Brandon Lingle's work has appeared in various publications including The American Scholar, Guernica, The Normal School, The North American Review, and New York Times At War. He edits nonfiction for War, Literature, and the Arts. Views are his own. "Tourniquet" was a notable in The Best American Essays 2016.

Lingle's nonfiction, “Tourniquet,” was originally published in The Southeast Review Volume 33.2.

Tourniquet

The Iraqi boy beside me

reaches down to slide his fingertip in Retro Colonial Blue,

an interior latex, before writing

T, for Tourniquet, on my forehead.

—Brian Turner, “At Lowe’s Home Improvement Center”

Pre-deployment training, Camp Bullis, Texas:

During the block on combat first aid, or Care Under Fire, our instructor pulled out a new tourniquet—a candy-bar shape vacuum- sealed in clear plastic—and called for a volunteer. The instructor handed our classmate the package and yelled, “BOOM! Your right arm’s blown off! Get the tourniquet on! You’re bleeding out.” The simulated casualty, a righty, wrestled the wrapped tourniquet, bit and pulled at the plastic with his left hand. The instructor counted time with a Southern twang, “ten, eleven, twelve seconds.” Now, the student—a flat-topped NCO—bit at the tourniquet and pulled at the Velcro. “Twenty, twenty-one seconds, twenty-two, twenty-three.” He balanced the strap on his right biceps, reached under his arm to grab the end, but it fell. “Thirty-eight, thirty- nine, forty.” He tried again, the strap dropped again. Along with sixty others, I watch as the man struggled against the black strap in a pretend battle for his life. He frowned, his face reddened, sweat clung just below the hairline on his crinkled forehead. The instructor slapped the desk, said, “Stop, you’re dead.” He continued, “Learn this here. Learn this now, dammit. Keep your tourniquets ready. I know the supply guys tell you not to open your first aid kits unless you need ’em, but I’m telling you different. When you need ’em it’s too late.”

Despite all the training and preparation, the mind runs wild in the days before deployment. I always think of the different ways my commander could explain my death to my wife and children. No matter the circumstance that story will always positively portray the fallen. Siegfried Sassoon wrote in “The Hero” that an officer told a dead soldier’s mother “some gallant lies / That would nourish all her days no doubt.” I didn’t want anyone to be forced to concoct a story about me. I paid attention in training because my life depended on it, and I knew that all the training and equipment in the world couldn’t stop a bomb or bullet meant for me.

WARNING:

This is a single use product. The use of any tourniquet is A LAST RESORT and should only be employed when bleeding cannot be stopped and the situation is life threatening.

Instructions for Use: Two-handed Application

  1. Apply tourniquet proximal to the bleeding site. Route the band around the limb and pass the tip through inside slit of the buckle. Pull the band tight.

  2. Pass the tip through the outside slit of the buckle. The friction buckle will lock the band in place.

  3. Pull the band very tight and securely fasten the band back on itself.

  4. Twist the rod until bright red bleeding has stopped and the distal pulse is eliminated.

  5. Place the rod inside the clip, locking it in place. Check for bleeding and distal pulse. If bleeding is not controlled, consider additional tightening or applying a second tourniquet proximal side by side to the first and reassess.

  6. Secure the rod inside the clip with the strap. Prepare the patient for transport and reassess. Record the time of application.

In ’04, before the Battle of Fallujah, Marines wore tourniquets wrapped loosely around their biceps and thighs as they rolled into battle. That way, when an RPG took an arm or suicide bomber stole a leg, the Marine was ready. Tighten, twist, secure—mere seconds meant the difference between bleeding out and survival under the bright Iraqi sun. I wonder what it was like to willingly walk into a fight, ready to surrender a limb. In many ways all of us had already placed that bet when we set foot in our Mideast warzones.

I’ve searched for images of soldiers sporting pre-positioned tourniquets. More often than not, I find images of tourniquets strapped or rubber-banded to body armor. In 2011, during an interview with former Army surgeon Dr. Ron Glasser, National Public Radio reported “Marines, without anyone ordering them to do so, have begun heading out on foot patrols with the tourniquets already loosely strapped around their thighs, so they can be tightened quickly if a foot or a leg is blown off.” And, “Officers don’t like it. They view it as a kind of defeatism on the part of the troops.” He continued: “But the Marines don’t care. They basically say, ‘The hell with it. We’re going to wear it anyway. If our legs get blown off, at least we’ll survive.’” And, in ’09 the Wall Street Journal published a photo of Marines from Lima Company wearing tourniquets loosely on their ankles in Zad, Afghanistan. I know those tourniquets, I’ve seen their black straps sandwiched between ammunition and holsters or body armor and unit patches of skulls and Latin phrases.

As a fourth-grade Cub Scout, during a meeting at Kellogg Elementary School in Goleta, California, I watched the Cubmaster pull his red paisley handkerchief from a back pocket, wrap it around a skinny kid’s arm, tie a knot, stick his pen through, and twist. He said, “you’ll probably never have to use one of these, but I wanted to show you just in case.” That demonstration followed a lesson debunking legendary snakebite treatments, “Never, never, carve an ‘X’ where a snake bit someone, and never, never try to suck out the venom.”

A tool once considered the work of the devil, today’s tourniquets— black plastic and Velcroed fabric— are nothing more than reimagined ancient technology. The American Journal of Surgery reported that “A sixth century BC Hindu medical text described tourniquet use in snakebite care.” When “Alexander the Great invaded the Indus River valley,” the Hindu doctors “introduced tourniquets to the Greeks.” The Greek knowledge flowed to the Romans and both used bronze and leather straps to stem the blood flow. Throughout the 1500s surgeons in Prussia, Spain, North Africa, and Germany described using early tourniquets. And, “the first unambiguous claim of battlefield tourniquet use” came in 1674 when French army surgeon Etienne J. Morel “described a tourniquet used at the siege of Besançon.”

Most credit Jean Louis Petit, a French surgeon, with fashioning the first modern form of the device in 1718. Late in the 1700s many British sailors carried tourniquets, thanks to Sir William Blizard, but doctors remained divided on their effectiveness. Many felt the risks outweighed the benefits. British surgeon George H. B. Macleod debated their use in the Crimean War. During the American Civil War, Confederate surgeon,

J. Julian Chisholm “noted poor tourniquet results in a war surgery manual,” while Union surgeon Samuel D. Gross advocated that all soldiers should carry the tool. Dr. John F. Kragh wrote, “the most famous casualty in need of a tourniquet was a Confederate commander, Albert Sidney Johnston, who died of a gunshot wound while riding his horse, Fire-eater, at the battle of Shiloh in 1862. He had massive hemorrhage from a partial transection of the popliteal artery, yet an unused tourniquet was in his pocket.”

The debate continued throughout World War I, and some argued “It is no exaggeration to say that many limbs have been lost during indiscriminate use of them.” Following the Spanish Civil War, New Zealander Douglas W. Jolly echoed this sentiment: “More limbs and lives are lost at the front from the improper use of the tourniquet than are saved by its proper use.” During World War II, the “US Army strap and buckle tourniquet lost tension during application, and it was often ineffective on thighs.” The military used the same ineffective design through Korea and Vietnam with dubious results.

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