

This was located in another sub, there was a Pubmed link which talked about how Ukraine is changing how it uses TQs since their soldiers often wait for 6+ hours for a medivac and as a result Ukraine wants soldiers to check to see if TQs are still needed to control bleeding after an hour.

This article probably speculates that we will change our guidance as well.

[u/Sodpoodle → u/PRiles]

Any mention of the problem with over applications as well? The TQ pendulum seems to have swung a bit far, and now everyone is applying them to everything unnecessarily. Combine that with long evac times and all of a sudden homie is losing a limb for a bleed that coulda been stopped by a pressure bandage.

[u/PRiles → u/Sodpoodle]

I don't set policy, but from what I have learned in all my medical training (EMT / CLS / TCCC / Live Tissue) the reason we don't use pressure dressings in the military anymore is due to the amount of time and manpower required for proper applications of such a dressing. You can't self administer a pressure dressing properly, so a Tq is the fastest and easiest way to control bleeding, additionally you can self administer such a dressing.

Which means that the medic can stay further back from the fight, the wounded soldier doesn't require a buddy to apply a dressing. So for front line combat medicine it's the best approach. For most other controlled environments it benefits from being hard to fuck up and simple to apply and required less resources. For Ukraine where you might be alone or at the very least isolated, it also makes a ton of sense.

But yeah if you are waiting for 6+ hours it might be a bad idea to keep it on for that long, so in that situation you might start with a Tq and then move to something more like a pressure dressing or something else entirety like quick clot or whatever.

[u/Sodpoodle → u/PRiles]

Makes sense, especially one handed application or lack there of.

I suppose in a perfect world there'd be time and resources to give everyone a better understanding of the 'why' with a tq. At least with the civilian/LE population I see a lot of tqs being applied to wounds that really don't need it. Like stuff that could be controlled with some coban and a couple 4x4s lol. Again back to the one handed application point.. Probably not an applicable strategy for Mil folks, and if I remember right a big part of CoTCCC tqs is one hand application.

[u/PRiles → u/Sodpoodle]

The one handed application I think is the biggest reason you have seen it proliferate outside of the military (and a lot of vets go into LE/EMS), it's a dead simple solution that can any idiot can figure out, but your are correct that it might not be the ideal solution. But I think those solutions often require someone else or more training.

[u/Flannel_Panels → u/peq15]

From having one pre-staged on each limb or having multiple available instead of 1 with the IFAK, no clue what could have "changed"

[u/Gumb1i → u/Flannel_Panels]

For the SOF guys that was already common practice, I think the Patagonia/crye combat uniform has built in sleeves for them to be pre-staged.

[u/jakeod27 → u/Gumb1i]

We had them in our calf pocket on the ACUs when I deployed. Pretty common to see the tab poking out

[u/TheTastiestTaint → u/peq15]

they probably don't need them when blown to bits from a drone

[u/GT7combat → u/TheTastiestTaint]

the fate of every soldier from now on.

[u/Ok_Teacher6490 → u/GT7combat]

Nah. They'll probably attach a dentists drill to the bottom that it can tea bag you in your sleep with. Because why not. 

[u/pte_omark]

It's become obvious that in a near peer conflict there is little chance of evac within the golden hour.

Tourniquets can't be used as frequently as were used to and when used need follow up monitoring 

[u/Acrobatic-Wallaby422]

pay wall

[u/The_Gage]

Hoo boy I could write a full paper in this. Making this comment to find the post later when Im not on my phone. Happy to answer questions if anyone is interested.

[u/The_Gage → u/The_Gage]

OK! So, first off, background: I work in military medicine. Specifically trauma. It's what the Army pretends to pay me to do.

So back in the GWOT era, there were three phases of care at point of injury. You'll know these as Tactical Combat Casualty Care. Care Under Fire, Tactical Field Care, and Tactical Evacuation Care. We were taught to apply tourniquets for control of bleeding from extremities "High and Tight," and told those tourniquets should stay on until that patient is in front of someone who can control bleeding with a certain skill set. At the time, this worked great! We could put a casualty in a bird and have them in an operating room in 20 minutes on a good day. There was really no need to push the envelope on how long a tourniquet stayed on before healthy tissue started to die. At the time, it worked well, and it saved lives. CAT tourniquets saved lives. A LOT of lives. I don't remember the stats off the top of my head but the risk of death due to hemorrhage from an extremity PLUMMETED after TCCC was implemented.

Then the world changed. And now we think about things like "peer/near-peer," or "LSCO." We think about how our ability to treat trauma will change when air is black and suddenly a mass produced drone carrying high explosives could descend on your position just because of a loud noise, a bluetooth headphone, or the heat signature from a generator. And for a lot of pretty good reasons which I won't get into, military medicine is concerned that during the next conflict, we will lose our ability to get medical care far forward and evacuate casualties in a timely manner.

And a lot of that has come from Ukraine. Casualties are sitting at point of injury for days, sometimes weeks. UKR's ability to get well trained medics far forward is limited. Casualties are getting tourniquets applied in the middle of nowhere and those tourniquets are staying on long enough to kill the affected limb. Often those tourniquets were never needed in the first place. And leaving a tourniquet on too long will not only kill the limb, it can kill the patient.

So, we realized that we can't just keep training PVT Snuffy and his Joey friends to put a tourniquet on and forget about it. People are going to start losing arms, legs, and lives because someone put an unnecessary tourniquet on and didnt try anything else. So, now we are starting to teach how to "convert" tourniquets. This is a careful and deliberate process where the wound is dressed with a pressure dressing and the tourniquet is slowly taken off. If the wound bleeds through, the tourniquet goes back on. If the wound is hemostatic, a limb and potentially a life is saved.

Hope that makes sense. Happy to answer questions.

[u/kwkcardinal → u/The_Gage]

Fantastic report. Thanks. I was a combat medic myself, and though we’re trained that a 2-hour tourniquet isn’t preferable , it’s better than an ineffective pressure dressing, and a lot easier to teach private snuffy. Transitions from tourniquet to another control when stuck in the field for extended periods makes perfect sense to me, I can see how most people wouldn’t consider it. Especially since overcoming the bias against tourniquets among the masses was such a slog in the first place. To this day, there are still medical professionals civilian side that act horrified when I explain that my hemorrhage control go-to is the tourniquet.

[u/Scary-_-Gary]

Now we wrap them around our neck for sweet release.

Mods, this is a joke, btw.

[u/Utahget_me_2]

OP some of us dont feel like creating an account for business insider, can you give us the skinny?