The effectiveness of tourniquets in prehospital care
DOI:
https://doi.org/10.33448/rsd-v11i11.24619Keywords:
Tourniquets; Hemorrhage; Emergency and prehospital care.Abstract
Objective: To analyze the effectiveness of tourniquets in prehospital care, looking at their benefits and possible risks. Methods: This is an integrative literature review, consisting of scientific articles on the theme "The effectiveness of tourniquets in the PHC" For this purpose, the Virtual Health Library (VHL) was used as a research source through the databases: SCIELO and PubMed. Results: Studies report that the early application of tourniquets serves to control damage and reduce mortality in traumatic accidents, as the containment of severe hemorrhages is the first step in the chain of survival. The tourniquet has proven and reported efficacy in controlling bleeding and its application can be performed in about 18.9 seconds, however, no tourniquet is free from complications and the user of such a tool at the PHC must understand its potential risks of complications and respect the length of permanence and reassessment limits. Final Considerations: The use of tourniquets in a civil prehospital environment, despite being much debated, can save lives and prevent damage. The tool allows a quick and effective control of severe hemorrhages, which can be the difference between life and death of a victim in the PHC, and the complications arising from it are largely due to its misuse. Proper instruction regarding the use of the tourniquet is of paramount importance so that the application of this tool is effective and that the possible damages arising from its application are minimal and, if they occur, reversible.
References
Aden, J. K., Ahimer, A., Baruch, E. M., Benov, A., Berg, A. L., Glassberg, E., Kragh, J. F., Jr., Shina, A., Shaifer, A. & Yitzhak, A. (2017). “Confidence-Competence Mismatch and Reasons for Failure of Non-Medical Tourniquet Users.” Prehosp Emerg Care 21 (1): 39-45.
Arborelius, U. P., Brännström, A., Günther, M., Gustavsson, J., Hartman, J., Nyman, N. & Rocksén, D. (2018). “Abdominal Aortic and Junctional Tourniquet release after 240 minutes is survivable and associated with small intestine and liver ischemia after porcine class II hemorrhage.” J Trauma Acute Care Surg 85 (4): 717-724.
Avraham, Y., Benov, A., Glassberg, E., Nachman, D., Nadler, R., Nirit, Y. & Shovali, A. (2017). “Slack Reducing Band Improves Combat Application Tourniquet Pressure Profile and Hemorrhage Control Rate.” Military Medicine 182 (1): 53-58.
Belcik, J. T., Davidson, B. P., Landry, G., Lindner, J. R. & Mott, B. H. (2016). “Quantification of residual limb skeletal muscle perfusion with contrast-enhanced ultrasound during application of a focal junctional tourniquet.” J Vasc Surg 63 (1): 148-153.
Benítez, C. Y., Guemes, A., Khan, M., Lima, D. S., Ottolino, P., Pereira, B. M. & Ribeiro, M. A. F., Jr. (2021). “Uso de torniquete nas hemorragias de extremidades na população civil: revisão sistemática da literatura.” Rev. Col. Bras. Cir 48 (1): 1809-1818.
Bennett, B. L., Drew, B. & Littlejohn, L. (2015). “Application of current hemorrhage control techniques for backcountry care: part one, tourniquets and hemorrhage control adjuncts.” Wilderness & Environmental Medicine 26 (2): 236-245.
Bernardin, B., Khwaja, K., Malo, C. & Nemeth, J. (2015). “Prolonged prehospital tourniquet placement associated with severe complications: a case report.” CJEM 17 (4): 443-446.
Brown, D. J., Kharod, C. U., Mapp, J. G., Redman, T. T., Ross, E. M. & Wampler D. A. (2018). “The Tourniquet Gap: A Pilot Study of the Intuitive Placement of Three Tourniquet Types by Laypersons.” J Emerg Med 54 (3): 307-314.
Callaway, D. W., Fabiano, S. E., Hannon, T., Puciaty, A. & Robertson, J. (2017). “Case Report: Life Saving Application of Commercial Tourniquet in Pediatric Extremity Hemorrhage.” Prehosp Emerg Care 21 (6): 786-788.
Callaway, D. W., Robertson, J. & Sztajnkrycer, M. D. (2015). “Law enforcement-applied tourniquets: a case series of life-saving interventions.” Prehosp Emerg Care 19 (2): 320-327.
Charuta, A., Leszczynski, P. & Zacharuk, T. (2021). “Cadaver as an educational tool increasing the effectiveness of Combat Application Tourniquet use in extremity injuries.” Ulus Travma Acil Cerrahi Derg 27 (2): 161-166.
Coleman, M. H., Dyer, S., Fisher, J., Gates, J., Kue, R. L., Temin, E. S. & Weigner, S. G. (2015). “Tourniquet Use in a Civilian Emergency Medical Services Setting: A Descriptive Analysis of the Boston EMS Experience.” Prehosp Emerg Care 19 (3): 399-404.
Cotton, B. A. & Wandling M. W. (2020). “Prehospital Care is Critical to Improving Outcomes After Major Trauma.” British Journal of Surgery 107 (4): 129-131.
Duchesne, J. C., Khan, M. A. & Stewart, S. K. (2015). “Improvised tourniquets: Obsolete or obligatory?” J Trauma Acute Care Surg 78 (1): 178-183.
Dulce, D., Eisenkraft, A., Gavish, L., Gerassi, S. D., Mark, N., Nachman, D. & Wagnert – Avraham, L. (2020). “Assessement of the Efficacy and Safety of a Novel, Low-Cost, Junctional Tourniquet in a Porcine Model of Hemorrhagic Shock.” Military Medicine 185 (1): 96-102.
Eilertsen, K. A., Hval, G., Jeppesen, E., Winberg, M. & Wisborg, T. (2020). “Prehospital Tourniquets in Civilians: A Systematic Review.” Cambridge University Press 36 (1): 86-94.
Gowen, J. T., Sexton, K. W. & Thrush, C. (2020). “Hemorrhage-Control Training in Medical Education.” Journal of Medic Education and Curricular Development. doi: 10.1177/2382120520973214.
McKay, P. L., Rasmussen, T. D., Rich, N. M. & Welling, D. R. (2012). “A Brief History of the Tourniquet.” Historical Vignettes in Vascular Surgery 55 (1): 286-290.
Mill, V.; Montán, C. & Wellme, E. (2020). “Evaluating tourniquet use in Swedish prehospital care for civilian extremity trauma.” Eur J Trauma Emerg Surg 47 (6): 1861-1866.
National Association of Emergency Medical Technicians. (2020). “PHTLS Prehospital Trauma Life Support. 9th Ed.” Burlington: Jones e Bartlett Learning.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Antônio Alves de Oliveira Neto; Andrey Hudson Interaminense Mendes de Araújo; Djair Soares de Farias
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.