Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review

Pablo Roman; Amanda Rodriguez-Alvarez; Daniel Bertini-Perez; Carmen Ropero-Padilla; Luis Martin-Ibañez; Miguel Rodriguez-Arrastia

doi:10.1111/jocn.15834

Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review

J Clin Nurs. 2021 May 9. doi: 10.1111/jocn.15834. Online ahead of print.

Authors

Pablo Roman^{1

2

3}, Amanda Rodriguez-Alvarez⁴, Daniel Bertini-Perez⁵, Carmen Ropero-Padilla^{6

7}, Luis Martin-Ibañez⁸, Miguel Rodriguez-Arrastia^{6

7}

Affiliations

¹ Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.
² Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain.
³ Health Research Centre, University of Almeria, Almeria, Spain.
⁴ Torrecardenas University Hospital, Almeria, Spain.
⁵ Emergency Department, University Hospital of Guadalajara, Guadalajara, Spain.
⁶ Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castellon de la Plana, Spain.
⁷ Research Group CYS, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain.
⁸ Field Artillery Group, Light Infantry Brigade "King Alfonso XIII" II of the Legion, Almeria, Spain.

PMID: 33969561
DOI: 10.1111/jocn.15834

Abstract

Aims and objectives: The aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use.

Background: Trauma-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 methods: An 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.

Results: A 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.

Conclusions: Commercial tourniquets such as Combat Application Tourniquet or Emergency Tourniquet models are a valuable and safe instrument for haemorrhage control in both military and civilian out-of-hospital care settings. Nurses, as part of emergency teams, and other professionals should be aware that there is a possibility of adverse complications, but they are directly proportional to the time of tourniquet placement and generally temporary. In addition, national and international guidelines ensure the need for all civilian emergency services to be equipped with these devices, as well as for the training of healthcare professionals and first responders in their use.

Relevance to clinical practice: Despite the lack of complications in the use of tourniquets in these cases, their use has been a matter of debate for decades. In this sense, this review yields up-to-date guidelines in the use of tourniquets, their recommendations and their significance among professionals to manage complicated situations.

Keywords: extremity trauma; first aid; haemorrhage control; injuries; review literature as topic; tourniquets.

Publication types

Review