Tourniquets like the CAT (Combat Application Tourniquet) have been around for decades, but the conception of tourniquet application was invented long before that.
It’s no surprise, then, that over such an extensive timeline, rules about applying tourniquets have changed in ways big and small. Each tweak of the process and adjustment to protocol has been the result of dedicated research and testing, and we can therefore confidently adhere to the changes knowing that we are providing the best emergency medical response that we are capable of providing in that moment.
Any time information changes, confusion can form and misinformation can spread. Many times, people fail to realize anything has changed at all. To squelch some of the confusion, we’re addressing some commonly overlooked or unknown best practices for tourniquet application.
Studies show that leaving a tourniquet on for more than two hours increases the risk of neurological damage. In most instances, neurological damage is not a concern because EMS will arrive and take over medical treatment long before an injured person has reached the two-hour threshold.
However, extreme circumstances sometimes occur in which a person may be stranded, lost, or unable to call for help. Situations like these may result in wearing tourniquet for an extended period of time, and while a tourniquet can cause permanent damage to a limb, removing it could result in death if the injured person loses too much blood. Therefore, the solution is simple: Do not remove a tourniquet. EMS and other medical professionals will know what to do when they reach you. Until then, your main goal is to stop the bleed.
There’s often confusion over whether or not an injured person should be moved. Moving someone with a severe hemorrhage will increase the flow of blood through their body and therefore increase their loss of blood. However, you must weigh your options and choose the lesser of two evils. If the injured person is in immediate danger (ex. in a hallway where an active shooter is approaching) drag them to safety (ex. inside an office with a lockable door). Once the person is removed from the direct threat, then work to stop the bleeding with a tourniquet or a makeshift tourniquet.
A person can bleed out in just 2-3 minutes, so do not let the fear of causing neurological damage keep you from applying a tourniquet. The alternative of not applying a tourniquet at all is much worse, and every moment wasted in hesitating to treat a severe hemorrhage is another ounce of blood lost.
Apply a tourniquet when…
Tourniquet application is not rocket science, but in an emergency situation, a person’s ability to think clearly is severely inhibited. That’s why it’s important to note what sometimes seem like very basic facts. Here are a few:
Do you feel ready to apply a tourniquet in an emergency? With skill-based, hands-on training, you will be able to confidently answer YES! Contact us today about our on-site emergency medical training classes for active shooter situations and more!
Jim served as a Sheriff’s Deputy in Illinois for 30 years. During his time as a Deputy, Jim served on the SWAT team as an operator, team leader and Commander. Jim was involved in several barricaded gunman/hostage incidents as well as service of high risk arrest and search warrants.
Jim was a member of the US Marshals Great Lakes Regional Fugitive Task Force where he performed surveillance and fugitive apprehension. His team was responsible for thousands of high risk felony fugitive arrests. Jim also served in the patrol division where he earned the rank of Sergeant and was responsible for patrol operations. Jim received numerous awards throughout his career to include Deputy of the Year, medal of valor and unit citation for SWAT operations.
Jim was a state certified CQB (Close Quarter Battle) SWAT instructor as well as an Active Shooter Response instructor, providing training for multiple law enforcement agencies throughout the state of Illinois.
I’m a proven leader with a diverse background in defense, law enforcement, and emergency response. My career began as a Scout Sniper in the U.S. Marine Corps, where I earned the Navy and Marine Corps Commendation Medal. I then served as a security contractor in Afghanistan and Iraq, further developing my tactical and crisis management skills.
Domestically, I served as a Deputy for the Greenville County Sheriff’s Office, earning a Medal of Valor, and as a firefighter, where I was awarded a Life Saving Ribbon. These roles reflect my commitment to safety and service, demonstrating leadership under pressure and a passion for protecting others.
As part of the Proactive Response Group Team, I design and deliver comprehensive medical training, developing lesson plans and conducting hands-on sessions. I ensure that participants are equipped with essential medical skills, fostering a culture of continuous improvement and readiness. My role is vital in preparing our team to handle medical emergencies confidently and competently.
Email: jpregel16@gmail.com
Phone: 720-382-3184
LinkedIn: https://www.linkedin.com/in/james-pregel-67765451/
Chris is a retired Major from the Greenville County Sheriff’s Office in South Carolina. Chris was third in command over operations, overseeing more than 300 sworn Deputies as well as all special teams within the Sheriff’s Office. In 2012, Chris helped to organize a Dignitary Protection Team within the Sheriff’s Office that assisted the Secret Service with Presidential and Vice Presidential visits throughout the state. In addition to his normal duties, Chris performs private security for dignitaries, celebrities, as well as 12 years with the Miss America Organization. Chris has been instructing Active shooter Response with ProActive Response Group since 2021.
In his down time, Chris enjoys time with his wife and daughter, as well as watching sports and fishing.
Email: ctaylor@proactiverg.com
Phone: 864-979-0978
LinkedIn: https://www.linkedin.com/in/chris-taylor-331b00150/
Tyrie Fowler is an Active Shooter Response instructor at Proactive Response Group and an Emergency Medicine Trauma Nurse at Prisma Health in Greenville. A Greenville native, Tyrie earned his Exercise Science degree from the University of South Carolina and his nursing degree from Mary Black School of Nursing. He joined Greenville Health System in 2015, transitioning from Orthopedic Trauma to Emergency Medicine. At Prisma Health, a Level One Trauma Center, he is part of the Trauma Nurse Leader team, with training in Advanced Trauma Care (ATCN) and Tactical Emergency Casualty Care (TECC). Tyrie is pursuing certifications in Emergency Nursing (CEN) and Trauma Certified Registered Nurse (TCRN).
Tyrie enjoys Fall for its long runs, college football (Go Gamecocks!), and hunting, including deer and quail. He also loves smoking recipes with a creative twist. As a medical instructor, Tyrie empowers bystanders to provide critical assistance in emergencies, teaching them to control bleeding and manage injuries, ensuring they leave his class confident in making a difference.
Steven J. Anderson is currently an Active Shooter Response Instructor for ProActive Response Group; he enjoys empowering people to survive in life threatening situations. Steve grew up in central Minnesota and spent three years with the United States Army. He graduated from St. Cloud State University with a degree in Criminal Justice. Steve worked as a federal agent for the United States Border Patrol where he was a member of the U.S. Border Patrol Tactical Unit (BORTAC): completing multiple assignments in Central & South America, an assignment with the United Nations and the Deputy Director (A) of the National Air Security Operation Center. In 2020 he retired from working in Federal Law Enforcement.
In his spare time he enjoys the outdoors especially bow hunting. Steve is a proud husband and father to 3 wonderful daughters.
Rob is originally from Louisville, CO. He joined the U.S. Marine Corps in 2003 and served as a Combat Engineer Officer until 2012. Rob deployed in support of Operation Enduring Freedom in 2009 and 2010 where he planned and implemented force protection strategy, counter improvised explosive device operations, and mobility operations for Third Battalion Sixth Marine Regiment and Third Battalion Seventh Marine Regiment . Upon his departure from the military, Rob began to teach firearms and tactics with Arizona based Alpine Arms while simultaneously running his own small residential security consulting firm. Rob relocated the South Carolina in 2021 and joined ProActive Response Group in early 2023.
When not working Rob spends time with his wife Lindsey and son Theo. He enjoys stand up paddle boarding, visiting the rifle range, four wheeling, and camping.
Phone: 720-382-3184
LinkedIn: https://www.linkedin.com/in/robert-christian-29579649/
Andy Sexton spent 12 years with the Greenville County Sheriff’s office in South Carolina, where he held the rank of Uniform Patrol Sergeant. His experience includes serving as an assistant SWAT team leader, involvement in high-risk incidents, including hostage rescues and the protection of dignitaries, working in criminal investigations (including armed robbery and homicide), and serving on the training committee for the Greenville County Sheriff’s Office.
