Eur J Trauma Emerg Surg. 2019 Sep 5;Epub ahead of print

# International perspective of tourniquet use in extremity vascular trauma: a commentary from the Sri Lankan civil war experience.

Ratnayake A, Bala M, Worlton T

Civilian trauma care has always been influenced by lessons learned in war trauma. Currently this transfer of knowledge has been exemplified by The Hartford Consensus III: Implementation of Bleeding Control which examines and advocates for tourniquet use in civilian settings. The authors seek to share their unique experience with combat extremity vascular trauma for a global perspective on use of tourniquets in unconventional warfare.

A recent single-institution retrospective analysis by Smith et al. of pre hospital tourniquet application matched with a comparable group without tourniquets in a civilian level 1 trauma center concluded that tourniquet application was favorably associated with less shock at presentation to emergency department, decreased blood product utilization and decreased limb related complications. In this study, the average time from tourniquet placement to arrival in the Emergency Department was 23.9 min and the majority were placed by trained medical personnel.