{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:26:23Z","timestamp":1792218383647,"version":"4.4.0"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"11-12","license":[{"start":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T00:00:00Z","timestamp":1705536000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Hands-on training and social media sites have heavily emphasized the use of tourniquets to treat limb injuries during the Ukraine war. Tourniquet overuse or misuse can lead to significant tragedy\u2014limb loss, physiologic complications, and even death. Casualty evacuation in Ukraine often exceeds 6\u2009hours, and the liberal use of limb tourniquets may have unintentionally increased morbidity. Tourniquet application was appropriate in 24.6% of the wounded with tourniquets in one recent publication by a Ukrainian vascular surgeon. The longer a limb tourniquet is in place raises the risk of compartment syndrome, vascular thrombosis, rhabdomyolysis, and irreversible myonecrosis resulting in major tissue loss and often necessitating limb amputation. If bleeding is controlled with a tourniquet, attempts to remove the tourniquet as early as possible to avoid the negative consequences are essential. Training in tourniquet use without explaining possible limb loss and other complications resulting from tourniquets left in situ more than 2\u2009hours makes use risky. Tourniquets should be loosened at one hour if the tactical situation allows, and the injury assessed to determine if major bleeding persists or to determine if other methods of hemostasis would be effective. Ukraine must improve the training so that everyone becomes aware of the risks of prolonged or improper tourniquet use. This tourniquet training information must be transmitted to military medical leaders, Ukrainian military medics, civilian volunteers, volunteers in Ukraine, and NATO trainers in allied countries conducting medical training for Ukrainian soldiers. A trauma registry and tracking through echelons of care can enhance performance improvement through timely feedback.<\/jats:p>","DOI":"10.1093\/milmed\/usad503","type":"journal-article","created":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T23:04:45Z","timestamp":1705705485000},"page":"304-308","source":"Crossref","is-referenced-by-count":52,"title":["Misuse of Tourniquets in Ukraine may be Costing More Lives and Limbs Than They Save"],"prefix":"10.1093","volume":"189","author":[{"given":"Rom A","family":"Stevens","sequence":"first","affiliation":[{"name":"Professor of Anesthesiology and Medicine, Rosalind Franklin University of Medicine and Sciences , North Chicago, IL 60525,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4761-0995","authenticated-orcid":false,"given":"Michael S","family":"Baker","sequence":"additional","affiliation":[{"name":"Osher Life Long Learning, University of California , Berkeley, CL 94549,","place":["USA"]},{"name":"Osher Life Long Learning, Calif State University, East Bay, Cal State University Channel Islands, CA, Dominican University Marin , Lafayette, CA 94549,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ostap B","family":"Zubach","sequence":"additional","affiliation":[{"name":"Ukrainian Military Medical Service , Dovzheno St 9\/23, Lviv 79070,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Samotowka","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Novant Presbyterian Hospital , Charlotte, NC 28204,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"2024110620115564500_R1","author":"Deployed Medicine"},{"issue":"1","key":"2024110620115564500_R2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.55460\/TDTK-RIN8","article-title":"Optimizing the use of limb tourniquets in tactical combat casualty care: TCCC guidelines change 14-02","volume":"15","author":"Shackelford","year":"2015","journal-title":"J Spec Oper Med"},{"issue":"2","key":"2024110620115564500_R3","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1097\/XCS.0000000000000707","article-title":"Putting medical boots on the ground: lessons from the war in Ukraine and applications for future conflict with near-peer adversaries","volume":"237","author":"Epstein","year":"2023","journal-title":"J Am Coll Surg"},{"key":"2024110620115564500_R4"},{"issue":"4","key":"2024110620115564500_R5","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1097\/BOT.0b013e3180437dd9","article-title":"Extended (16-hour) tourniquet application after combat wounds: a case report and review of the current literature","volume":"21","author":"Kragh","year":"2007","journal-title":"J Orthop Trauma"},{"issue":"6","key":"2024110620115564500_R6","doi-asserted-by":"publisher","first-page":"e54","DOI":"10.1097\/TA.0000000000004134","article-title":"Rethinking limb tourniquet conversion in the pre-hospital environment","volume":"95","author":"Holcomb","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"2024110620115564500_R7","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usac208","article-title":"Application of hemostatic tourniquet on wounded extremities in modern \u201ctrench\u201d warfare: the view of a vascular surgeon","author":"Yatsun","year":"2022","journal-title":"Mil Med"},{"key":"2024110620115564500_R8","volume-title":"The Medical Department - Medical Service in the European Theater of Operations - U.S. Army Center of Military History","author":"Cosmas","year":"1992"},{"key":"2024110620115564500_R9","article-title":"Marines Show Appreciation for 115 Years of Commitment","year":"2023"},{"key":"2024110620115564500_R10","article-title":"The department of defense center of excellence for Trauma","author":"Joint Trauma System"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/11-12\/304\/60454240\/usad503.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/11-12\/304\/60454240\/usad503.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T20:12:06Z","timestamp":1730923926000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/189\/11-12\/304\/7577546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,18]]},"references-count":10,"journal-issue":{"issue":"11-12","published-online":{"date-parts":[[2024,1,18]]},"published-print":{"date-parts":[[2024,11,5]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usad503","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,11]]},"published":{"date-parts":[[2024,1,18]]}}}