Place of a tourniquet in the modern algorithm to temporarily stop the bleeding in the prehospital phase

G.I. Pоsternak, V.V. Lesnoy


The article analyzes the evidence and disputed points in the algorithm of the temporary bleeding stop in the prehospital phase using modern tourniquets. The paper provides a brief description of Combat Application Tourniquet, SWAT-Tourniquet as the most common ones. Both the immediate survival of victims in extreme conditions and the quality of later life due to the minimization of post-tourniquet complications (tourniquet syndrome, peripheral neuralgia, limb frostbite in the cold season) depend on the knowledge of the staff of emergency medical teams about the modern tourniquets (Combat Application Tourniquet, Special Operations Forces Tactical Tourniquet, Mechanical Advantage Tourniquet, Ratcheting Medical Tourniquet, SWAT-Tourniquet). More than 100 years of using rubber band tourniquet revealed its shortcomings, which necessitated the search for new solutions and analysis of the problems identified. In 2004, after extensive researches and field tests conducted by the United States Army Institute of Surgical Research, which analyzed 10 different models of tourniquets, specific models of tourniquets were identified recommended for the use in rescue services. In contrast to all other methods of temporary hemostasis, tourniquet stops the blood flow not only in the damaged great vessel, but also in all its collaterals. In the absence of oxygenated blood flow, metabolism occurs by anaerobic type. Exceeding the permissible time for applying a tourniquet, the limb accumulates oxidized products of metabolism that cause cytolysis. After removing a tourniquet, oxidized products enter the bloodstream, causing a sharp shift in the acid-base balance towards metabolic acidosis. Сytolysis products cause gene­ralized vasoplegia, and myoglobin released from the muscle fibers is filtered in the urine and under acidosis precipitated in the renal tubules causing acute renal failure. External bleeding is the leading cause of deaths among the wounded persons with damage to the great vessels of the limbs. Tourniquet — an effective mean of temporary homeostasis in massive bleeding from the wounds of the extremities, but the violation of algorithm for temporary bleeding stop in the prehospital phase can neutralize the positive effects of modern tourniquets. Bleeding from the wounds of the major vessels of the limbs in not less than 75 % of cases can be stopped by pressure bandage. When using modified compression bandages together with modern local hemostatic agents, the frequency of the effective application of gentle methods of hemostasis in the prehospital phase will increase even more.


external bleeding; tourniquets; emergency medical care


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