Page 95 - Journal of Special Operations Medicine - Fall 2015

Figure 2 For instructional purposes, the same tourniquet is Figure 3 The next step is placement of the “Plus-1”
shown without uniform pants. The simulated injury is to the tourniquet proximal to the original tourniquet. The Plus-1
distal thigh (red marker). No active bleeding is noted and the tourniquet is not tightened.
distal pulse is confirmed absent.

Figure 5 The hemostatic agent is secured with a pressure
dressing. If no further bleeding is noted, both the original and
Figure 4 Attempted conversion to hemostatic agent. Plus-1 tourniquets remain in place completely loosened.
The wound is inspected, the original tourniquet is loosened,
and a hemostatic agent is applied with manual pressure for
3–5 minutes.

Figure 7 The original tourniquet is moved as close to the
wound as possible and retightened. The Plus-1 tourniquet is
left in place completely loosened. If bleeding recurs, the
Plus-1 tourniquet is already positioned for rapid tightening.
Figure 6 Conversion fails and the wound bleeds through the
hemostatic agent/pressure dressing.

agent and hold pressure for 3–5 minutes. If no further Contraindications for Tourniquet Conversion
bleeding is noted, leave both loose tourniquets in place
and dress the wound. If hemostatic agents fail to control When should tourniquets not be converted? There
the bleeding, tighten the original tourniquet in as distal should be no attempt to convert tourniquets used for am-
a position as possible to control the bleeding. Ensure the putations. The tourniquet should be placed 2–4 inches
distal pulse is absent. Leave the Plus-1 tourniquet loose above the amputation, avoiding joints, but proximally
and proximal to the tightened tourniquet. enough to prevent bleeding. Another contraindication

Tourniquet Conversion in Prolonged Field Care 83