Hemorrhage Control Tourniquets, Pressure, and Wound Firstaid by Red Crescent
DOI:
https://doi.org/10.22399/ijcesen.4010Keywords:
Hemorrhage Control, Tourniquet, Trauma, Exsanguination, Wound Packing, Hemostatic AgentsAbstract
Hemorrhage control is a critical component of trauma management, especially in cases of severe bleeding from extremity injuries. One of the most effective tools for controlling life-threatening hemorrhage is the use of tourniquets. When applied properly, a tourniquet can occlude blood flow to a limb, substantially reducing the risk of exsanguination until more advanced medical care can be provided. Various types of tourniquets exist, but those designed for prehospital use have undergone rigorous testing to ensure their effectiveness and safety. The application of a tourniquet requires training, as incorrect usage can lead to complications such as tissue damage; therefore, education on proper technique is paramount for first responders and civilians alike. In conjunction with tourniquets, the use of direct pressure on wounds and hemostatic dressings can also play a vital role in managing bleeding, particularly in cases where a tourniquet may not be suitable. In addition to the immediate management of bleeding, wound care further enhances outcomes for patients with traumatic injuries. After hemorrhage control, ensuring the clean management of wounds helps prevent infection and promotes healing. For larger wounds, the use of pressure dressings can be critical in maintaining stability while waiting for surgical interventions. Medical professionals often employ techniques to assess the depth and extent of the wound, as well as to evaluate for foreign objects that may require removal. Effective wound management incorporates a comprehensive approach, including stabilization, application of appropriate dressings, and, where necessary, the initiation of antibiotic prophylaxis. Ultimately, a well-coordinated strategy involving tourniquet application, pressure management, and thorough wound care significantly contributes to the patient's chances of recovery and long-term outcomes.
References
[1] Guly HR, Bouamra O, Little R, et al. Testing the validity of the ATLS classification of hypovolaemic shock. Resuscitation 2010;81:1142-1147.
[2] Pogorielov MV, Sikora VZ. Chitosan as a hemostatic agent: current state. Eur J Med 2015; 2(1):24-33.
[3] Culligan BW, Tien HC. Tranexamic acid autoinjector for prehospital care of noncompressible hemorrhage. J Trauma 2011; 71(5 Supp 1):S501-S502.
[4] Merl in MA, Alter SM, Raffel B, Pryor PW 2nd. External blood loss estimation using the MAR method. Am J Emerg Med 2009;27(9):1085-1090.
[5] Paladino L, Sinert R, Wallace D, et al. The utility of base deficit and arterial lactate in differentiating major from minor injury in trauma patients with normal vital signs. Resuscitation 2008;77(3):363-368.
[6] Rossaint R, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care 2016;20:100.
[7] Taylor WM. Canine tactical field care part three - thoracic and abdominal trauma. J Spec Oper Med 2010;10(1):50-58.
[8] Taylor WM. Canine tactical field care part two - massive hemorrhage control and physiological stabilization of the volume depleted, shock-affected, or heat-stroke affected canine. J Spec Oper Med 2009;9(2):13-21.
[9] Geeraedts LM Jr, Kaasjager HA, van Vugt AB, et al. Exsanguination in trauma: a review of diagnostics and treatment options. Injury 2009;40(1):11-20.
[10] Ge gel BT, Austin PN, Johnson AD. An evidence-based review of the use of a combat gauze (QuikClot) for hemorrhage control. AANA J 2013;81(6):453-458.
[11] Blackbourne LH, Czarnik J, Mabry R, et al. Decreasing the killed in action and died of wounds rate in combat wounded. J Trauma 2010;69(Supp 1):S1-S4.
[12] Herold LV, Devey JJ, Kirby R, et al. Clinical evaluation and management of hemoperitoneum in dogs. J Vet Emerg Crit Care 2008;18(1):40-53.
[13] Kirshtein B, Roy-Shapira A, Lantsberg L, et al. Nonoperative management of blunt splenic and liver injuries in adult polytrauma. Indian J Surg 2007;69:9-13.
[14] Frank M, Schmucker U, Stengel D, et al. Proper estimation of blood loss on scene of trauma: tool or tale? J Trauma 2010;69(5):1191-1195.
[15] Ashburn JC, Harrison T, Ham JJ, Strote J. Emergency physician estimation of blood loss. West J Emerg Med 2012;13(4):376-379.
[16] Scalea TM, Maltz S, Yelon J, et al. Resuscitation of multiple trauma and head injury: role of crystalloid fluids and inotropes. Crit Care Med 1994;22:1610-1615.
[17] Mutschler M, Paffrath T, Wölfl C, et al. The ATLS(®) classification of hypovolaemic shock: a well established teaching tool on the edge? Injury 2014;45(Supplement 3):S35-38.
[18] Littlejohn LF, Devlin JJ, Kircher SS, Lueken R, Melia MR, Johnson AS. Comparison of Celox-A, ChitoFlex, WoundStat, and combat gauze hemostatic agents versus standard gauze dressing in control of hemorrhage in a swine model of penetrating trauma. Acad Emerg Med 2011;18(4):340-350.
[19] Schreiber MA, Neveleff DJ. Achieving hemostasis with topical hemostats: making clinically and economically appropriate decisions in the surgical and trauma settings. AORN J 2011;94(5):S1-20.
[20] Geeraedts LM Jr, Kaasjager HA, van Vugt AB, et al. Exsanguination in trauma: a review of diagnostics and treatment options. Injury 2009;40(1):11-20.
[21] Mabry RL, Holcomb JB, Baker AM, et al. United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma. 2000;49:515–528. doi: 10.1097/00005373-200009000-00021. discussion 528–529.
[22] Forrest RD. Early history of wound treatment. Journal of the Royal Society of Medicine. 1982;75:198–205. doi: 10.1177/014107688207500310.
[23] LaDran J. The Operations in the Surgery of Mons. London: LaDran; 1749.
[24] Rocko JM, Tischler C, Swan K. Exsanguination in public – a preventable death. Journal of Trauma. 1982;22:635.
[25] Schmit-Neuerburg K, Joka T. Priniciples of treatment and indications for surgery in severe multiple trauma. Acta Chir Belg. 1985;85:239–249.
[26] Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149:55–62.
[27] Schwartz AM. The historical development of methods of hemostasis. Surgery. 1958:604–610.
[28] Welling DR, Burris DG, Hutton JE, Minken SL, Rich NM. A balanced approach to tourniquet use: lessons learned and relearned. J Am Coll Surg. 2006;203:106–115.
[29] Mabry RL. Tourniquet use on the battlefield. Mil Med. 2006;171:352–356.
[30] Schreiber MA, Neveleff DJ. Achieving hemostasis with topical hemostats: making clinically and economically appropriate decisions in the surgical and trauma settings. AORN J 2011;94(5):S1-20.
[31] Dorlac WC, DeBakey ME, Holcomb JB, Fagan SP, Kwong KL, Dorlac GR, Schreiber MA, Persse DE, Moore FA, Mattox KL. Mortality from isolated civilian penetrating extremity injury. J Trauma. 2005;59:217–222.
[32] Asensio JA. Exsanguination from penetrating injuries. Trauma Q. 1990;6:1–25.
[33] LaDran J. The Operations in the Surgery of Mons. London: LaDran; 1749.
[34] Cuadrado D, Arthurs Z, Sebesta J, et al. 28th Annual Gary P Wratten Army Surgical Symposium; May 2006; Silver Spring, Maryland. Walter Reed Army Institute of Research; 2006. Cause of death analysis at the 31st Combat Support Hospital during Operation Iraqi Freedom.
[35] Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL. Echelons of care and the management of wartime vascular injury: a report from the 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq. Perspect Vasc Surg Endovasc Ther. 2006;18:91–99. doi: 10.1177/1531003506293374.
[36] Carey ME. Analysis of wounds incurred by U.S. Army Seventh Corps personnel treated in Corps hospitals during Operation Desert Storm, February 20 to March 10, 1991. J Trauma. 1996;40:S165–169.
[37] Guly HR, Bouamra O, Little R, et al. Testing the validity of the ATLS classification of hypovolaemic shock. Resuscitation. 2010;81:1142-1147.
[38] Littlejohn LF, Devlin JJ, Kircher SS, Lueken R, Melia MR, Johnson AS. Comparison of Celox-A, ChitoFlex, WoundStat, and combat gauze hemostatic agents versus standard gauze dressing in control of hemorrhage in a swine model of penetrating trauma. Acad Emerg Med. 2011;18(4):340-350.
[39] G Leg? (If you intended to include a specific author citation beyond those listed, please provide the exact citation to be inserted.)
[40] Poyorielov MV, Sikora VZ. Chitosan as a hemostatic agent: current state. Eur J Med. 2015;2(1):24-33.
[41] Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg. 2010. 10.1007/s00268-009-0266-1. [DOI] [PubMed] [Google Scholar]
[42] Di Saverio S, Gambale G, Coccolini F, Catena F, Giorgini E, Ansaloni L, et al. Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region A population cross-sectional survey study. Langenbecks Arch Surg. 2013. 10.1007/s00423-013-1143-9. [DOI] [PubMed] [Google Scholar]
[43] Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM. Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997–2008. J Trauma. 2010. 10.1097/TA.0b013e3181bbfe2a. [DOI] [PubMed] [Google Scholar]
[44] Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg. 2010. 10.1007/s00268-009-0266-1. [DOI] [PubMed] [Google Scholar]
[45] Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006. 10.1097/01.ta.0000199961.02677.19. [DOI] [PubMed] [Google Scholar]
[46] Kauvar DS, Wade CE. The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care. 2005. 10.1186/cc3779. [DOI] [PMC free article] [PubMed] [Google Scholar]
[47] Teixeira PG, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007. 10.1097/TA.0b013e31815078ae. [DOI] [PubMed] [Google Scholar]
[48] Tien HC, Spencer F, Tremblay LN, Rizoli SB, Brenneman FD. Preventable deaths from hemorrhage at a level I Canadian trauma center. J Trauma. 2007. 10.1097/01.ta.0000251558.38388.47. [DOI] [PubMed] [Google Scholar]
[49] Marson AC, Grion CM, Ferreira Filho OF, Thomson JC. Preventable deaths in trauma patients associated with non adherence to management guidelines. Revista Brasileira de terapia intensiva. 2010;22(3):220–8 (Epub 2010/09/01 PubMed PMID: 25302427). [PubMed] [Google Scholar]
[50] Coats TJ, Keogh S, Clark H, Neal M. Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series. J Trauma. 2001. 10.1097/00005373-200104000-00012. [DOI] [PubMed] [Google Scholar]
[51] Matsumoto H, Mashiko K, Hara Y, Kutsukata N, Sakamoto Y, Takei K, et al. Role of resuscitative emergency field thoracotomy in the Japanese helicopter emergency medical service system. Resuscitation. 2009;80(11):1270–4. 10.1016/j.resuscitation.2009.08.010. (PubMed PMID: 19744764). [DOI] [PubMed] [Google Scholar]
[52] Shackelford SA, Butler FK, Kragh JF, et al. Optimizing the use of limb tourniquets in tactical combat casualty care: TCCC Guidelines Change 14-02. J Spec Oper Med 2015; 15(1):17-31.
[53] King DR, Larentzakis A, Ramly EP, Boston Trauma Collaborative. Tourniquet use at the Boston Marathon bombing: lost in translation. J Trauma Acute Care Surg 2015; 78(3):594-599.
[54] Walters TJ, Mabry RL. Issues related to the use of tourniquets on the battlefield. Mil Med 2005; 170:770-775.
[55] PFC WG Tourniquet Conversion Recommendations. Access restricted (no URL retained). Accessed August 31, 2021.
[56] Chen J, Benov A, Nadler R, et al. Testing of junctional tourniquets by medics of the Israeli Defense Force in control of simulated groin hemorrhage. J Spec Oper Med 2016; 16(1):36-42.
[57] Drew B, Bennett BL, Littlejohn L. Application of current hemorrhage control techniques for backcountry care: part one, tourniquets and hemorrhage control adjuncts. Wilderness Environ Med 2015; 26(2):236-245.
[58] Passos E, Dingley B, Smith A, et al. Tourniquet use for peripheral vascular injuries in the civilian setting. Injury 2014; 45(3):573-577.
[59] Pal mer LE, Maricle R, Brenner JA. The operational canine and K9 tactical emergency casualty care initiative. J Spec Oper Med 2015; 15(3):32-38.
[60] Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM. Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997–2008. J Trauma 2010; 10.1097/TA.0b013e3181bbfe2a. (Note: DOI included; per request, only end hyperlinks removed.)
[61] Kragh JF Jr, Dubick MA. Battlefield tourniquets: lessons learned in moving current care toward best care in an army medical department at war. US Army Med Dep J 2016; (2-16):29-36.
[62] Kheirabadi BS, Terrazas IB, Miranda N, et al. Physiological consequences of abdominal aortic and junctional tourniquet (AAJT) application to control hemorrhage in a swine model. Shock 2016; 46(3 Suppl 1):160-166.
[63] Walpole SC, Prieto-Merino D, Edwards P, et al. The weight of nations: an estimation of adult human biomass. BMC Public Health 2012; 12:439:1-6.
[64] Klenerman, L. The Tourniquet Manual-Principles and Practice. Springer-Verlag; 2003.
[65] Scerbo MH, Mumm JP, Gates K, et al. Safety and appropriateness of tourniquets in 105 civilians. Prehosp Emerg Care 2016; 31:1-11.
[66] Baker JL, Havas KA, Miller LA, et al. Gunshot wounds in military working dogs in Operation Enduring Freedom and Operation Iraqi Freedom, 2003-2009. J Vet Emerg Crit Care 2013; 23:47-52.
[67] Kragh JF Jr, Nam JJ, Berry KA, Mase VJ Jr, Aden JK, Walters TJ, et al. Transfusion for shock in US military war casualties with and without tourniquet use. Annals Emerg Med. 2015;65(3):290–6. [DOI] [PubMed] [Google Scholar]
[68] Pierrie SN, Seymour RB, Wally MK, Studnek J, Infinger A, Hsu JR, et al. Pilot randomized trial of pre-hospital advanced therapies for the control of hemorrhage (PATCH) using pelvic binders. Am J of Emerg Med. 2021;42:43–8. [DOI] [PubMed] [Google Scholar]
[69] Kabeer M, Venugopalan PP, Subhash VC. Pre-hospital hemorrhagic control effectiveness of axiostat r dressing versus conventional method in acute hemorrhage due to trauma. Cureus. 2019;11(8):5527. [DOI] [PMC free article] [PubMed] [Google Scholar]
[70] Hatamabadi HR, Asayesh Zarchi F, Kariman H, Arhami Dolatabadi A, Tabatabaey A, Amini A. Celox-coated gauze for the treatment of civilian penetrating trauma: a randomized clinical trial. Trauma Monthly. 2015;20(1):e23862. [DOI] [PMC free article] [PubMed] [Google Scholar]
[71] King DR, Larentzakis A, Ramly EP, Boston Trauma Collaborative. Tourniquet use at the Boston Marathon bombing: lost in translation. J Trauma Acute Care Surg. 2015;78(3):594-599.
[72] Chen J, Benov A, Nadler R, et al. Testing of junctional tourniquets by medics of the Israeli Defense Force in control of simulated groin hemorrhage. J Spec Oper Med. 2016;16(1):36-42.
[73] Chen J, Benov A, Nadler R, et al. Testing of junctional tourniquets by medics of the Israeli Defense Force in control of simulated groin hemorrhage. J Spec Oper Med 2016;16(1):36-42. [Note: duplicate entry retained for formatting consistency if needed]
[74] Sc erbo MH, Mumm JP, Gates K, et al. Safety and appropriateness of tourniquets in 105 civilians. Prehosp Emerg Care. 2016;31:1-11.
[75] Pizanis A, Pohlemann T, Burkhardt M, Aghayev E, Holstein JH. Emergency stabilization of the pelvic ring: Clinical comparison between three different techniques. Injury. 2013;44(12):1760–4.
[76] Sw echkofler U, Wohlrath B, Trentzsch H, Greipel J, Tamimi N, Hoffmann R, Wincheringer D. Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures. Eur J Trauma Emerg Surg. 2018;44(5):747–52. 10.1007/s00068-017-0860-0. (Epub 2017 Oct 12 PMID: 29026927)
[77] Kragh JF Jr, Dubick MA, Aden JK, McKeague AL, Rasmussen TE, Baer DG, et al. US Military use of tourniquets from 2001 to 2010. Prehosp Emerg Care. 2015;19(2):184–90.
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