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Updated: Apr 8, 2026

Integrated Compensatory Responses in a Human Model of Hemorrhage
Published on: November 20, 2016
"High and tight to pack and press": Prioritization of tourniquet conversion in unconventional warfare improves
Luke J Hofmann1, Jason M Hiles, Michael Hetzler
1Acute Care Surgery, Baylor Scott and White Medical Center, Temple (L.J.H.); Four Winds Professional Guild, El Paso, Texas (J.M.H., E.H., A.A.G.); Security and Defense Medicine, School of Medicine, University College Cork, Cork, Ireland (M.H.); Special Forces Medic, Florida Army National Guard, Valparaiso, Florida (E.D.); Acute Care Surgery, Penn State College of Medicine, Hershey, Pennsylvania (J.S.O., S.B.A.); Acute Care Surgery, St. Alphonsus Regional Medical Center, Boise, Idaho (A.A.G.).
Background:
In military conflicts beyond the global war on terror, combatants often lack air superiority, rapid evacuation to surgical care, and sufficient medical resources. Consequently, obtaining definitive care becomes a significant challenge, leading to complications associated with tourniquet (TQ) use in many active combat zones.
Methods:
Data were retrospectively analyzed from a mobile surgical team operating in an unconventional warfare environment. Descriptive statistics summarized demographics, injury mechanisms, interventions, and outcomes, with categorical variables reported as frequencies and percentages.
Results:
Results from a mobile surgical team supporting a MASCAL in unconventional warfare were analyzed. A total of 46 casualties were evaluated and treated. There were 14 TQs utilized on 12 patients. All 14 TQs were evaluated, and 93% (13) of these TQs were converted. Thirty-one percent (4) of the converted TQs required surgical intervention for hemostasis before packing and pressure. One (7%) TQ was transitioned lower on the extremity closer to the point of wounding. There were no deaths from extremity hemorrhage and no complications reported related to TQ use.
Conclusions:
Prioritization of TQ conversion in an unconventional warfare environment with prolonged evacuation times can save lives and limbs. ( J Trauma Acute Care Surg . 2026;101: 291-296. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
Level Of Evidence:
Therapeutic/Care Management; Level IV.
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