Page 189 - 2026 SMOG

TOURNIQUET CONVERSION
Clinical Indications
• Wounds that have a high possibility of compressible hemorrhage control with hemostatic or
pressure dressings, where a tourniquet originally controlled the hemorrhage
Contraindications
• Patient showing signs and symptoms of hypotensive/hemorrhagic shock
• Tourniquets controlling hemorrhage for amputated or partially amputated extremity.
• Tourniquets that have been in place for >6 hours.
• Unable to monitor wound for bleeding post-tourniquet conversion due to task saturation,
limited visibility, or poor positioning.
Procedure
Limb tourniquets and junctional tourniquets should be converted to hemostatic or pressure
dressings as soon as possible if none of the contraindications noted above are present.
Every effort should be made to convert tourniquets in less than 2 hours if bleeding can be
controlled with other means. Do not remove a tourniquet that has been in place for more
than 6 hours.
• Confirm the patient is not showing any signs of hypotensive/hemorrhagic shock.
• With the tourniquet in place, attempt to pack the wound with hemostatic dressing and apply a
pressure dressing.
˚ Combat Gauze is the CoTCCC hemostatic dressing of choice
˚ Alternate hemostatic adjuncts:
■ Celox Gauze
■ ChitoGauze
■ XStat (best for deep, narrow-tract junctional wounds)
■ iTClamp (may be used alone or in conjunction with hemostatic dressing or XStat)
• Loosen but don’t remove the tourniquet by unwinding the windlass until pulses return, and
closely monitor for return of bleeding for 5min.
• If bleeding returns, retighten the tourniquet until loss of distal pulse and document procedure
failure.
• If no bleeding returns, loosen the tourniquet completely but leave it loosely looped around the
limb and monitor for the return of bleeding.
**Document procedure, results, and vital signs.**
Revised/reviewed March 2025 IAW current published JTS TC3 CPG guidelines; (High Bilateral) Amputations
and Dismounted Complex Blast Injury, 05 August 2024; Damage Control Resuscitation in Prolonged Field Care,
CPG: 73 01 October 2018.

2026 Standard Medical Operating Guidelines (SMOG) • 181