Page 187 - 2026 SMOG

TOURNIQUET APPLICATION
Clinical Indications
• Extremity trauma with continued hemorrhage or amputation.
Contraindications
• None
Procedure
All medical personnel should be regularly trained in deploying and applying all CoTCCC-
approved tourniquets (TQ). Tourniquets in the kit should be pre-set and removed from the
wrapping (ready for immediate use and application).
Initial HASTY placement ok over clothing, clearly proximal to bleeding. If the site of life-
threatening bleeding is not readily apparent, place the tourniquet “high and tight” as proximally
as possible on the injured limb. HASTY tourniquet placement is appropriate for initial treatment
of massive hemorrhage or hemorrhage while in the Care Under Fire phases. Reassess all HASTY
placement tourniquets and assess if hemorrhage is manageable by other methods while in
tactical field care or transition to tactical evacuation care. If a tourniquet is necessary to manage
hemorrhage, replace all HASTY placement tourniquets with DELIBERATE placement
tourniquets, preferably prior to patient evacuation or movement, per the following steps:
• Remove clothing as necessary to visualize the bleeding area.
• Place TQ directly on skin proximal to the wound. It should be placed at least 2–3" above the
bleeding site, avoiding placement directly over a joint (place above or below).
• Tighten TQ by twisting the included rod until bleeding stops. If converting from HASTY to
DELIBERATE TQ placement, loosen the HASTY TQ after the DELIBERATE TQ is placed,
but keep it in place as a backup. If bleeding is not well controlled with the first TQ, apply a
second side-by-side with the first.
• Secure the ends of the tension bar to prevent unwinding (such as with tape).
• Document TQ time of placement. (“T” signifies tourniquet). Do not cover TQ. Recheck
intermittently (q15min) and after any movements or repositioning to ensure no new bleeding/
loosening has occurred.
• TCCC recommendations on TQ removal/conversion (clearly document timing and
effectiveness):
˚ Convert all necessary HASTY tourniquets to DELIBERATE tourniquets as soon as tactically
feasible, as outlined above.
˚ Limb TQs should be converted to hemostatic or pressure dressings as soon as able if three
criteria are met:
■ The casualty is not in shock;
■ It is possible to monitor the wound closely for bleeding; and
■ The tourniquet is not being used to control bleeding from an amputation.
˚ Every effort should be made to convert tourniquets in less than 2 hours if bleeding can be
controlled with other means.
Revised/reviewed March 2025 IAW current published JTS TC3 CPG guidelines.

2026 Standard Medical Operating Guidelines (SMOG) • 179