Re: https://www.hifa.org/dgroups-rss/%E2%80%98cult%E2%80%99-tourniquets-caus...
The report that inappropriate use of tourniquets is causing thousands of unnecessary amputations and deaths in Ukraine is an example of a failure of basic healthcare information. All too often, it is a failure to apply *basic* information that is the cause of preventable deaths, not only in trauma care but across the whole health spectrum.
Below are the citation and conclusion of an interesting review on the subject, and a comment from me:
CITATION: Tourniquet-related complications in extremity injuries: a scoping review of the literature
Anaida Xacur-Trabulce, Gessner Casas-Fuentes, Veronica Ruiz-Vasconcelos, Marianne Marchini Reitz, Sharon M. Henry, Thomas M. Scalea & Marcelo A. F. Ribeiro Jr.
World Journal of Emergency Surgery volume 20, Article number: 57 (2025)
https://wjes.biomedcentral.com/articles/10.1186/s13017-025-00625-3
CONCLUSION
Improved training is essential to help providers accurately assess bleeding severity and apply appropriate interventions, reducing complications and enhancing outcomes. Future research opportunities should consider: (1) prospective interventional randomized controlled studies aiming to compare the use of tourniquets to different methods of hemorrhage control; (2) development and validation of easy-to-use scores predicting complications and the need of amputation in both civilian and military settings including upper and lower extremities, to better guide clinical decisions and future guidelines; (3) development of better ways to teach lay providers to recognize life threatening bleeding; and (4) development of guidelines for timing of tourniquet loosening, removal or conversion.
COMMENT (NPW): I have looked for guidelines on use of tourniquets and top of the Google search i the American Red Cross, which states:
'After you've applied the tourniquet, don't loosen or remove it — this should only be done by a medical professional.'
https://www.redcross.org/take-a-class/resources/articles/how-to-apply-a-...
The American Red Cross guidance says nothing about the potential complications of tourniquet use (such as loss of arm/leg due to prolonged use).
A second guideline from firstaid.co.uk has different advice. It says: 'A tourniquet should never be applied for longer than two hours. If a tourniquet is left in place for longer than this, it can permanently damage the nerves, muscles and blood vessels.'
I looked for WHO guidance and could not find any.
Can anyone help to identify authoritative international guidance on the use of tourniquets? Are you aware of any educational resources that you would recommend?
It is especially important that individuals in the general public receive first aid training, including on the use of tourniquets. Does anoyone have experience of this?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org