Extracts below from a news item and a comment from me. Fulltext: https://www.telegraph.co.uk/global-health/terror-and-security/cult-of-to...
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‘Cult’ of tourniquets causing thousands of unnecessary amputations and deaths in Ukraine, say surgeons
The strong bands are used to stop catastrophic bleeding – but if left on for too long they can cause tissue death
The tourniquet has saved many thousands of lives and limbs in war zones around the world, but misuse of the device is causing huge numbers of excess amputations and deaths in Ukraine, say top military surgeons.
Captain Rom A Stevens, a retired senior US medical navy officer who has served in Iraq, Afghanistan, and East Africa, estimates that of the roughly 100,000 amputations performed on Ukrainian soldiers since Russia’s full-scale invasion in 2022, as many as 75,000 were caused by improper use of tourniquets.
“I’ve seen tourniquets that have been left on for days, often for injuries that could have been stopped by other methods. Then [the patient] has to have their limb amputated because the tissue has died,” Captain Stevens told The Telegraph.
Tourniquets are strong bands used to stop catastrophic bleeding by cutting off blood flow, and are standard issue for most modern armies.
But if left on over two hours, they can cause tissue death, meaning the arm or leg which has the tourniquet on is no longer viable and requires amputation...
In Ukraine, it has left “a generation of men traumatised by unnecessary amputations,” he said...
They are also often being applied too high on damaged limbs, said Captain Stevens. “They are often taught to place on the tourniquets well above the wounds, and the result is a very high amputation, making it difficult to later fit a prosthesis,” he said.
An updated version of the Ukrainian TCCC disseminated to the armed forces in January 2024 specifically reads: “Place the tourniquet “high and tight” on the wounded extremity.”...
Experts stress that tourniquets continue to save many lives and should not be abandoned.
Instead, they say that in places like Ukraine where rapid evacuation is difficult they should only be used in the three circumstances in which they are absolutely necessary.
The first is when a limb has been completely severed. “In that situation, you need a tourniquet, but you need to put it as low down as possible to try and save as much of the limb as you can,” said Captain Stevens.
The second is when the limb is so damaged that it cannot be saved – a decision that requires judgement and medical experience.
The third is when a person has uncontrolled arterial bleeding that cannot be stopped with direct pressure or any other method.
Captain Stevens said tourniquets are often applied by panicked soldiers, who lack the knowledge or confidence to try other methods first...
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COMMENT (NPW): Poor quality care, with resulting mortality and morbidity, is so often due to *basic* errors in care, as described above. These errors are sometimes due to a lack of basic information and knowledge, and sometimes (as above) they are due to incorrect information, such as the incorrect instruction to 'Place the tourniquet “high and tight”'. A few incorrect words can lead to loss of limb and life.
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