Chapter 9 prehospital tourniquets: review, recommendations, and future research

Area of Science:

• Medical History
• Trauma Care
• Surgical Innovation

Background:

• Tourniquets have a long history, dating back to the Middle Ages, primarily for surgical amputation and creating bloodless fields.
• Their use in the operating room has evolved with research and is considered a standard of care.
• The prehospital application of tourniquets, however, has faced historical debate and scrutiny regarding efficacy and safety.

Observation:

• The historical trajectory of tourniquet use diverges significantly between the operating room and prehospital settings.
• Debates surrounding prehospital tourniquet application for life-threatening hemorrhage began in the 17th century and persist.
• This review examines the origins of this debate and the current scientific understanding of prehospital tourniquet use.

Findings:

• Tourniquets are established as standard care in operative procedures worldwide.
• Current scientific evidence supports the use of tourniquets in prehospital settings under established clinical guidelines.
• Knowledge gaps in prehospital tourniquet use are addressed by referencing operating room literature.

Implications:

• Standardized clinical guidelines for prehospital tourniquet use are recommended.
• Further research into prehospital tourniquet application is warranted to refine best practices.
• Evidence-based recommendations aim to improve outcomes in emergency limb hemorrhage management.