Tactical Survival

Wilderness medical professionals often operate in austere environments where evacuation is delayed and resources are limited. In such settings, the tactical use of tourniquets can be both life-saving and limb-threatening. Recent conflicts and remote disaster responses have shown that while tourniquets prevent exsanguination, their prolonged use without proper reassessment can lead to severe complications . The Ukraine conflict, for example, revealed that evacuation delays of 12-24 hours can turn a properly applied tourniquet into a source of significant morbidity when left in place too long . Reports from Ukrainian surgeons describe a "prolonged tourniquet application syndrome," including unnecessary amputations, compartment syndrome, rhabdomyolysis, and acute kidney injury due to tourniquets left on for many hours . These sobering lessons underscore the need for evidence-based tourniquet guidelines tailored to wilderness and other remote contexts.