Terrorist attacks and civilian mass-casualty events are frequent, and some countries have implemented tourniquet use for uncontrollable extremity bleeding in civilian settings. The aim of this study was to summarize current knowledge on the use of prehospital tourniquets to assess whether their use increases the survival rate in civilian patients with life-threatening hemorrhages from the extremities.

Systematic literature review in Medline (Ovid), Embase (Ovid), Cochrane Library, and Epistemonikos was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. The search was performed in January 2019.

All types of studies that examined use of tourniquets in a prehospital setting published after January 1, 2000 were included.

The primary outcome was mortality with and without tourniquet, while adverse effects of tourniquet use were secondary outcomes.

Among 3,460 screened records, 55 studies were identified as relevant. The studies were highly heterogeneous with low quality of evidence. Most studies reported increased survival in the tourniquet group, but few had relevant comparators, and the survival benefit was difficult to estimate. Most studies reported a reduced need for blood transfusion, with few and mainly transient adverse effects from tourniquet use.

Despite relatively low evidence, the studies consistently suggested that the use of commercial tourniquets in a civilian setting to control life-threatening extremity hemorrhage seemed to be associated with improved survival, reduced need for blood transfusion, and few and transient adverse effects.

The transfer of experiences gained after prehospital medical responses to major incidents has largely been nonsystematic, and better-structured reporting methods have been advocated. A consensus-based template was recently created and implemented as an open-access website. This qualitative study assessed the feasibility of using the template and reporting site.

Informants who had used or who had been asked to use the template were interviewed. The semi-structured interviews were transcribed verbatim, and the transcripts were analyzed by using an inductive approach based on grounded theory methodology.

The major theme identified was a need for “defining purpose” as explained by the minor themes “relevance,” “scope,” “resources,” and “usefulness.” Informants reported that the template content needed to be revised and that the scope and rationale behind each question should be conveyed to the user. Resources necessary for reporting and clarity regarding the aim and outcome also need to be communicated to users and policy-makers. The interface between informants and the template is critical.

Informants considered the template and website useful but reported that the workload exceeded their expectations. Despite pilot testing of the template before implementation, early revision of the template is recommended. (Disaster Med Public Health Preparedness. 2017;11:403–406)

To study the rate of prehospital mortality before establishment of a rescue system for victims of land-mines in Iran.

Survey at rural clinics in mine-affected areas, and retrospective review of public patient records.

A total of 36.4% of casualties from land-mines in the study area died during the period of 1989–1999. The mortality seems highest in those victims who were torso injured.

The mortality rate from accidents involving land-mines in the study area was high. Most fatalities seemingly occurred in the prehospital setting.

Post-injury hypothermia is a risk predictor in trauma patients whose physiology is deranged. The aim of the present study was to examine the effect of simple, in-field, hypothermia prevention to victims of penetrating trauma during long prehospital evacuations.

A total of 170 consecutively injured landmine victims were included in a prospective, clinical study in Northern Iraq and Cambodia. Thirty patients were provided with systematic prehospital hypothermia prevention, and for 140 patients, no preventive measures were provided.

The mean value for the time from injury to hospital admission was 6.6 hours (range: 0.2–72). The incidence of hypothermia (oral temperature <36°C) before prevention/rewarming was 21% (95% confidence interval: 15% to 28%). The Prevention Group had a statistically significant lower rate of hypothermia on hospital admission compared to the control group (95% confidence interval for difference: 6% to 24%).

Simple, preventive, in-field measures help to prevent hypothermia during protracted evacuation, and should be part of the trauma care protocol in rural rescue systems.