Tourniquet Conversion: A Recommended Approach in the Prolonged Field Care Setting

Drew, Brendon; Bird, D. J.; Matteucci, Michael J.; Keenan, Sean

doi:10.55460/ij9c-6aif

Cited by 17 publications

(22 citation statements)

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“…Military experience has defined circumstances where tourniquet "conversion" can be considered. 23 The current experience motivated the study system to implement a formal conversion protocol. Further study of field tourniquet conversion would add to the understanding of which tourniquets can be safely removed by EMS providers.…”

Section: Discussionmentioning

confidence: 99%

“…This dual role for EMS may not be fully appreciated but requires that EMS providers understand not just when to apply a tourniquet but when a tourniquet may not be needed so it can be removed. Military experience has defined circumstances where tourniquet “conversion” can be considered 23 . The current experience motivated the study system to implement a formal conversion protocol.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prehospital tourniquet use: An evaluation of community application and outcome

Barnard¹,

Guan²,

Zarmer³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:There is substantial investment in layperson and first responder training involving tourniquet use for hemorrhage control. Little is known however about prehospital tourniquet application, field conversion, or outcomes in the civilian setting. We describe the experience of a metropolitan region with prehospital tourniquet application. METHODS:We conducted a retrospective cohort study characterizing prehospital tourniquet use treated by emergency medical services (EMS) in King County, Washington, from January 2018 to June 2019. Emergency medical services and hospital records were abstracted for demographics, injury mechanism, tourniquet details, clinical care, and outcomes. We evaluated the incidence of tourniquet application, who applied the device (EMS, law enforcement, or layperson), and subsequent course. RESULTS:A total of 168 patients received tourniquet application, an incidence of 5.1 per 100,000 person-years and 3.48 per 1,000 EMS responses for trauma. Tourniquets were applied for penetrating trauma (64%), blunt trauma (30%), and bleeding ateriovenous fistulas (7%). A subset was critically ill: 13% had systolic blood pressures of <90 mm Hg, 8% had Glasgow Coma Scale score of <13, and 3% had cardiac arrest. Among initial applications, 48% were placed by law enforcement, 33% by laypersons, and 18% by EMS. Among tourniquets applied by layperson or law enforcement (n = 137), EMS relied solely on the original tourniquet in 45% (n = 61), placed a second tourniquet in 20% (n = 28), and removed the tourniquet without replacement in 35% (n = 48). Overall, 24% required massive transfusion, 59% underwent urgent surgery, and 21% required vascular surgery. Mortality was 3% (n = 4). At hospital discharge, the tourniquet limb was fully functional in 81%, partially functional in 10%, and nonfunctional in 9%; decreased function was not attributed to tourniquet application. CONCLUSION:The high rate of application, need for urgent hospital intervention in a subset, and low incidence of apparent complication suggest that efforts to increase access and early tourniquet use can provide public health benefit.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prehospital tourniquet use: An evaluation of community application and outcome

Barnard¹,

Guan²,

Zarmer³

et al. 2021

J Trauma Acute Care Surg

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show abstract

“…[86][87][88][89] Drew et al have published a guideline for prolonged field care in the military, and this is a suitable referent for civilian consideration as it describes a procedure for qualified and trained medical personnel to safely exchange limb tourniquets for local wound dressings-a process called conversion. 85 A case report and review of prolonged use of tourniquets in a war setting noted the importance of limb temperature because the duration of tolerable ischemia is greater if the limb is cool. 89 Prolonged environmental exposure risks mechanical degradation of the material properties of field tourniquets, so it is recommended that they be protected from the elements by being stowed in a first aid pouch or case.…”

Section: Best Practices In Tourniquet Use and Its Adjuncts In Bleedin...mentioning

confidence: 99%

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

Kragh

Dubick

2017

Wilderness & Environmental Medicine

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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.

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“…A safe duration of ischemia ultimately depends on the organ and tissue being deprived of blood flow. In the case of muscle, nerve, and vascular tissue, a safe time limit of ischemia is somewhere between 1–3 h, but this remains poorly defined (Drew et al, 2015; Pedowitz, 1991). In general, the less time tissues spend under ischemia the better they recover.…”

Section: Introductionmentioning

confidence: 99%

“…calpain, ischemia, leupeptins, tourniquets, vascular system injuries 1-3 h, but this remains poorly defined (Drew et al, 2015;Pedowitz, 1991). In general, the less time tissues spend under ischemia the better they recover.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of leupeptin in treating ischemia in a rat hind limb model

Gurevich

Iocolano

Martin

et al. 2022

Physiological Reports

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Prolonged tourniquet use can lead to tissue ischemia and can cause progressive muscle and nerve injuries. Such injuries are accompanied by calpain activation and subsequent Wallerian‐like degeneration. Several known inhibitors, including leupeptin, are known to impede the activity of calpain and associated tissue damage. We hypothesize that employment of leupeptin in a rat model of prolonged hind limb ischemia can mitigate muscle and nerve injuries. Sprague–Dawley rats (n = 10) weighing between 300–400 g were employed in this study. Their left hind limbs were subjected to blood flow occlusion for a period of 2‐h using a neonatal blood pressure cuff. Five rats were given twice weekly intramuscular leupeptin injections, while the other five received saline. After 2 weeks, the animals were euthanized, their sciatic nerves and gastrocnemius muscles were harvested, fixed, stained, and analyzed using NIH Image J software. The administration of leupeptin resulted in larger gastrocnemius muscle fiber cross‐sectional areas for the right (non‐tourniquet applied) hindlimb as compared to that treated with the saline (p = 0.0110). However, no statistically significant differences were found between these two groups for the injured left hindlimb (p = 0.1440). With regards to the sciatic nerve cross‐sectional areas and sciatic functional index, no differences were detected between the leupeptin and control treated groups for both the healthy and injured hindlimbs. This research provides new insights on how to employ leupeptin to inhibit the degenerative effects of calpain and preserve tissues following ischemia resulting from orthopedic or plastic surgery procedures.

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Tourniquet Conversion: A Recommended Approach in the Prolonged Field Care Setting

Cited by 17 publications

References 0 publications

Prehospital tourniquet use: An evaluation of community application and outcome

Prehospital tourniquet use: An evaluation of community application and outcome

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

Efficacy of leupeptin in treating ischemia in a rat hind limb model

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