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in low temperatures, as the risk of unnoticed re-bleeding might 8. Agha RA, Franchi T, Sohrabi C, et al. The SCARE 2020 guideline:
be heightened by the use of thermal insulation devices. updating consensus Surgical CAse REport (SCARE) Guidelines.
Int J Surg. 2020;84:226–230. doi:10.1016/j.ijsu.2020.10.034
9. Kazmirchuk A, Yarmoliuk Y, Lurin I, et al. Ukraine’s experience
The present case report highlights the importance of using with management of combat casualties Using NATO’s four-tier
tourniquets that can generate sufficient pressure to stop ar- “changing as needed” healthcare system. World J Surg. 2022;46
terial blood flow to the limb while being sturdy enough to (12):2858–2862. doi:10.1007/s00268-022-06718-3
withstand the mechanical stresses of application and patient 10. Chapter 16: Medical Support: Medical Operational Principles. In:
evacuation in combat settings. NATO Logistics Handbook. October 1997. Accessed November
7, 2023. https://www.nato.int/docu/logi-en/1997/lo-1605.htm
11. President of Ukraine’s official website. 2021. Head of State ap-
Conclusion proves Strategic Defense Bulletin of Ukraine. Accessed November
7, 2023. https://www.president.gov.ua/en/news/glava-derzhavi-
This case report highlights the risks associated with using insuf- zatverdiv-strategichnij-oboronnij-byuleten-uk-70713
ficiently robust tourniquets to treat life-threatening limb hem- 12. Anonymous A. Tactical Combat Casualty Care (TCCC) Guide-
orrhage in combat settings. It emphasizes the need for stringent lines for Medical Personnel 15 December 2021. J Spec Oper Med.
quality control measures and strict regulations to prevent the 2022;22(1):11–17. doi:10.55460/ETZI-SI9T
use of counterfeit or uncertified tourniquets, thereby avoiding 13. Haque U, Naeem A, Wang S, et al. The human toll and humanitar-
preventable deaths. ian crisis of the Russia-Ukraine war: the first 162 days. BMJ Glob
Health. 2022;7(9):e009550. doi:10.1136/bmjgh-2022-009550
14. Mahase E. “Same tactics, same injuries”: the targeting of health-
Acknowledgments care in Syria and Ukraine. BMJ. 2022:378;o1745. doi:10.1136/
The authors thank the Ukrainian Armed Forces. bmj.o1745
15. Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tour-
Author Contributions niquet use in Operation Iraqi Freedom: effect on hemorrhage
EL, RB, and MS designed the study; RB retrieved the data; EL, control and outcomes. J Trauma. 2008;64(2 Suppl):S28–S37. doi:
10.1097/TA.0b013e318160937e
RB, MB, and MS wrote and revised the manuscript. 16. Kragh JF, Walters TJ, Baer DG, et al. Survival with emergency
tourniquet use to stop bleeding in major limb trauma. Ann Surg.
Disclosures 2009;249(1):1–7. doi:10.1097/SLA.0b013e31818842ba
The authors do not have any conflicts of interest to disclose. 17. Polston RW, Clumpner BR, Kragh JF, Jones JA, Dubick MA,
Billings S. No slackers in tourniquet use to stop bleeding. J Spec
Funding Oper Med. 2013;13(2):12–19. doi:10.55460/PBOM-EDWG
No funding was received for this study. 18. Nachman D, Benov A, Shovali A, et al. Slack reducing band im-
proves combat application tourniquet pressure profile and hem-
orrhage control rate. Mil Med. 2017;182(S1):53–58. doi:10.7205/
References MILMED-D-16-00126
1. Eastridge BJ, Holcomb JB, Shackelford S. Outcomes of traumatic 19. King DR, van der Wilden GM, Kragh JF, Blackbourne LH. For-
hemorrhagic shock and the epidemiology of preventable death ward assessment of 79 prehospital battlefield tourniquets used
from injury. Transfusion. 2019;59(S2):1423–1428. doi:10.1111/ in the current war. J Spec Oper Med. 2012;12(4):33–38. doi:
trf.15161 10.55460/BV5C-T9IG
2. Kragh JF, Littrel ML, Jones JA, et al. Battle casualty survival with 20. Mikdad S, Mokhtari AK, Luckhurst CM, et al. Implications of
emergency Tourniquet sse to stop limb bleeding. J Emerg Med. the national Stop the Bleed campaign: The swinging pendulum
2011;41(6):590–597. doi:10.1016/j.jemermed.2009.07.022 of prehospital tourniquet application in civilian limb trauma.
3. Smith AA, Ochoa JE, Wong S, et al. Prehospital tourniquet use in J Trauma Acute Care Surg. 2021;91(2):352–360. doi:10.1097/TA.
penetrating extremity trauma: Decreased blood transfusions and 0000000000003247
limb complications. J Trauma Acute Care Surg. 2019;86(1):43–51. 21. Wani ML, Ahangar AG, Ganie FA, Wani SN, Wani NU. Vascular
doi:10.1097/TA.0000000000002095 injuries: trends in management. Trauma Mon. 2012;17(2):266–
4. Covey DC, Gentchos CE. Field tourniquets in an austere military 269. doi:10.5812/traumamon.6238
environment: A prospective case series. Injury. 2022;53(10):3240– 22. Drew B, Bird D, Matteucci M, Keenan S. Tourniquet conversion:
3247. doi:10.1016/j.injury.2022.07.044 a recommended approach in the prolonged field care setting.
5. Lagazzi E, Ballardini G, Drogo A, et al. The certification mat- J Spec Oper Med. 2015;15(3):81–85. doi:10.55460/IJ9C-6AIF
ters: a comparative performance analysis of Combat Application 23. Weppner J, Lang M, Sunday R, Debiasse N. Efficacy of tourni-
Tourniquets versus non-certified CAT look-alike tourniquets. quets exposed to the Afghanistan combat environment stored in
Prehosp Disaster Med. 2023 Aug;38(4):450–455. doi:10.1017/ individual first aid kits versus on the exterior of plate carriers. Mil
S1049023X23006076 Med. 2013;178(3):334–337. doi:10.7205/MILMED-D-12-00454
6. Pegues J. Beware: counterfeit tourniquets could cost lives. CBS 24. Kragh JF Jr, Walters TJ, Baer DG, et al. Practical use of emergency
News. August 13, 2015. tourniquets to stop bleeding in major limb trauma. J Trauma.
7. Elliott S. Bogus tourniquets could endanger lives in combat. U.S. 2008;64(2 Suppl):S38–S50. doi:10.1097/TA.0b013e31816086b1
Army Medical Research Development and Command. Updated
May 22, 2023. Accessed August 24, 2024. https://mrdc.health.mil/ PMID: 39276363; DOI: 10.55460/60U2-4ATN
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