How often should a tourniquet be loosened?

If you work in military, police, or response environments where time is life, this is one of those questions that seems to have many answers… but in reality there is only one correct one.

Let's get to the point: in the modern tactical field (police, military, private security...) you do not loosen a tourniquet until qualified medical personnel take control in a controlled environment.

I repeat because it's key:
A tourniquet applied effectively MUST NOT be loosened during the intervention. It is only removed or converted by trained medical staff, once the threat has ceased and clinical criteria are met.

If you are equipping your first aid kit, here you can see tactical tourniquets certified and prepared for real use.

Why in the military setting is a tourniquet not loosened?

TCCC (Tactical Combat Casualty Care) protocols state that once a tourniquet is applied it is not loosened or released in the tactical environment. The reason is simple: a massive arterial hemorrhage can be lethal within minutes.

Loosening a tourniquet during an intervention can cause:

• Immediate resumption of arterial bleeding.
• Rapid worsening of hypovolemic shock.
• Contamination of the wound by moving tissues.
• Loss of hemorrhage control and the seal achieved.

When we are in an intervention there is no margin for error: the tourniquet is kept until medical personnel decide to convert or replace it.

How often should a tourniquet be loosened?

Official answer: It is never loosened periodically. The practice of “loosen to relieve” or “intermittent perfusion” is a dangerous myth and has been discarded.

Only trained medical personnel should remove the tourniquet. Conversion (changing the method of hemorrhage control) is performed in a medical or semi-secure environment when three criteria are met: the patient is not in shock, the wound can be monitored, and the tourniquet is not controlling an amputation. In addition, conversion is attempted within the first 2 hours if the bleeding allows, and a tourniquet that has been in place for more than 6 h is never removed except in the operating room.

Safe duration of a tourniquet

Combat evidence shows that a quality tourniquet can be maintained for several hours without compromising limb viability. Studies show that most limbs are saved with times under 4 hours, and that risks increase significantly after 6 hours. Therefore, it is recommended to convert before 2 hours when possible and to avoid exceeding 6.

Situations in which it can be removed or converted

Only doctors or highly trained medical personnel can:

• Reassess the tourniquet, expose the wound and check the distal pulse.
• Apply a replacement tourniquet directly over the skin and, if effective, slowly release the original.
• Convert it into a hemostatic or compressive dressing if the patient is stable, the wound can be monitored and there is no amputation.

This is never done under fire or during evacuation. It requires a safe environment and medical supervision.

Why the myth of “loosen every X minutes” arose

During the 20th century it was believed that keeping a tourniquet inevitably caused amputation. Today it is known that amputation depends on the initial injury and on extreme duration of ischemia, not on the tourniquet itself. The long-term risk is much lower than allowing the patient to bleed to death.

Which tourniquet to use in a military environment?

An inadequate tourniquet can fail to stop arterial flow, break, or slip. At SERMILITAR we work only with certified tourniquets used by military forces. You can see them here: tactical tourniquets.

Don't risk a comrade's life with imitations.

How a military person should apply a tourniquet

1. Place it high and tight

It should be above the wound, avoiding joints. Pain is normal and means it is properly tightened.

2. Apply it in less than 10–15 seconds

Training is key: practice with one hand so you can apply it even if you are wounded.

3. Check that bleeding and distal pulse have stopped

If it keeps bleeding or there is a pulse, tighten more or place a second tourniquet.

4. Record the time of application

It is critical for medical teams; write it on the tourniquet and on the evacuation card.

5. Keep the tourniquet visible

Do not cover it with clothing or dressings; medical staff must see it quickly.

6. Do not loosen it or “test” it

A properly applied tourniquet is left in place until hemorrhage control is guaranteed by medical personnel.

Situations where loosening a tourniquet would be deadly

• Under enemy fire or under direct threat.
• During evacuation or transfer of the casualty.
• Inside a moving vehicle.
• In any environment without medical control or supervision.
• When you cannot see the wound or monitor the bleeding.
• If the patient shows signs of shock or instability.

In all these situations, loosening a tourniquet can reopen the bleeding and compromise survival.

Frequently asked questions (military version)

Is a tourniquet loosened to relieve pain? Never. Pain is a lesser evil; bleeding kills.

Does the tourniquet cause amputation? Limb loss depends on the injury and the duration of ischemia. Most limbs are salvageable if converted before 4 h; risks increase after 6 h.

If the bleeding seems to have stopped, can I loosen it? No. Evaluation and conversion are only performed by medical personnel in a controlled environment.

Is an improvised tourniquet useful? Only if you don't have a certified one. A certified tourniquet is always preferable.

Is it better to put two tourniquets? If bleeding does not stop with one and there is distal pulse, yes: place a second one just above the first.

Conclusion

Burn this into memory:

In the military context, a tourniquet MUST NOT be loosened or removed except by trained medical personnel.

Keep it firm, well tightened and visible until a medic converts or replaces it.

Massive hemorrhage is one of the leading preventable causes of death in combat. A well-applied tourniquet saves lives; one loosened without control puts them at risk.