Optimizing the use of Limb Tourniquets in Tactical Combat Casualty Care: TCCC Guidelines Change 14-02.

摘要

The early use of limb tourniquets has been documented to save lives on the battlefield, but has the potential for significant morbidity. This change has four goals: 1. Clarification of tourniquet conversion guidelines. Since its inception, Tactical Combat Casualty Care (TCCC) has emphasized the early and liberal use of tourniquets to control life-threatening hemorrhage in the Care Under Fire (CUF) phase. Because evacuation times in Iraq and Afghanistan have been relatively short, the recommendation in the TCCC Guidelines to re-evaluate the need for a tourniquet in the Tactical Field Care (TFC) phase of care and use other means of hemorrhage control has been de-emphasized in practice by users. There is often no attempt to convert tourniquets to hemostatic or pressure dressings because of the short evacuation times in Afghanistan at present. Increasingly, worldwide casualty care scenarios are anticipated to include long-range evacuation. Recent real-world events in theaters other than the Middle East have demonstrated that reinforcement of tourniquet conversion guidelines is needed at this time. 2. Clarification of effective tourniquet placement. Ineffective venous tourniquets have been shown to be a relatively common occurrence that increases blood loss and complications.1-3 Optimal use of limb tourniquets must result in both cessation of bleeding and stoppage of the distal pulses in the extremity. 3. Clarification of the location of tourniquet placement during CUF. During a prehospital trauma care assessment in Afghanistan in 2012, inconsistencies relating to tourniquet placement were noted between the TCCC guidelines and actual training in some TCCC courses. In particular, high and tight tourniquet placement (also termed hasty tourniquet placement) is not specified in the TCCC Guidelines, which call for tourniquet placement proximal to the bleeding site in the CUF phase.