Tourniquet usage in Modern Conflict and in Emergency Medicine

Purpose: Our purpose is to identify and summarize relevant studies concerning tourniquet usage, safety, effectiveness, and identify obstacles preventing tourniquet implementation. Methods: Literature review covering the past 15 years of relevant studies concerning tourniquet usage in modern conflict as well as their implementation in civilian arenas. Results: Early and aggressive tourniquet application in extremity trauma has a negligible complication rate when compared against the lifesaving potential. Several studies list complication rates between 1% and 36%. The higher the complication rate is associated with increased tourniquet time with a cut off of 2 hours by one study. Conclusions: Tourniquet application is a safe and effective method to control a variety of extremity hemorrhage. Early and aggressive implementation of tourniquets is indicated in patients suffering from extremity hemorrhage not easily controlled through direct pressure. Barriers to use include: improper application, inappropriate implementation, fears of tissue ischemia, ischemic sequelae, and the liabilities associated with treatment complications.