TOURNIQUET REVISITED : A HISTORICAL REVIEW TO DISTINGUISH GOOD PRACTICE FROM BAD PRACTICE

Abstract

　　Tourniquet has been used to control hemorrhage since antiquity. The tourniquets have had a unique place in military papers : love-hate relationships throughout history with each war having surgeons take opposite stances on their safety and efficacy. It has been called at times ‘an invention of the Evil One', and at other times life-saving although with the caveat of being a ‘last resort'. Following the wars in Afghanistan and Iraq, a great change in attitude towards the use of the tourniquet has happened. Several significant advancements were introduced in combat casualty care in those wars, leading to dramatic increases of survival and limb-saving rates. Among these advances, tourniquet application was the most important factor. A paradigm shift has occurred, as wartime innovations have been translated to civilian emergency medicine. The tourniquet is now applied in civilian-level trauma care widely throughout the world. In Japan, however, prehospital tourniquet application by paramedics or EMTs is still met with resistance, despite guidelines for the application of such treatments in The Educators Handbook of Improving Hemorrhage Control for Response Capabilities against Terrorism in 2018. The purpose of this study was to review the history of the tourniquet from ancient times to the current situation, clarify the significance of the tourniquet, and recognize present issues in Japan.