Surgeons and medical officers of the Civil War began to develop systems for managing the initial treatment of the wounded. They also instructed troops in emergency first aid.
Union surgeon Samuel D. Gross gave instruction on using tourniquets:
"When the wound is severe, or involving a large artery or vein, the bleeding may prove fatal in a few minutes. Hundreds of persons die on the field of battle from this cause. They allow their life-current to tun out, as water pours from a hydrant, without an attempt to stop it by thrusting the finger in the wound, or compressing the main artery of the injured limb.They perish simply from their ignorance, because the regimental surgeon has failed to give the proper instruction.
"Every one may put into his pocket a stick of wood, six inches long, and a handkerchief, with a thick compress, and be advised how, where, and when they are to be used. By casting the handkerchief round the limb, and placing the compress over its main artery, he can put at once an effectual stop to the hemorrhage. This simple contrivance, which has been instrumental in saving thousands of lives, constitutes what is called the "field tourniquet". A fife, drumstick, knife, or ramrod may be used, if no special piece of wood is at hand."