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For their own good
Fifty years ago, they were screwed-up kids sent to the Florida School for Boys to be straightened out. But now they are screwed-up men, scarred by the whippings they endured. Read the story and see a video and portrait gallery.
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The tourniquet: a lifeline maligned no more
It was thought that this low-tech device did more harm than good. Iraq veterans beg to differ.
By Lane DeGregory, Times Staff Writer
Published October 14, 2007
EMT and Army medic Andrew Harriman of Largo, who saved his own life and several others' using tourniquets, is recovering with physical therapy.
The Combat Application Tourniquet is a nylon and plastic device with a Velcro strip.
The Army medic was climbing into a helicopter outside Baqubah, Iraq, when he felt the bullets sear through his left thigh.
He lurched backward, crumpled to the ground. His pants leg grew heavy with his blood.
Andrew Harriman, 24, grew up in Largo. A graduate of Admiral Farragut Academy, he became an EMT for SunStar ambulance service at 18, joined the Army six months later.
Now - just before 11 p.m. on March 26 - he writhed in the dark, groping at his wound. He felt his life draining through his leg.
As he lay beside the helicopter, he dug into the left pocket of his blood-sticky pants and yanked out a decidedly low-tech tool that has proved to be a lifesaver in this high-tech war: a tourniquet.
He always carried at least eight.
He slipped the black strap around his thigh, twisted the stick and cinched it tight, like a noose. He felt his skin tissue compressing, bone crushing, "the greatest pain you can imagine - worse than the bullets." Almost instantly, his blood stopped spurting.
He saved his leg - and his life.
"When I first got to my unit in 2004, they told us not to use tourniquets. They were a last resort," Harriman said. "But the thought on that has changed. I know I wouldn't be here if I hadn't put that one on."
* * *
In this modern war of bullet-proof vehicles, Kevlar body armor and blood-clotting bandages, soldiers are saving lives with one of the oldest and simplest tools of combat medicine.
Harriman alone applied tourniquets 24 times during his eight months in the war. He saved an Iraqi police officer whose leg had been blasted through and a young Army specialist who was ambushed by insurgents.
When an anti-tank mine exploded beneath a truck of Iraqi soldiers, blowing limbs across the desert, Harriman applied 11 tourniquets.
Tourniquets have been used on battlefields for more than 300 years, but they had been shunned by the military since the end of World War II.
Now Army doctors say they're indispensable - and they've begun designing more modern versions, including a type that can be tied with one hand. The Combat Application Tourniquet was named one of the Army's 10 greatest inventions for 2005.
Last year, every soldier sent to Iraq was issued one in his first aid kit.
For $19, you can buy one on eBay.
"We've seen a tremendous increase in the use of tourniquets across the entire Iraq-Afghanistan theater," U.S. Army Col. Brian Eastridge said last week from Baghdad. Eastridge, a trauma surgeon, travels to medical centers throughout the war zone.
"From soldiers to surgeons," he said, "there's no longer any question that tourniquets have saved hundreds of lives."
* * *
Named from the French verb tourner, to turn, tourniquets stop bleeding by crimping a severed artery. A French Army surgeon first tied one on a soldier in 1674. During the Civil War, troops had to carry a 6-inch stick of wood and a handkerchief - and know how to tie them into a tourniquet. The U.S. military issued rope-and-peg-style versions during the two world wars.
Then word started spreading: Tourniquets caused gangrene. Soldiers who waited 12, 20 hours, or even days to be evacuated to field hospitals lost limbs because their tourniquets were tied on too long. Doctors began denouncing them; medics stopped using them.
"A lot of our bad mojo about using tourniquets was just dogma from an era gone by," Eastridge said. "They became basically taboo in the U.S. because of the risk of limb loss. But if you're bleeding to death, obviously, we want to choose life over limb."
Hundreds of men - maybe thousands - who bled to death in Korea and Vietnam could have been saved, Army surgeons now say, with a device any Boy Scout could fashion with a bandanna and a stick.
You can bleed to death in 10 minutes. It takes 30 seconds to tie a tourniquet.
* * *
Many of the first deaths during the Iraq war were soldiers who lost a limb and bled to death in the field. Some soldiers tried to make tourniquets out of Ace bandages, bungee cords, rifle slings. But in the desert, they couldn't find sticks to twist them tight enough.
"We were seeing all kinds of improvised devices coming into the hospitals here," Eastridge said. Soldiers arrived with their thighs sheathed in wire, tightened around fuel can nozzles and tire irons. Others had tried to stave the bleeding with bandages.
Now that most of the injured are transported to medical centers within a few hours, the tourniquets don't have to be on long enough to lose limbs. So doctors decided they needed to clear the device of its bad name - and come up with a better design.
It was the first time they'd been able to change doctrine during a war.
In 2004, during what was dubbed the "Tourniquet-Off," volunteers tested nine designs at the U.S. Army Institute of Surgical Research in San Antonio.
A pneumatic device, like a really tight blood-pressure cuff, couldn't withstand the dust from Iraqi deserts. Other versions couldn't be applied quickly enough. In the end, only three worked.
"We settled on the Combat Application Tourniquet, which has its own bar to twist and a Velcro strap to secure it," said Eastridge. "It's a simple, cheap device that has made a huge advance in the way we manage battlefield injuries."
* * *
These days, the colonel said, 15 to 25 percent of the injured soldiers who come into military medical centers in Iraq show up with tourniquets - an average of 100 a month.
Without a tourniquet, 40 percent of the injured soldiers die.
With a tourniquet, 90 percent live.
"I can't think of a single soldier who has lost a limb because of a tourniquet," said Eastridge, who has served four stints in Iraq.
"But because of tourniquets, hundreds have survived."
Harriman, the Largo medic who saved his own life - and two dozen others - with tourniquets, said he wishes he could use them on Pinellas County ambulances. As an EMT, he's not supposed to try a tourniquet.
Eastman, though, said the military's experience might change civilian attitudes toward tourniquets. "We'll probably start seeing them in paramedic training back home," the colonel said. "Because of what we've learned in this war, there might soon be tourniquets on every ambulance."
Times news researcher Angie Drobnic Holan and staff writer William R. Levesque contributed to this report. Lane DeGregory can be reached at (727) 893-8825 or firstname.lastname@example.org.