Should Civilian Pre-Hospital Emergency Care Provision Include Tourniquets for the Management of Uncontrolled Traumatic Haemorrhage?

Abstract

<jats:p>IntroductionTourniquets are used extensively in military settings, where they have proven to be an effective means of controlling major traumatic haemorrhage. This review aims to determine the value of tourniquets in the civilian pre-hospital setting.MethodA literature search was performed using the following electronic databases from inception to June 2014: Medline, Academic Search Premier and Cochrane Library. Additional searches were conducted in the Victoria University Library search engine. Key search terms included pre-hospital, tourniquet, military, complications, failure, ischemia, metabolic changes, history, and paramedics. Using the search terms outlined above, 236 articles were identified. With further examination 220 were excluded, leaving 16 for review (dated from 1974 - 2014). Of the 16 articles, 2 were determined to be relevant, published and peer reviewed case reports whilst the other 14 were peer reviewed and published studies.ResultsTourniquet use for controlling major haemorrhage is more accepted for military rather than civilian applications. Factors contributing to this include: lack of education and training, variation and incidence of specific mechanisms of injury, complications such as ischemia, decreased civilian scene times, and decreased civilian transport times to definitive care. Civilian research was inhibited by study numbers, with much of the data emanating from military research.ConclusionTo date, there is little evidence of tourniquet use in civilian environments. They are considered controversial due to complications and shortfalls. These factors contribute to user apprehension.</jats:p>

Dynamics of endogenous intoxication indicators in condition of acute blood loss complicated by ischemia-reperfusion of the limb, and their correction by carbacetam

“…In the works of some authors it is noted that reperfusion of the ischemic limb after removal of the tourniquet and restoration of blood flow causes inflammation of damage-induced local areas. Inflammatory mediators and toxic metabolites, entering the systemic bloodstream, can adversely affect vital organs [4,5]. It is proved that under conditions of acute blood loss complicated by ischemia-reperfusion of the limb, there are prerequisites for the development of dysfunction of internal organs [6].…”

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.…”

Dynamics of antioxidant-prooxidant balance in abdominal injury with underlying hypovolemic shock and reperfusion syndrom of the limbs in experiment

“…Certain scientific papers admit that reperfusion of ischemic limb after a hemostatic tourniquet is removed and blood circulation is restored provokes inflammation of the injured places (reperfusion damage of organs and tissues is possible 60 minutes after local ischemia) [19]. In their turn, produced mediators of inflammation and other toxic substances cause disorders of vital organs after penetration to the systemic circulation [20,21]. Considering the mentioned above examination of the effect of hemostatic tourniquet [28] application in case of a combined injury is important, especially under conditions of delayed pre-admission stage.…”