"High and tight to pack and press": Prioritization of tourniquet conversion in unconventional warfare improves outcomes.

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.