How hemorrhage control became common sense (original) (raw)
Related papers
Military Medicine, 2011
INTRODUCTION Historically most emergency tourniquet use results have been bad, but we reported recently the fi rst quality evidence that tourniquets could be lifesaving. Although prehospital hemorrhage control is held to be vital to improved trauma care 1-5 and recent American military reports indicate tourniquets appear lifesaving, 6-9 yet are controversial even on the battlefi eld. 8,10,11 Some military surgeons have offered limited and guarded support of tourniquets, 10,12 whereas other authors have described them as good and bad tools depending on how they were used. 13-16 For want of data and analysis, a pattern of tourniquet lessons learned and lost has been repeated on battlefi elds since the decline and fall of the Roman Empire. 17-19 Until recently tourniquets were considered a treatment of last resort, therefore, few clinicians accrued substantial experience with them. Lack of experience and knowledge led to morbidity and mortality in prior wars. 19 For example, some experienced surgeons felt that more limbs and lives were lost from improper tourniquet use than were saved by proper use. 20-26 Recent developments in Tactical Combat Casualty Care led by Captain Frank Butler focused efforts aimed to save lives of limb-injured casualties on the battlefi eld. 3,27-30 Since the preponderance of historical data confl icted with our recent reports, changes in investigators, possibly changing mechanisms of injury and resultant wounding patterns, we felt it was imperative to see if the prior results were consistent over time. We continued with clinical research at the U.S. combat support hospital in Baghdad, Iraq, where all providers turned over in a scheduled fashion and the on-site primary investigator changed to begin another 6-month period. 6,13,31 We hypothesized that tourniquets might cause morbidity associable with such changes. Our objective was to analyze emergency tourniquet use to assess consistency in results. METHODS Study Design We aimed to see if our prior work fi ndings on emergency tourniquet use were report consistent. If the results were consistent, then to pool data and see if there was justifi cation to refi ne practical recommendations. We continued the approved protocol (Brooke Army Medical Center institutional review board). The fi rst 6-month period began in March 2006 and the second 6-month period followed the fi rst. There was a 4-day training period for the second author with the fi rst author. The fi rst author, an orthopedic surgeon with extensive experience with emergency tourniquet use, was replaced as site investigator by a registered nurse of the military's Deployed Combat Casualty Care Research Team who was new to emergency tourniquets. The investigators and hospital providers turned over simultaneously. Methods are detailed in our previous reports. 6,13 In brief, we continued a prospective observational survey with cohort and subgroup analyses (NCT00517166 at
Combat casualty care research at the U.S. Army Institute of Surgical Research
Journal of the Royal Army Medical Corps, 2009
The Institute of Surgical Research is the U.S. Army's lead research laboratory for improving the care of combat casualties. The Institute follows a rigorous process for analyzing patterns of injury and the burden of disease to determine where research can be conducted in order to positively impact care. These analyses led the ISR to focus research on: preventing death from bleeding; developing improved pain control techniques; developing improved vital signs analysis techniques; improving the treatment of extremity injuries; preventing burn injuries on the battlefield; and improving critical care for combat casualties. This process has resulted in numerous improvements in care on the battlefield. Highlights include development, fielding, and efficiency testing of tourniquets and improved dressings for bleeding control. Significant progress has also been made in the resuscitation of combat casualties using blood products instead of crystalloid or colloid solutions. Improvements i...
Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience
The Journal of trauma, 2003
Tourniquet application is a known means for bleeding prevention in the military prehospital setting. This study was a 4-year retrospective analysis of silicone and improvised tourniquet applications by Israeli Defense Force soldiers. Of 550 soldiers who were treated in the prehospital setting, tourniquets were applied to 91 (16%) patients and in less than 15 minutes in 88% of the cases with almost no complications. Penetrating trauma was the main mechanism of injury. The indication was situational and nonmedical in 58 (53%) of the cases. The patients' ischemic time was 83 +/- 52 minutes (range, 1-305 minutes). A total of 78% of applications were effective, with higher success rates for medical staff compared with fellow soldiers and for upper limbs (94%) compared with lower limbs (71%, p < 0.01). Tourniquet application is an effective and easily applied (by medical and nonmedical personnel) method for prevention of exsanguination in the military prehospital setting.
Journal of Clinical Nursing, 2021
Aims and objectivesThe aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use.BackgroundTrauma‐related haemorrhage constitutes one of the most preventable deaths among injured patients, particularly in multi‐casualty incidents and disasters. In this context, safe instruments such as tourniquets are essential to help healthcare professionals to minimise loss of life and maximise patient recovery.Design and methodsAn integrative review was conducted in Medline, Nursing & Allied Health Premium, and Health & Medical Collection, using published data until March 2021 and following the PRISMA guidelines.ResultsA total of 25 articles were included. Evidence has been synthesised to understand the use of different types of tourniquets, environment of application, indication for their placement and potential complications associated with tourniquet placement.ConclusionsCommercial tourniquets such a...
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2013
The vast majority of combat casualties who die from their injuries do so prior to reaching a medical treatment facility. Although most of these deaths result from nonsurvivable injuries, efforts to mitigate combat deaths can still be directed toward primary prevention through modification of techniques, tactics, and procedures and secondary prevention through improvement and use of personal protective equipment. For deaths that result from potentially survivable injuries, mitigation efforts should be directed toward primary and secondary prevention as well as tertiary prevention through medical care with an emphasis toward prehospital care as dictated by the fact that the preponderance of casualties die in the prehospital environment. Since the majority of casualties with potentially survivable injuries died from hemorrhage, priority must be placed on interventions, procedures, and training that mitigate death from truncal, junctional, and extremity exsanguination. In response to th...
Black Hawk Down: The evolution of resuscitation strategies in massive traumatic hemorrhage
Critical Care, 2008
Expanded Abstract Citation Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, Jenkins D, Wade CE, Holcomb JB: The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 2007, 63:805-813 [1].
Military medicine, 2015
Military data demonstrate that exsanguinating hemorrhage is the leading cause of potentially preventable combat death. The purpose of this study was to evaluate attitudes and approaches of civilian law enforcement personnel in the management of acute hemorrhagic trauma. Anonymous survey administered via an online distribution mechanism. 1,317 U.S. law enforcement personnel began the survey. 370 respondents (30.4%) reported their agencies issued tourniquets, whereas 48.8% indicated their agencies had provided specific training in tourniquet application. Pressure dressings were provided to 43.6% of respondents while hemostatic agents were available to 29.8%. Tourniquets were considered the intervention most likely to save a life, but were also deemed most likely to possibly cause harm or injury if used inappropriately. 43 respondents (0.036%) stated they were aware of circumstances within the past year in which an officer in their agency sustained injuries where a tourniquet could hav...
Prehospital Tourniquet Use in Operation Iraqi Freedom: Effect on Hemorrhage Control and Outcomes
The Journal of Trauma: Injury, Infection, and Critical Care, 2008
Background: Up to 9% of casualties killed in action during the Vietnam War died from exsanguination from extremity injuries. Retrospective reviews of prehospital tourniquet use in World War II and by the Israeli Defense Forces revealed improvements in extremity hemorrhage control and very few adverse limb outcomes when tourniquet times are less than 6 hours.
Managing Life-threatening Traumatic Hemorrhage
2019
Millions of people die from major trauma annually. 30-40% of these deaths are due to exsanguination, with nearly half dying prior to hospital arrival. When properly managed, these deaths are preventable. This paper summarizes data relating to the extent of hemorrhage as a cause of mortality in the traumatic arena. An overview of the pathophysiological steps occurring during massive bleeding and their clinical implication is presented. A variety of treatment options, both historical and current, is then discussed, including vascular occlusion methods and hemostatic dressings, along with their limitations and complications. Finally, WoundClot, a new hemostatic gauze, is introduced, which not only requires no compression when it is applied, but allows the first responder to rapidly and effectively treat more than one casualty within seconds. Additionally, it is adaptable to a wide array of clinical applications, both traumatic and surgical, including situations where vascular occlusion...