We continue to recommend applying the tourniquet “high and tight” for extremity injuries and at least a “hand palm” width above the injury, never over a joint. It has been found, that even for prolonged applications of the tourniquet, long term CMS injury to the distal extremity is limited. Orthopedic surgeons use the intervention frequently for joint replacement, etc, to limit bleeding, with positive outcomes. In order for a tourniquet to work adequately, it has to be placed over the part of the extremity that has a single bone in order to get adequate compression.