Tactical tourniquet: Surgical management must be within 3 hours

Despite longstanding controversy, tourniquets are widely used in tactical combat casualty care, with undisputed benefits for recent conflicts in Iraq and Afghanistan. Increased time delays are a particular issue in large areas, such as the Sahel-Saharan band. Complications associated with tourniquet use are predominantly related to acute ischemia with risk of amputation and ischaemia-reperfusion injury, as shown in the first clinical case. Often stated but poorly described, misuse of tourniquet and subsequent failure to interrupt arterial blood flow is also a clinical scenario that should be recognized. In the case of misuse of the tourniquet, more significant blood loss may be expected because of venous compression (« venous tourniquet », second clinical case). Early medical re-evaluation of the tourniquet is an essential component in prolonged field care. This includes reassessment of the tourniquet's ability to achieve hemostasis, abolish the downstream pulse and the relevance of the tourniquet altogether. This combat tool requires training to be successful and complications are time dependent. Tourniquet use requires appropriate application, re-evaluation and triage of wounded personnel within 3 h towards more structured surgical management.