{
  "abstract": "The current use of tourniquets in Ukraine has caused an unacceptably high rate of complications, including rhabdomyolysis, compartment syndrome, thrombosis and myonecrosis, preventable amputations, renal failure and even death.1 There is no questioning that tourniquets have saved numerous lives on the battlefields since the introduction of Tactical Combat Casualty Care (TCCC).2 Indeed, in a mature operational environment with a military trauma system and short evacuation times, there appear to be few complications related to their use.3 On the other hand, complications due to the prolonged application of tourniquets are well known.4 These complications must be anticipated in situations involving delayed evacuation, such as near peer conflicts where air superiority is not guaranteed, and ground evacuation is contested. The severe complications of tourniquets are mainly related to ischaemia, due to obstruction of arterial blood flow, and are time dependent.5 Shorter ischaemia times will have few complications, but ischaemia lasting more than 6 hours will result in irreversible myonecrosis distal to the tourniquet. Exactly how long a tourniquet can safely be left in situ is controversial and likely depends on multiple factors such as the physiological status of the casualty. The tourniquet management recommendations in this article are based on experience from elective orthopaedic surgery, animal studies and from emergency use of tourniquets on the battlefields and in civilian practice (evidence level V).",
  "authors": [
    {
      "affiliations": [
        "Norwegian Armed Forces Joint Medical Services, Sessvollmoen, Norway",
        "Department of Trauma, St. Olav's University Hospital, Trondheim, Norway"
      ],
      "name": "Christian Medby"
    },
    {
      "affiliations": [
        "NATO Centre of Excellence for Military Medicine, Budapest, Hungary"
      ],
      "name": "J Ricks"
    },
    {
      "affiliations": [
        "NATO Allied Special Operations Forces Command, Mons, Belgium",
        "Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"
      ],
      "name": "B Ingram"
    },
    {
      "affiliations": [
        "Canadian Armed Forces Health Services Headquarters, Ottawa, Ontario, Canada"
      ],
      "name": "C Forestier"
    },
    {
      "affiliations": [
        "Research and Clinical Innovation, Defence Medical Services, Birmingham, UK"
      ],
      "name": "D Parkhouse"
    },
    {
      "affiliations": [
        "Research and Clinical Innovation, Defence Medical Services, Birmingham, UK"
      ],
      "name": "I Gurney"
    },
    {
      "affiliations": [
        "Landstuhl Regional Medical Center, Landstuhl, Germany"
      ],
      "name": "C A Burnett"
    },
    {
      "affiliations": [
        "Military Medical Center Frauenfeld, Frauenfeld, Switzerland"
      ],
      "name": "A Faas"
    }
  ],
  "title": "Removal of tourniquets: the next step in saving lives and limbs",
  "uid": "a6d672ac-87a5-5cc0-9677-38719816c505"
}