Life Over Limb: Why Not Both? Revisiting Tourniquet Practices Based on Lessons Learned From the War in Ukraine

Area of Science:

• Trauma Surgery
• Military Medicine
• Emergency Medical Services

Background:

• Tourniquets are a standard treatment for life-threatening limb hemorrhage in military and civilian settings.
• Current guidelines from the U.S. Department of Defense (DoD) Committee on Tactical Combat Casualty Care (CoTCCC) and NATO are based on evidence from conflicts with short transport times and lower casualty rates.
• Prolonged tourniquet application or misuse can lead to complications.

Purpose of the Study:

• To examine tourniquet practices in the context of the war in Ukraine.
• To identify factors contributing to tourniquet-related complications in prolonged care scenarios.
• To propose interventions to reduce morbidity and mortality associated with tourniquet use in high-intensity conflicts.

Main Methods:

• Case series analysis from the war in Ukraine.
• Review of factors influencing tourniquet efficacy and complications in prolonged field care.
• Discussion of potential interventions for current and future conflict settings.

Main Results:

• Preliminary findings suggest that current tourniquet practices in Ukraine are associated with increased limb amputations.
• Observed complications include higher overall morbidity and mortality.
• There is an increased burden on the medical system due to these complications.

Conclusions:

• The changing nature of warfare, including near-peer conflicts and contested airspace, necessitates a re-evaluation of tourniquet protocols.
• Prolonged time to definitive care and limited training resources in high-intensity conflicts exacerbate tourniquet-related complications.
• Interventions are needed to mitigate the risks of tourniquet misuse and prolonged application, aiming to reduce adverse outcomes.