Prehospital Tourniquets Placed on Limbs Without Major Vascular Injuries, Has the Pendulum Swung Too Far?

Legare, Timothy B; Schroll, Rebecca; Hunt, John P.; Duchesne, Juan; Marr, Alan B.; Schoen, Jonathan; Greiffenstein, Patrick; Stuke, Lance; Smith, Alison

doi:10.1177/00031348221088968

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…Complications were evaluated for each reported tourniquet exposure time in each article. Three articles reported times less than 55 minutes: 22, 40, 48, and 52 minutes, respectively [12][13][14][15]. These articles did not report significant complications.…”

Section: Complication Evaluationmentioning

confidence: 87%

Use of Tourniquets for Haemorrhage Control in Civilian and Military Prehospital Settings: Metabolic, Haemodynamic, and Anatomical Complications Derived From Exposure Time

Pineros Alvarez,

Villate–Lamos,

Munoz-Trejos

2024

Disaster Emerg Med J

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Section: Complication Evaluationmentioning

confidence: 87%

Use of Tourniquets for Haemorrhage Control in Civilian and Military Prehospital Settings: Metabolic, Haemodynamic, and Anatomical Complications Derived From Exposure Time

Pineros Alvarez,

Villate–Lamos,

Munoz-Trejos

2024

Disaster Emerg Med J

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“…A number of recent reports from the US civilian sector have also found, however, that tourniquets are often applied when they are not medically indicated, which is to say that the bleeding seen in the injured extremity was not severe enough to threaten the life of the trauma victim. 17,[34][35][36][37][38] The application of tourniquets when they were not medically indicated has been observed in both EMS and non-EMS first responders. The incidence of nonmedically indicated tourniquets in civilian settings ranges from 10.5% in one report 17 to 100% in one small case series.…”

Section: Prehospital Tourniquets Are Often Not Medically Indicatedmentioning

confidence: 99%

Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war

Butler,

Holcomb,

Dorlac

et al. 2024

J Trauma Acute Care Surg

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BACKGROUND Extremity tourniquets have proven to be lifesaving in both civilian and military settings and should continue to be used by first responders for trauma patients with life-threatening extremity bleeding. This is especially true in combat scenarios in which both the casualty and the first responder may be confronted by the imminent threat of death from hostile fire as the extremity hemorrhage is being treated. Not every extremity wound, however, needs a tourniquet. One of the most important aspects of controlling life-threatening extremity bleeding with tourniquets is to recognize what magnitude of bleeding requires this intervention and what magnitude of bleeding does not. Multiple studies, both military and civilian, have shown that tourniquets are often applied when they are not medically indicated. Overuse of extremity tourniquets has not caused excess morbidity in either the recent conflicts in Iraq and Afghanistan or in the US urban civilian setting. In the presence of prolonged evacuation, however, applying a tourniquet when it is not medically indicated changes tourniquet application from being a lifesaving intervention to one that may cause an avoidable amputation and the development of an array of metabolic derangements and acute kidney injury collectively called prolonged tourniquet application syndrome. METHODS The recent literature was reviewed for papers that documented the complications of tourniquet use resulting from the prolonged casualty evacuation times being seen in the current Russo-Ukrainian war. The literature was also reviewed for the incidence of tourniquet application that was found to not be medically indicated, in both the US civilian setting and from Ukraine. Finally, an in-person meeting of the US/Ukraine Tourniquet Working Group was held in Warsaw, Poland, in December of 2023. RESULTS Unnecessary loss of extremities and life-threatening episodes of prolonged tourniquet application syndrome are currently occurring in Ukrainian combat forces because of nonindicated tourniquet use combined with the prolonged evacuation time seen in the Russo-Ukrainian war. Specific numbers of the complications experienced as a result of tourniquet use by Ukrainian forces in the current conflict are treated as classified information and are not available, but multiple sources from the Ukrainian military medical personnel and from the US advisors providing medical assistance to Ukraine have all agreed that the problem is substantial. CONCLUSION Unnecessary tourniquet morbidity might also occur in US forces in a variety of potential future combat scenarios in which evacuation to surgical care is delayed. Prehospital trauma training programs, including but not limited to tactical combat casualty care, place insufficient emphasis on the need to avoid leaving tourniquets in place when they are not medically indicated. This aspect of training should receive emphasis in future Tactical Combat Casualty Care (TCCC) and civilian first responder curriculum development. An interim ad hoc training solution on this topic is available at the websites noted in this articles. Additional training modalities may follow in the near future. LEVEL OF EVIDENCE Therapeutic/Care Management; Level V.

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Prehospital tourniquet application in extremity vascular trauma: Improved functional outcomes

Thai,

Tseng,

Kishawi

et al. 2023

Surgery

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Prehospital Tourniquets Placed on Limbs Without Major Vascular Injuries, Has the Pendulum Swung Too Far?

Cited by 4 publications

References 21 publications

Use of Tourniquets for Haemorrhage Control in Civilian and Military Prehospital Settings: Metabolic, Haemodynamic, and Anatomical Complications Derived From Exposure Time

Use of Tourniquets for Haemorrhage Control in Civilian and Military Prehospital Settings: Metabolic, Haemodynamic, and Anatomical Complications Derived From Exposure Time

Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war

Prehospital tourniquet application in extremity vascular trauma: Improved functional outcomes

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