Risks and complications of tourniquet syndrome in blast injuries in the context of contemporary military conflicts

Abstract

The purpose was to analyze the impact of the use of tourniquets by military personnel during massive or critical bleeding, as well as in cases of traumatic amputations of limbs. Special attention is devoted to the timely conversion of the tourniquet, determining the feasibility and inappropriateness of its use, assessing the duration of its application, and analyzing complications arising from excessively long use, especially in conditions of intense hostilities or prolonged evacuation. We conducted review of the scientometric databases Scopus, PubMed, ResearchGate, as well as professional periodicals: Health.mil, Military Medicine, Ukrainian Journal of Military Medicine etc. We used the following keywords for search: “tourniquet”, ”alternative”, “stop the bleed”. Our part of clinical study described in this article was conducted on the basis of a Role 2 surgical hospital in the hottest combat zone in April-May, 2024, n=70 servicemen. The article describes 4 clinical cases of temporary stopping of critical bleeding in military personnel,medical interventions at the Role 2 stage to transfer medical evacuation to the Role 3 stage of medical support. The analysis of the duration of tourniquet application showed that they were used for 1-2 hours in 50.0% of cases, from 2 to 3 hours in 40.0% of cases-, and the duration of its implementation after combat trauma exceeded 3 hours in 10.0% of cases. Thus, the application of tourniquets was inappropriate in 30.0% of servicemen. According to the results of the study, one of the most serious complications of tourniquet application is irreversible limb ischemia, which requires amputation and was observed in 45.0% of cases observed by us. The importance of timely, correct tourniquet application technique is reflected in the experience of tactical medicine personnel in self- and mutual aid on the battlefield and saves the lives of servicemen.