Author: Ustaz Hussein
Most of the time I ask martial artists what a tourniquet is and they have all sorts of funny replies. The sound of the word elicits ridiculous French-related answers ranging from a French biscuit to Cajun stew. Those who have been exposed to a bit more reality-based training will inevitably drive down the right highway and start talking about hemorrhage control and tactical tourniquets. Street medicine is one of the most neglected aspects of martial arts training. Hence, the knowledge gap. But knowing even the basics will directly impact your survival percentages in real-life problems.
Those of you training in Pencak Silat, Filipino Martial Arts (FMA), Libre, etc. are true masters of close-quarter fighting with edged weapons. It’s the nature of the arts and we are all proud of those capabilities we work hard to acquire. But when the shit hits the fan and you are the one who gets seriously injured by the weapon you love, you must make sure you have the skills to survive and continue fighting on. Your life and maybe others will depend on the actions you take in those few seconds after a serious injury. So, let’s dig into tactical tourniquets and see how they can save your ass on the street!
Using a tourniquet will increase your chances of surviving injury
Tactical tourniquets are good for all situations that require control of serious extremity bleeds that are not being adequately controlled with direct pressure, which should be your first step. In this case, a tourniquet will increase your chances tremendously. From 499 combat casualties in Iraq and tactical tourniquets placed on 651 limbs…there was an 87% survival rate. (Col Kragh, Journal of Emergency Medicine) That’s a significant increase compared to years prior when tourniquets were shunned by medical professionals as antiquated. One of the best things to have come out of over a decade of continuous warfare in the Middle East, Afghanistan, etc. is that it has taught the world a lot of new lessons about combat casualty care. Using a tactical tourniquet correctly will directly increase your chances of surviving serious extremity hemorrhage from firearms or knife attacks. And this doesn’t have to be a combat situation, it could also be an accident in your dojo or training center during a demonstration. These types of situations are not uncommon. One of the worst martial accidents I saw was in a Silat demonstration about 20 years ago in Malaysia. The two demonstrators paired off with parangs (machetes) to show their skills and one of them ended up with a machete chopping him in the head at full speed. Needless to say, the results were nasty. This was not a tourniquet amenable situation, but it goes to show that serious accidents can and do result from hardcore martial arts live-blade demonstrations/training prevalent in Pencak Silat and FMA. If it was a serious injury to a limb (much more common in training), a tourniquet, properly applied, may just have saved that person’s life.
The usual, old-style Hollywood tourniquet is a rope or belt wrapped around a dying man’s limb to keep him from expiring. There is no doubt about it, doing something will always be better than doing nothing at all. But these types of improvised tourniquets rarely have sufficient pressure to stop arterial blood flow. You need a lot of physical pressure to actually get blood to stop coming out of a human when there is a serious puncture, slash or gunshot wound. If you really have no other choice, create a windmill tourniquet by using a rigid object and a piece of cloth then rotating it like a garrotte to stop the blood flow like I did in the video at the bottom of the article. Believe it or not, your Silat or FMA stab/slash from a sharp knife can cause a wound severe enough to bleed out a healthy adult in less than 3 minutes…so use what you have on hand. Running over to the dollar store to pick up supplies will likely be a no go. So stay on site, talk to the victim, and get the tourniquet going with whatever you have on hand. Use commercially produced tactical tourniquets for best results on yourself and others. The improvised stuff can help a bit but it’s not something you would want to bet your life on.
These are the best options and their purpose is to stop arterial blood flow and keep you from going 100% zombie. Tactical tourniquets will deliver maximum occlusion due to the incredible pressure they can exert on the limb when applied. Applying a tourniquet is actually a very painful experience for the receiver but not as painful as the alternative, hence the usual paramedic instructors professional statement, “Fucking turn more!” The first time I got a tactical tourniquet twisted on my leg with some force I realized the bitter misery of medieval torture devices. These professionally made tools come in different sizes and have different advantages and disadvantages. What you need to do is look at your environment and requirements and suit the tourniquet to that. A soldier with full body armor will have different needs than a civilian who carries a tactical tourniquet in their IFAK (individual first-aid kit) in the back of their car. So research what’s available on the manufacturer’s site and email customer service of those companies to be sure you get what is correct for your situation.
Keep turning me on baby
When applying a tactical tourniquet make sure to use enough pressure that you can see the blood stop flowing. Sometimes you think it’s so much pressure, it’s enough. Trust me it isn’t. Keep on applying the pressure until you visually see it stop flowing even if the injured person is complaining or crying. Like I said, it’s painful but absolutely necessary to prevent further blood loss. A regular adult can have a class 1 hemorrhage and lose upto 15% of their total blood volume and still seem “normal”. So don’t get fooled by them saying “stop, it hurts I’m ok”. Which they will do to get you to stop turning. It will hurt like a bitch, but if you don’t stop a serious bleed they will eventually go into hemorrhagic shock (at around 20% blood loss) and then you’re really in shitsville. Apply the tactical tourniquet properly, turn until the blood stops, mark down the time you put it on, mark down the location on the body, inform EMS or the hospital staff when you see them. Lastly, don’t take off a tourniquet once it’s applied. Wait until you can reach a hospital and the doctor will remove it and have proper equipment ready to handle the consequences of that removal.
Common folklore and mythical beasts
Contrary to mythology your leg won’t fall off because you have a tactical tourniquet applied to it. Your leg won’t suddenly become ischemic (lack of blood to the area) and turn green, blue, purple or any other rainbow color that comes to your mind and require amputation. In reality, you have about 2 hours before any tourniquet-related tissue damage starts to work on your limb. After about 4 hours there will be widespread nerve and muscle damage but even that will be temporary and you’ll recover. Only at around 6+ hours will you really need to start thinking about where to find a saw and do this the old-fashioned way. So unless you’re out in the middle of the Sahara, you’ll probably be able to find medical help within a 2-hour timeframe. The threat of you or the person you’re caring for going into hemorrhagic shock and dying far outweighs any tissue damage you might have due to a tourniquet.
Realities of the mean streets
Another consideration is that you might be in a hostile environment where going to a local hospital will be as dangerous as not going. This can happen if you’re being pursued by criminals, militias or corrupt law enforcement, especially in third-world countries. The hospital staff act as informants for these groups in equal measure. Not all the time, but many times. Hospitals in these places are medical businesses, not healing centers. And the staff are more often than not, poorly paid and happy for extra income. So you waltzing in with your jacked up leg asking for help is just a free cash advance for these guys. Expect a visit from the unfriendlies in a short amount of time. That being said, many embassies have their own emergency medical staff or people trained in BLS (basic life support) on their roster of employees, so if you can actually reach your embassy or any friendly embassy, they might have people around that can help you. Another way to get under-the-table medical treatment is from off-duty nurses, paramedics, and unlicensed immigrant doctors. Many of them have more medical training than they are paid for and/or are studying in advanced training programs for their careers. In many developing countries, doctors are paid peanuts and moonlight as medics or other work for extra income. A couple of years back I met a Moroccan surgeon working as a donut filler in Montreal. He couldn’t use his license in Canada so he took any job just to feed his wife and kids when they landed. Job changed but the knowledge was still there and he was busting his ass studying to get a local medical equivalency. Ask him anything about tourniquets, airways, chest tubes, hemostatic agents, pericardial tamponade, or rapid sequence intubation and he could talk until your head spins. He confused me on many occasions as we discussed the finer aspects of emergency cricothyrotomies…my medical French being less than stellar not helping the situation. Point being, knowledge isn’t confined to the walls of a hospital. In desperate circumstances, look elsewhere and you will find people with the pre-requisite knowledge and in need of money enough that they’re willing to risk helping you. And the word “risk” my dear reader, should never be forgotten. Stay Safe.