[NousDefionsDoc]

From the Special Operations Forces Medical Handbook (2001).

Circulation: Uncontrolled hemorrhage is the leading cause of preventable battlefield deaths. Rapid identification and effective management of bleeding is perhaps the single most important aspect of the primary survey while caring for the combat casualty.
Obvious external sources of bleeding should be controlled with direct pressure initially followed by a field dressing or pressure dressing. If bleeding is not controlled by the previous measures or if gross arterial bleeding is present, an effective tourniquet should immediately be applied. Clamping of injured vessels is not indicated unless the bleeding vessel can be directly visualized. Blind clamping of vessels may result in additional injury to neurovascular structures and should not be done.

NOTE: The current ATLS manual discourages the use of tourniquets in the pre-hospital setting because of distal tissue ischemia, tissue crush injury at the tourniquet site, which may necessitate subsequent amputation. This admonition is based on the civilian model of trauma care where most penetrating injuries are low velocity in nature and rapid evacuation to a trauma center is available. Withholding the use of tourniquets on the battlefield for patients with severe extremity hemorrhage may result in additional death or injury that might have otherwise been prevented.
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