{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:16:17Z","timestamp":1792084577206,"version":"4.4.0"},"reference-count":12,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J R Army Med Corps"],"published-print":{"date-parts":[[2009,9]]},"abstract":"<jats:p>It has been stated that the application of a pre-hospital tourniquet could prevent 7% of combat deaths, however their widespread use has been questioned due to the potential risk from prolonged ischaemia. We reviewed members of the UK Armed Forces who sustained severe limb-threatening injuries in Iraq and Afghanistan, and performed a matched cohort study based on the presence or absence of pre-hospital tourniquet application. When a pre-hospital tourniquet had been applied, 19\/22 patients had a least one complication compared to 15\/22 where no tourniquet had been applied [p=0.13]. There were 10 limbs with at least one major complication in the pre-hospital tourniquet group but only four in the group with no tourniquet [p=0.045].<\/jats:p><jats:p>The significant difference in the incidence of major complications is a concern, particularly as the difference was mainly due to a deep infection rate of 32% vs. 4.5%. Although a number of variables could have influenced these small groups, such as choice of fracture fixation implant and method and timing of wound closure, the use of a matched cohort study design with a statistical significance level of p &lt; 0.05, suggests the use of a pre-hospital tourniquet as a factor. Althoughthe use of pre-hospital tourniquets cannot be decried as a result of this study, the need to continually prospectively review their use to determine their risk\/benefit ratio remains.<\/jats:p>","DOI":"10.1136\/jramc-155-03-06","type":"journal-article","created":{"date-parts":[[2013,3,19]],"date-time":"2013-03-19T23:43:32Z","timestamp":1363736612000},"page":"200-202","source":"Crossref","is-referenced-by-count":37,"title":["Limb Complications following Pre-Hospital Tourniquet Use"],"prefix":"10.1136","volume":"155","author":[{"given":"J","family":"Clasper","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KV","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2009,9,1]]},"reference":[{"key":"ref_1","first-page":"13","article-title":"A profile of combat injury","volume":"54","author":"Champion, H.R.; Bellamy, R.F.; Roberts, P.; Leppaniemi, A.","year":"2003","unstructured":"Champion HR, Bellamy RF, Roberts P, Leppaniemi A. A profile of combat injury. J Trauma 2003;54:S13-S19.","journal-title":"J Trauma"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/TA.0b013e318160937e","article-title":"Prehospital tourniquet use in Operation Iraqi Freedom: Effect on hemorrhage control and outcomes","volume":"64","author":"Beekley, A.C.; Sebesta, J.A.; Blackbourne, L.H.","year":"2008","unstructured":"Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: Effect on hemorrhage control and outcomes. J Trauma 2008;64:S28-S37.","journal-title":"J Trauma"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"770","DOI":"10.7205\/MILMED.170.9.770","article-title":"Issues related to the use of tourniquets on the battlefield","volume":"170","author":"Walters, T.J.; Mabry, R.L.","year":"2005","unstructured":"Walters TJ, Mabry RL. Issues related to the use of tourniquets on the battlefield. Mil Med 2005;170:770-775.","journal-title":"Mil Med"},{"key":"ref_4","first-page":"310","article-title":"Tourniquet use in combat trauma: UK military experience","volume":"153","author":"Brodie, S.; Hodgetts, T.J.; Ollerton, J.; McLeod, J.; Lambert, P.; Mahoney, P.","year":"2008","unstructured":"Brodie S, Hodgetts TJ, Ollerton J, McLeod J, Lambert P, Mahoney P. Tourniquet use in combat trauma: UK military experience. J R Army Med Corps 2008;153:310-313.","journal-title":"J R Army Med Corps"},{"key":"ref_5","first-page":"8","article-title":"The military tourniquet","volume":"153","author":"Parker, P.J.; Clasper, J.C.","year":"2008","unstructured":"Parker PJ, Clasper JC. The military tourniquet. J R Army Med Corps 2008;153: 8-13.","journal-title":"J R Army Med Corps"},{"key":"ref_6","article-title":"Complications of extremity vascular injuries in conflict","author":"Brown, K.V.; Ramasamy, A.; Tai, N.; MacLeod, J.; Midwinter, M.; Clasper, J.C.","year":"2009","unstructured":"Brown KV, Ramasamy A, Tai N, MacLeod J, Midwinter M, Clasper JC. Complications of extremity vascular injuries in conflict. J Trauma 2009;In press.","journal-title":"J Trauma"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1097\/00005373-199005000-00007","article-title":"Objective criteria accurately predict amputation following lower extremity trauma","volume":"30","author":"Johansen, K.; Daines, M.; Howey, T.; Helfet, D.; Hansen, S.T.","year":"1990","unstructured":"Johansen K, Daines M, Howey T, Helfet D, Hansen ST. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma 1990;30:568-73.","journal-title":"J Trauma"},{"key":"ref_8","first-page":"219","article-title":"The tourniquet controversy","volume":"54","author":"Navein, J.; Coupland, R.M.; Dunn, R.","year":"2003","unstructured":"Navein J, Coupland RM, Dunn R. The tourniquet controversy. J Trauma 2003;54:S219-S220.","journal-title":"J Trauma"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1136\/emj.2006.039610","article-title":"ABC to <CABC>: redefining the military trauma paradigm","volume":"23","author":"Hodgetts, T.J.; Mahoney, P.F.; Russell, M.Q.; Byers, M.","year":"2006","unstructured":"Hodgetts TJ, Mahoney PF, Russell MQ, Byers M. ABC to <CABC>: redefining the military trauma paradigm. Emerg Med J 2006;23:745-746.","journal-title":"Emerg Med J"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/SLA.0b013e31818842ba","article-title":"Survival with emergency tourniquet use to stop bleeding in major limb trauma","volume":"249","author":"Kragh, J.F.; J, Walters T.; Baer, D.G.","year":"2009","unstructured":"Kragh JF, Walters T J, Baer DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009;249:1-7.","journal-title":"Ann Surg"},{"key":"ref_11","first-page":"11","article-title":"Infections in combat casualties during Operations Iraqi and Enduring Freedom. Abstract from: Advanced Technology Applications for Combat Casualty Care","author":"Murray, C.K.","year":"2008","unstructured":"Murray CK. Infections in combat casualties during Operations Iraqi and Enduring Freedom. Abstract from: Advanced Technology Applications for Combat Casualty Care. St. Petes Beach, Florida 2008;Aug 11-13.","journal-title":"St. Petes Beach, Florida"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1097\/00005373-198408000-00009","article-title":"Problems in the management of type III [severe] open fractures: A new classification of type III open fractures","volume":"24","author":"Gustilo, R.B.; Mendoza, R.M.; Williams, D.N.","year":"1984","unstructured":"Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III [severe] open fractures: A new classification of type III open fractures. J Trauma 1984;24:742-6.","journal-title":"J Trauma"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-155-03-06","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T05:28:15Z","timestamp":1716182895000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-155-03-06"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,9]]},"references-count":12,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2009,9,1]]},"published-print":{"date-parts":[[2009,9]]}},"alternative-id":["10.1136\/jramc-155-03-06"],"URL":"https:\/\/doi.org\/10.1136\/jramc-155-03-06","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"value":"0035-8665","type":"print"},{"value":"2052-0468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,9]]}}}