Should civilian pre-hospital emergency care provision include tourniquets for the management of uncontrolled traumatic haemorrhage?

Abstract

Introduction Tourniquets are used extensively in military settings, where they have proven to be an effective means of managing uncontrolled external haemorrhage. This review aims to determine the value of tourniquets in the civilian pre-hospital setting. Methods A literature search was performed using the following electronic databases from inception to June 2014: MEDLINE, Academic Search Premier and the Cochrane Library. Additional searches were conducted in the Victoria University Library search engine. Key search terms included: pre-hospital, tourniquet, military, complications, failure, ischaemia, 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, two were determined to be relevant, published and peer reviewed case reports while the other 14 were peer reviewed and published studies. Results Tourniquet use for controlling major external 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 ischaemia, 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. Conclusion To date there is little evidence of tourniquet use in civilian environments, yet recent inclusion into clinical practice by ambulance services in the United Kingdom may yet provide valuable data through future studies. Tourniquet use in civilian environments is considered controversial due to complications and shortfalls. These factors contribute to user apprehension.