Bleeding Control With Limb Tourniquet Use in the Wilderness Setting: Review of Science

Abstract

The purpose of this review is to summarize tourniquet science for possible translation to wilderness settings. Much combat casualty data has been studied since 2005, and use of tourniquets in the military has changed from a last resort to first aid. The US Government has made use of tourniquets a health policy aimed to improve public access to bleeding control items. International authorities believe that education in first aid should be universal, as all can and should learn first aid. The safety record of tourniquet use is mixed, but users are reliably safe if trained well. Well-designed tourniquets can reliably attain bleeding control, may mitigate risk of shock progression, and may improve survival rates, but conclusive proof of a survival benefit remains unclear in civilian settings. Even a war setting has a bias toward survivorship by sampling mostly survivors in hospitals. Improvised tourniquets are less reliable than well-designed tourniquets but may be better than none. The tourniquet model used most often in 2016 by the US military is the Combat Application Tourniquet (C-A-T), and civilians use an array of various models, including C-A-T. Evidence on tourniquet use to date indicates that most uses are safe and effective in civilian settings. Future directions for study relevant to the wilderness setting include consideration of research priorities, study of the burdens of injury or capability gaps in caregiving for various wilderness settings, determination of the skill needs of outdoor enthusiasts and wilderness caregivers, and survey of wilderness medicine stewards regarding bleeding control.

How important is the damage to the liver after lower limb ischemia-reperfusion? An experimental study in a rat model

“…One of the standard hemostatic procedures applied to patients who are exposed to vascular injuries is the application of a tourniquet to the injury area or a more proximal area in emergency departments. [10][11][12] Although there are debates on its effectiveness, this practice is still actively used in both military and civilian medicine. [10][11][12] The most common complications of this application are muscle cell necrosis, myoglobinuria, renal failure, and even death due to limb ischemia, particularly in prolonged tourniquet applications.…”

“…[10][11][12] Although there are debates on its effectiveness, this practice is still actively used in both military and civilian medicine. [10][11][12] The most common complications of this application are muscle cell necrosis, myoglobinuria, renal failure, and even death due to limb ischemia, particularly in prolonged tourniquet applications. [13,14] Definitely, this phenomenon, which may also affect the distant organs, is another problem that can arise from reperfusion injury, which may be a result of prolonged tourniquet applications.…”

Multiple trauma management in mountain environments - a scoping review

“…Continued extremity bleeding should be controlled with a tourniquet [63][64][65]. Modern tourniquets can decrease haemorrhage, prevent shock, decrease limb loss caused by ischaemia, and permit rapid extrication [66,67]. Mortality increases if tourniquet use is delayed until trauma-centre arrival [68].…”

Prehospital Tourniquets in Civilians: A Systematic Review

“…12 Two more studies were originally excluded from the title and abstract review, but were included after reading the full-text from references: one case report 13 and one literature review. 14 After excluding all non-primary literature such as literature reviews [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] and systematic reviews, [30][31][32][33][34][35] a total of 55 studies were included in this systematic review. The process from search result to inclusion is illustrated in Figure 1.…”