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

The tourniquet is a simple device that has been used since the Middle Ages. Although different variations have been designed throughout its history, the simplicity of design has remained. The history of tourniquets follows two distinct paths--the operating room and the prehospital setting. From the earliest recorded history, tourniquets have been used for surgical procedures which were originally to amputate war-ravaged limbs and then to create a bloodless field for routine limb surgery. This history has continued uninterrupted since the early 1900s with continued research to foster advances in knowledge. The history of tourniquets in the prehospital setting, however, has not progressed as smoothly. The debate regarding the use of a tourniquet to save a life from excessive limb hemorrhage began in the 1600s, and continues to this day. This chapter will explore the prehospital use of tourniquets, which may shed some light on where this debate originated. The current state of the knowledge regarding tourniquets will then be discussed with a focus on prehospital use, using the operating room literature when needed to fill knowledge gaps. The chapter will conclude with recommendations for prehospital tourniquet use and some areas for future research. Tourniquets are used for operative procedures within accepted clinical guidelines throughout the world as the standard of care. Current science supports a similar stance for the use of prehospital tourniquets within clinical guidelines.