There was the fear that leaving a tourniquet on led to limb loss. So there was guidance to loosen it every so often. That is wrong.

Combat data out of Iraq and Afghanistan settled the question. Properly applied tourniquets left in place under two hours almost never result in limb loss. Complications stay uncommon well past that. The gangrene-and-amputation warning I grew up on described a rare outcome and presented it as the expected one.

The hesitation that warning produced cost more lives than the tourniquets ever cost limbs.

That sentence should bother you. It bothers me.

Here is the current version.

If someone is bleeding to death from an arm or a leg, put the tourniquet on. High and tight if you are under pressure and can’t think, two to three inches above the wound if you have a moment to be deliberate. Never over a joint — go above it. Crank it until the bleeding stops completely, not until it slows down. A tourniquet tightened halfway is worse than none at all, because it blocks the low-pressure venous return while the arterial blood keeps going.

Write down the time. On the tourniquet, on his forehead, on his hand, wherever. That number matters to whoever gets him next.

Then leave it alone. Do not loosen it to let some blood through. Do not take it off in the field to check.

Buy a real one. A CAT or a SAM XT, from a legitimate source, for around twenty dollars. The knockoffs sold on marketplace sites fail under load and there is a documented history of them doing exactly that at the worst moment. A belt will work in an emergency because it is what you have, but a belt is a poor tourniquet — it is hard to get tight enough and it has no windlass. I have a good tourniquet and also bleed stopping gear on the first aid page on my gear page. I keep a blood kit with tourniquet in the house and in my Jeep.

One more thing, and it is the piece most people are missing.

A tourniquet only works on a limb. It does nothing for the groin, the armpit, the neck, or the shoulder — the junctional wounds, where a lot of people bleed out. For those you need wound packing: gauze stuffed directly down into the wound, onto the bleeding vessel, packed tight, more added until the cavity is full, then three solid minutes of hard pressure by the clock. I am also a big fan of combat bandages with have material implanted in them to stop bleeding.

The corrected guidance is in the updated edition of The Green Beret Preparation and Survival Guide.

I was taught something that was wrong, I taught it forward, and now I am unteaching it. That is how this is supposed to work.

The Green Beret Preparation and Survival Guide is here: https://amzn.to/3BYEq5E

To read what a survival scenario looks like and how to respond, my fiction Green Beret Survival Series is here: https://amzn.to/4nEf1XB