TS13 HAEMOSTASIS IN THE AUSTRALIAN DEFENCE FORCE: THE TOURNIQUET CONTROVERSY

In civilian trauma concerns about tourniquet‐related problems has rendered tourniquets virtually obselete. The use of tourniquets in a battlefield setting however remains surrounded by controversy. Whilst many accept that if properly used, tourniquets can be life saving devices, opinion is divided regarding its role. Some surgeons have recommended abolition of the tourniquet, whist others advocate that every combat solder should be issued with a tourniquet as part of their personal equipment. The recent introduction of the self applied C‐A‐T tourniquet into the Australian Defence Force has re‐ignited controversy as to the appropriate role of tourniquets in an operational setting. During Vietnam, Desert Storm and Somalia haemorrhage from extremity wounds was a leading cause of preventable combat deaths. Improvements in body armour and increased exposure to blast injury has resulted in a relative increase in limb injuries in recent operations. Experience in Somalia, Iraq and Afghanistan particularly by Special Operations communities has led to a re‐assessment of the efficacy of battlefield tourniquet systems. The C‐A‐T tourniquet has been widely used in Iraq and Afghanistan. No iatrogenic injury has been reported, even with tourniquet times up to 8 hours. This paper will discuss the history of tourniquet use in the military from its first introduction in 1674 to the most recent ADF doctrine (ADFP XXX). It will also present trial results from the UK and US and recommendations from the 2006 Advanced Technologies Applied to Combat Casualty Care Conference (ATACC). This paper will address the basis of current doctrine and provide a case for and against the use of tourniquets in an operational setting.