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in the Middle East (e.g., Iraq and Afghanistan during the most offers many more opportunities for the possible implementa-
recent conflicts), has led to an exponential increase in blast tion and development of tourniquets. The choice and com-
wounds and damage to bodies and limbs, affecting both mili- mitment to advocate for the consideration of tourniquets in
tary and civilian personnel, forcing an adaptation of the pro- life-saving trauma in every environment and context will be
tocol of triage, and shifting priorities to the control of massive a success not only in the military arena but also in civilian
bleeding. Massive hemorrhage control draws the attention of environments.
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the entire medical community; nevertheless, only the military
sphere has sensed the urgency to address this topic. In conclusion, the tourniquet has been a life saver in countless
occasions in the military, and we are seeing similar results with
Tourniquets have been developed and improved for almost its ongoing introduction in the civilian world with a different
two decades and are well known to armed forces throughout variety of patients. We recommend continued consideration
the world. Although civilian medical care has often benefited and further study of tourniquets in the pediatric arena, par-
from studies and case reports derived from the military sphere, ticularly because its use in this field has not been well docu-
only in recent years have tourniquets been taken into consider- mented or thoroughly studied.
ation in the civilian environment, where excellent results have
been reported. Acknowledgments
Special thanks to D’Agostino Luca, anesthetist at the Azienda
Extreme effectiveness, combined with simplicity in application Socio-Sanitaria Territoriale di Pavia and Anesthetist in the
(modern tourniquets were first designed for self-application), Army Reserve and Military Red Cross, who helped us by re-
make this device preferable in the prehospital environment, viewing this article from an experienced medical perspective.
despite variations in the rate of use: Teixeira et al. reported Last but not least, the authors give special thanks to Mike
9
wide variation in prehospital tourniquet use when analyzing Hetzler for his support and help in writing this article.
11 trauma centers in Texas between 2011 and 2016. Use rates
ranged from 61.9% to 1.4%. Author Contributions
This case report was designed by MG, who conducted the in-
It is clear that ease (i.e., the ability to use it with little train- terview. NS redacted the discussion and the conclusion, while
ing, as suggested by recent studies ) and effectiveness make MA and LG collected and verified the references. Drafting and
11
the tourniquet an attractive device for life-threatening hemor- revising the manuscript was performed by all four authors. All
rhage control by members of law enforcement, national health authors read and approved the final manuscript.
structures, and civil protection, and by volunteers. Campaigns
such as the American College of Surgeons “Stop the Bleed” Financial Disclosure
have been fundamental in raising awareness about hemor- The authors have no financial relationships relevant to this
rhage-control devices and methods used originally in combat article to disclose.
trauma and now being adopted for civilian use and benefit.
Since 2013, members of the Hartford Consensus (formed Funding Disclaimer
by the American College of Surgeons Board of Regents, the The authors have no source of funding to report.
American College of Surgeons Committee on Trauma, the
Prehospital Trauma Life Support Program, the Federal Bu- References
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Our goal here was to present data in favor of tourniquet ap- 8. Ross EM, Bolleter S, Simon E, Kharod CU. Pediatric extremity hem-
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