Removal of the Prehospital Tourniquet in the Emergency Department

Matthew J. Levy*, Jason Pasley, Kyle N. Remick, Alexander L. Eastman, Asa M. Margolis, Nelson Tang, Craig A. Goolsby

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Life-threatening hemorrhage from extremity injuries can be effectively controlled in the prehospital environment through direct pressure, wound packing, and the use of tourniquets. Early tourniquet application has been prioritized for rapid control of severe extremity hemorrhage and is a cornerstone of prehospital trauma resuscitation guidelines. Emergency physicians must be knowledgeable regarding the initial assessment and appropriate management of patients who present with a prehospital tourniquet in place. Discussion: An interdisciplinary group of experts including emergency physicians, trauma surgeons, and tactical and Emergency Medical Services physicians collaborated to develop a stepwise approach to the assessment and removal (discontinuation) of an extremity tourniquet in the emergency department after being placed in the prehospital setting. We have developed a best-practices guideline to serve as a resource to aid the emergency physician in how to safely remove a tourniquet. The guideline contains five steps that include: 1) Determine how long the tourniquet has been in place; 2) Evaluate for contraindications to tourniquet removal; 3) Prepare for tourniquet removal; 4) Release the tourniquet; and 5) Monitor and reassess the patient. Conclusion: These steps outlined will help emergency medicine clinicians appropriately evaluate and manage patients presenting with tourniquets in place. Tourniquet removal should be performed in a systematic manner with plans in place to immediately address complications.

Original languageEnglish
Pages (from-to)98-102
Number of pages5
JournalJournal of Emergency Medicine
Issue number1
StatePublished - Jan 2021
Externally publishedYes


  • prehospital tourniquet
  • stop the Bleed
  • tourniquet conversion
  • tourniquet removal


Dive into the research topics of 'Removal of the Prehospital Tourniquet in the Emergency Department'. Together they form a unique fingerprint.

Cite this