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In Reply I agree with Dr Levy and colleagues that civilian tourniquet use is based primarily on the military’s experiences in Iraq and Afghanistan. I am a strong supporter of the efforts of the American College of Surgeons’ Stop the Bleed efforts. The Stop the Bleed course teaches direct pressure, wound packing, and the application of commercial tourniquets. The American College of Surgeons did recommend that “improvised tourniquets be applied only if no commercial device is available,” but commercial tourniquets are often not publicly available. Some state legislatures are working on policy to improve tourniquet availability, but in the meantime, recommendations to apply improvised tourniquets in the absence of commercial tourniquets should be followed.
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