Protocol T—Tourniquet Application Can Be Life-Altering

It is incredible to witness the evolution of the protocol before your very eyes. Years ago, when Protocol T: Tourniquet was released in Medical Priority Dispatch System^™ (MPDS^®) v13.2, there were many questions from EMDs who had been around for years. The biggest misconception was the perception taught in EMT/paramedic school that tourniquets were taboo and should never be used.

I recall several incidents from my younger years in which a tourniquet would have been very helpful in treating a patient. Thanks to research, science, and advancement in medicine, these are used in many EMS agencies, by the military, and are available to the general public. You can purchase one for $30 online, and it may be considered FSA/HSA eligible.

In 2015, the “Stop the Bleed” initiative was launched across the United States, and tourniquets were being placed in public areas, usually next to an AED for easy access. The International Academies of Emergency Dispatch^® (IAED^™) was on the front lines of this initiative, with Dr. Jeff Clawson leading the way. The IAED Research and Standards Department did a fantastic job developing a protocol for instructing a caller in a non-visual environment, including how to apply both a commercial and a makeshift tourniquet. Protocol T was validated through a 911 call simulation study, the first of its kind, and the research article was subsequently published in Prehospital Emergency Care, a major peer reviewed EMS journal.¹

Hopefully, you can appreciate the complexity of developing a new set of instructions like this. Imagine trying to teach someone over the phone how to tie a shoe who has never seen or worn a laced shoe before. These instructions are specific, time-sensitive, and rather complex when a commercial device is not available.

As we fast-forward to today, every country, region, and language using the MPDS has these instructions available. While Protocol T: Tourniquet is not commonly used, it is a vital tool in the toolbox for the EMD to use in potentially life-preserving instructions. The most important aspect of this protocol is the EMD recognizing the need to use it. This is why the DLS Link is specific to “Severe limb injury with catastrophic Hemorrhage evident.” EMDs should not hesitate, or be fearful, in applying a tourniquet when it is clearly appropriate—it usually takes a few hours after complete restriction of blood flow before real complications occur. Remember, it’s important to keep direct pressure on the wound while someone else retrieves the materials needed to create a tourniquet when one is not readily available.

Lastly, every EMD should take the time to review Protocol T and practice with a co-worker or someone else. The more familiar you are with this essential instruction sequence, the better prepared you will be when you need to give these potential life-preserving instructions.

Source
1. Scott, G., Olola, C., Gardett, M. I., Ashwood, D., Broadbent, M., Sangaraju, S., … Clawson, J. J. “Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions From an Emergency Medical Dispatcher.” Prehospital Emergency Care. 2020. doi.org/10.1080/10903127.2020.1718259 (accessed Dec. 18, 2025).