Standardizing Tourniquet Reassessment and Conversion Across TCCC Tiers: TCCC Guidelines Proposed Change 25-2
Koch EJ, Andersen M, Barbee GA, Boyd A, Clayton C, Hewitt CW, Maitha JC, Remley MA, Nguyen A, Kaleiohi J, Montgomery HR, Deaton TG, Butler FK, Gurney JM 26(1). 106
Publication Type: Classical Conference (TCCC Updates)
Abstract:
Operational experience from the Russo-Ukrainian War revealed frequent use of tourniquets that were not medically indicated and an increase in ischemic complications from prolonged tourniquet application as a consequence of extended evacuation times. In response to this, the Committee on Tactical Combat Casualty Care (CoTCCC) convened a working group to evaluate whether tourniquet reassessment and conversion practices should extend to the All Service Member (ASM) level. With input from NATO and partner nations, the Working Group developed a standardized, time-based algorithm that provides plain language guidance for reassessment, repositioning, and conversion. The proposed change replaces the term replacement with repositioning, affirms a reassessment window within 2 hours for nonmedical personnel, and limits conversion beyond 2 hours to medical personnel. These updates will expand lifesaving capability to nonmedical responders, reduce preventable morbidity and mortality from tourniquet use, and align TCCC principles with current operational realities.
Keywords: Tactical Combat Casualty Care; TCCC; tourniquet conversion; All Service Member; Tier 1; Prolonged Casualty Care
PMID: 41818038
DOI: doi.org/10.55460/J.Spec.Oper.Med.2026.M4V1-O3Y7
