Management Tactics for Bleeding in Children With Military Trauma: Literature Data

Abstract

The civilian population always suffers during hostilities. There are modern protocols for emergencymedical care for military trauma in adults. However, for children, there are no approved guidelines, especially forthe management of bleeding. Trauma is the leading cause of death between the ages of 1 and 19, with blood lossaccounting for 40% of all deaths from injury. Regarding the causes of death during the war, bleeding accounted for80%. Limb circumference in children is usually much smaller than in adults, which calls into question the abilityof a standard turnstile to effectively stop bleeding in a child. Many turnstiles have a rigidly fixed mechanicalclamping system (such as a windlass or ratchet), which eliminates their effectiveness in applying to the limb with acircumference less than expected. Also, the pressure of the mechanical windlass system for children can be excessiveand lead to complications. However, there is reliable data on the effective classic application of the tactical turnstileСAT in children aged 1 year with a circumference of the limb of at least 13 cm and can be used by a medicalprofessional of any qualification. It is allowed to use the СAT turnstile in children from 3 months of age, but theapplication technique requires modification and experience of a medical professional. When stopping bleeding,children under 2 years of age are recommended to start with direct pressure on the wound, and only if ineffectiveor impossible pressure to apply a tourniquet to the limb above the wound, or tamponade the wound with nodularbleeding. However, in any case, in the presence of massive bleeding from the limb or amputation of the limb, theprimary method of stopping bleeding is currently the imposition of a tactical turnstile САТ.