Tourniquets: A Review of Current Use with Proposals for Expanded Prehospital Use

Abstract

The use of arterial tourniquets in prehospital emergency care has been fraught with controversy and superstition for many years despite the potential utility of these tools. This review examines this controversy in the context of the history of the tourniquet as well as its recent use in surgery and modern battlefield casualty care. Safe prehospital tourniquet use is widespread in the military and is based on sound physiologic data and clinical experience from the surgical use of tourniquets. The physiologic, pathophysiologic, and clinical underpinnings of safe tourniquet use are reviewed here, along with a discussion of alternatives to tourniquets. Prehospital settings in which tourniquets are useful include tactical emergency medical services (EMS) and other law enforcement environments as well as disaster and mass casualty incidents. Beyond this, we present arguments for tourniquet use in more routine EMS settings, in which it may be beneficial but has heretofore been considered inappropriate. Protocols that foster safe, effective prehospital tourniquet use in these settings are then presented. Finally, we discuss future directions in which tourniquet research and other initiatives will further enhance the safe, rational use of this potentially life-saving tool.

An Evaluation Concerning Tourniquets Application in a Simulated Tactical Environment

“…Moreover, the effectiveness and circumstances of the use of tourniquets often depends on the application efficiency. [7,8,10,11] Walters et al [12] confirmed the equal effectiveness of CAT, Emergency & Military Tourniquet, and SOFTT by using Doppler auscultation at the popliteal artery. However, except for the equipment effectiveness, a rescuer skills are a valid factor.…”

“…[18] There is no doubt that despite disadvantages of tourniquet use, tourniquets greatly increase the chances of survival of victims. [10,17,18,19] The use of tourniquets is not exclusively reserved for military institutions. Because of the easy and quick access to specialist care, in case of massive hemorrhage in case of civil casualties, assistance is provided in stages, the last of which is the tourniquet application.…”

“…[1] Cite this article as: Sanak T, Brzozowski R, Dabrowski M, Kozak M, Dabrowska A, Sip M, et al Evaluation of tourniquet application in a simulated Tactical environment. Ulus Travma Acil Cerrahi Derg 2018;24: [9][10][11][12][13][14][15] should be noted that 60% of deaths on the battlefield is associated with massive hemorrhage from the limbs in this phase. Phase II or the so-called tactical field care is defined as the seemingly safe zone.…”

Prolonged prehospital tourniquet placement associated with severe complications: a case report

“…These increase the risk for underlying tissue injury and may partially occlude arterial flow and increase venous pressure, which may increase hemorrhage. 13 Examples of suboptimal improvised tourniquets include belts and similar straps, elastic bandages, or sphygmomanometer cuffs. We believe that commercial tourniquets should be used when available because they are easy to apply in less than 1 minute and are not prone to loosening.…”

Notfallmedizin up2date

“…Abb. 10a,b; [32,33] [34]. Derartige Granulate müssen rechtsmedizinisch von anderen Fremdkörpern in der Wunde unterschieden werden.…”