The setting was a military hospital in support of
combat and related security work in Iraq, where casualties,
including civilians, were admitted directly or transferred
from forward surgical teams. Prehospital tourniquets
were applied by people with a wide range of
medical skills and included casualties themselves, lay
bystanders, soldiers, medics, nurses, and doctors. Tourniquets
are part of standard prehospital care to stop
bleeding in combat and are often used before pressure
dressings during care under fire. All deployed US servicepersons
get tourniquet training with instructions to
apply them as soon as possible to stop potentially lethal
external limb bleeding; the soldiers were taught how to
use the tourniquets using a simplified form of Tactical
Combat Casualty Care in Prehospital Trauma Life Support
(14). The aim of tourniquet use is to prevent hemorrhagic
shock and save lives while minimizing morbidity.
Casualties were eventually transferred to other
hospitals for definitive care.