Page 124 - JSOM Spring 2021

An Ongoing Series

Tourniquet Use on a Pediatric Patient

Marco Gattere, NSOCM *; Niccolo Scaffei, NSOCM ;
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Luca Gozzetti, NSOCM ; Maverick Alessandrini, NSOCM 4

ABSTRACT
As a result of the increasing use and application of military Such experience affected the guidelines of care in military and
tourniquets in civilian settings, it is necessary to evaluate the combat environments, while in civilian care, tourniquet use
size and effectiveness of the equipment on patients that differ is still becoming accepted. The pediatric tourniquet case pre-
from the military-aged population for whom the devices have sented here demonstrates the need to study the effects these
been primarily created. This case report describes the applica- devices could have in large-scale usage on patients of ages and
tion of a tourniquet on a pediatric patient while also profiling sizes differing from military, law enforcement, and emergency
a common situation in which the Combat Application Tourni- service populations.
quet GEN 7 (C-A-T Resources) might be used in civilian care
systems. The case is that of a 14-month-old child who suffered The amount of data and surveys resulting from tourniquet use
a limb amputation secondary to a road accident in Italy and in pediatric war casualties has provided some evidence that
the ensuing life-saving treatment. The intervening nurse at the application of the device is problem free, with a survival
the scene had been trained on the use of hemorrhage-control rate of 93%, similar to that of the adult population, especially
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devices through the American College of Surgeons “Stop the when used in the field during the prehospital phase. Addition-
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Bleed” campaign. ally, in other data, commercial tourniquets are effective despite
the smaller circumference of pediatric limbs. 8
Keywords: tourniquets; hemorrhage; child; pediatric; mil-
itary personnel; accidents; amputation; Stop the Bleed; This case study clearly supports the hypothesis and earlier
NATO Special Operations Combat Medic; NSOCM findings that tourniquets are also indicated and effective in a
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civilian setting of variable ages and injury patterns. Addition-
ally, from the prehospital perspective, safety and effectiveness
of the device can also be demonstrated on pediatric patients.
Introduction
Tourniquet devices for controlling hemorrhage have been Case Report
widely used during recent conflicts in the past two decades.
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Their role in the control of extremity hemorrhage has been At 16:55 local time, emergency medical services (EMS) re-
pivotal in stopping bleeding as soon as possible and improving ceived the dispatch of two patients involved in a car accident.
a patient’s chances of survival. 2 The EMS team departed at 16:58 on Red Code (i.e., highest
priority) with a physician (general practitioner on duty) and a
During World Wars I and II, there were many extremity nurse. At 17:10, the team received an update en route for two
wounds and a great deal of tourniquet use, but because of patients: a 14-month-old infant with traumatic amputation of
delayed evacuation, the tourniquets stayed in place too long, a lower limb, spontaneous respirations, and a worsening level
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sometimes even for days. This resulted in necrosis and severe of consciousness, and a second patient in a woman complain-
tissue ischemia in the limbs, requiring surgical amputation ing of leg pain.
of the affected limb. These experiences often influenced sol-
diers to choose to continue to bleed rather than applying the At 17:15, the EMS team arrived at the vehicle accident, where
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tourniquet. However, in following conflicts, such as Korea a truck had lost control and hit a mother walking her child in a
and Vietnam, the use of tourniquets allowed many lives to be stroller. Police were providing safety at the scene. After a rapid
saved, leading to more favorable considerations. assessment and triage, the physician prioritized the child first
*Correspondence to marcogattere@hotmail.com
1 Mr Gattere is affiliated with the Italian Army and is currently a student in the Bachelor of Science (HONS) program in Paramedic Studies at the
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University College Cork in Ireland. Mr Scaffei, Mr Gozzetti, and Mr Alessandrini are presently working for the Italian Army.
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