Evaluation of Possible Tourniquet Systems for Use in the Canadian Forces

King, Roger; Filips, Dennis; Blitz, Sandra; Logsetty, Sarvesh

doi:10.1097/01.ta.0000215429.94483.a7

Cited by 61 publications

(32 citation statements)

References 17 publications

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“…12,13 However, this renewed emphasis on tourniquets for prehospital hemorrhage control of extremity injuries is not agreed upon by all authors 14 -16 with some authors discouraging prehospital use of tourniquets altogether. [17][18][19][20] Dorlac et al 21 showed that tourniquet use is indicated in civilian trauma, albeit in a very small percentage of patients.…”

mentioning

confidence: 99%

Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma

Kragh¹,

Walters²,

Baer³

et al. 2009

Annals of Surgery

520

251

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Objective: The purpose of this study was to determine if emergency tourniquet use saved lives. Summary Background Data: Tourniquets have been proposed as lifesaving devices in the current war and are now issued to all soldiers. Few studies, however, describe their actual use in combat casualties. Methods: A prospective survey of injured who required tourniquets was performed over 7 months in 2006 (NCT00517166 at ClinicalTrials.gov). Follow-up averaged 28 days. The study was at a combat support hospital in Baghdad. Among 2838 injured and admitted civilian and military casualties with major limb trauma, 232 (8%) had 428 tourniquets applied on 309 injured limbs. We looked at emergency tourniquet use, and casualties were evaluated for shock (weak or absent radial pulse) and prehospital versus emergency department (ED) tourniquet use. We also looked at those casualties indicated for tourniquets but had none used. We assessed survival rates and limb outcome. Results: There were 31 deaths (13%). Tourniquet use when shock was absent was strongly associated with survival (90% vs. 10%; P Ͻ 0.001). Prehospital tourniquets were applied in 194 patients of which 22 died (11% mortality), whereas 38 patients had ED application of which 9 died (24% mortality; P ϭ 0.05). The 5 casualties indicated for tourniquets but had none used had a survival rate of 0% versus 87% for those casualties with tourniquets used (P Ͻ 0.001). H emorrhage from injured extremities continues to be one of the leading sources of preventable death on the battlefield. 1-4 Data from recent conflicts involving US military personnel confirmed the continued importance of improving prehospital hemorrhage control. 3,[5][6][7] In response, the US Army implemented a design, testing, training, and fielding program for battlefield tourniquets, 8 -11 resulting in policy that all military personnel in theater carry tourniquets. As a result of this effort, tourniquets are now common on the battlefields of Iraq and Afghanistan, both in the hands of medical and nonmedical personnel.With the Tactical Combat Casualty Care initiative, the US military is not alone in establishing procedures and equipment for use of tourniquets in the prehospital environment by both medical and nonmedical personnel. 12,13 However, this renewed emphasis on tourniquets for prehospital hemorrhage control of extremity injuries is not agreed upon by all authors 14 -16 with some authors discouraging prehospital use of tourniquets altogether. [17][18][19][20] showed that tourniquet use is indicated in civilian trauma, albeit in a very small percentage of patients. However, the lifesaving capability of tourniquets has been unproven. Most of the controversy regarding the capacity of tourniquets to save lives versus tissue damage has been based more on speculation rather than actual data, as research in the human use of emergency tourniquets is limited. Clearly, the discussion would be better informed with actual data regarding these critical concerns. In 2003, we initiated data collection regarding e...

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confidence: 99%

Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma

Kragh¹,

Walters²,

Baer³

et al. 2009

Annals of Surgery

520

251

View full text Add to dashboard Cite

show abstract

“…Although the US military is not alone in establishing procedures and equipment for the use of tourniquets in the prehospital environment by both medical and nonmedical personnel, 6,7 tourniquet use remains controversial and not agreed upon by all authors, 8 -10 with some authors banning prehospital use of tourniquets altogether. 11 Because we showed that tourniquets were lifesaving devices, the next important controversy regards tourniquet capacity to damage tissue and cause amputation.…”

mentioning

confidence: 99%

Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma

Kragh

Walters

Baer

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

279

214

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“…6 The strong belief, later reinforced by data, of the military community that tourniquets save lives on the battlefield was the impetus for evolution in their design. The initial CF tourniquet was improvised from surgical tubing 7 and progressed to field-durable, user-friendly, light windlass tour niquets that have proven themselves highly effective in the laboratory and on the battlefield. Currently every deployed CF soldier is trained to use and carries at least 1 commercially available windlass tourniquet, such as a Combat Application Tourniquet (CAT; Composite Resources).…”

Section: Lessons Learnedmentioning

confidence: 99%