Improvised tourniquets: Obsolete or obligatory?

Abstract

L ife-threatening hemorrhage from the extremities is not confined to the military setting and is seen in civilian catastrophes such as terrorist attacks, postconflict improvised explosive device, land mine detonations, and natural disasters. In such settings, the demand for resources outstrips supply; the use of tourniquets may be necessitated despite not being readily available. Application of an improvised tourniquet in such a situation may be the only method of controlling bleeding. Despite this, evaluation of commercially available tourniquets have tended to favor analysis and debate, when their availability in such an event may be extremely limited. Commercially available tourniquets have had extensive investigation to arrive at an opinion of what makes an ideal tourniquet. There is currently a lack of research on the role of improvised tourniquets in situations requiring the control of catastrophic bleeding. Available literature on improvised tourniquets is often a side topic with the focus of the article being on the efficacy of commercial tourniquets. We argue that improvised tourniquets have a role in the control of hemorrhage in the prehospital environment. This is particularly in the context of civilian mass-casualty situations where commercial tourniquets may be a limited resource among caregivers. Conflicting evidence exists regarding the role improvised tourniquets have to play in such situations, from their indication for use to whether they should be used at all. This literature review sought to examine the current opinion on improvised tourniquets, albeit in its paucity, and present the arguments supporting and opposing its use in both military and civilian settings.