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Notfall + Rettungsmedizin

, Volume 16, Issue 4, pp 291–304 | Cite as

Blutstillung mittels Tourniquet in der präklinischen Notfallmedizin

  • S.W. Hauschild
  • G. Nöldge-Schomburg
  • J. Hoitz
Konzepte - Qualitätsmanagement

Zusammenfassung

Hintergrund

Bisher galt der Einsatz von Tourniquets aufgrund der häufig beobachteten Nebenwirkungen und Komplikation als obsolet und wurde, wenn überhaupt, nur als Ultima ratio bei lebensbedrohlichen Extremitätenblutungen nach dem Motto „life before limb“ eingesetzt. Gründe für die Nebenwirkungen und Komplikationen waren v. a. Anwendungsfehler sowie der Einsatz schlecht konstruierter Produkte.

Aktuelle Situation

Der Verlust einer Extremität aufgrund eines Tourniquet-Einsatzes stellt eine Rarität dar. Mittlerweile werfen die positiven Erfahrungen des Militärs bei den Konflikten im Irak und in Afghanistan ein neues Licht auf diese Form der Blutstillung. Bei einem protokollbasierten rationalen Einsatz bewährter und getesteter Tourniquets durch trainierte Anwender kann die Verwendung von Tourniquets bei einer Anlagedauer von bis zu 2 h als eine sichere, schnelle und v. a. lebensrettende Maßnahme eingestuft werden. Dies wird durch die aktuelle Datenlage belegt.

Schlussfolgerungen

Zukünftig sollten deshalb im zivilen Rettungsdienst industriell gefertigte Tourniquets vorgehalten und SOP-basiert eingesetzt werden. Die wichtigste Maßnahme, um mögliche Komplikationen abzuwenden, ist die Schulung des medizinischen Personals in der korrekten Anwendung sowie die Durchführung eines regelmäßigen Trainings. Für Spezialeinheiten der Behörden (SEK/MEK, GSG9, etc.) ist es sinnvoll, in taktischer Einsatzmedizin ausgebildetes Personal innerhalb der Einheiten einzusetzen, welches in einer „Care-under-Fire-Situation“ eine massive Extremitätenblutung mittels Tourniquet kontrollieren kann, noch bevor der Patient an den Rettungsdienst übergeben und durch diesen weiterbehandelt wird. Speziell für die taktische Verwundetenversorgung wurden in Deutschland bereits Richtlinien durch die TREMA e. V (Tactical Rescue & Emergency Medicine Association) ausgearbeitet.

Schlüsselwörter

Hämorrhagischer Schock Hämostyptika Polytrauma Taktische Verwundetenversorgung Tactical Combat Casualty Care 

Hemostasis with a tourniquet in preclinical emergency medicine

Abstract

Background

Until recently the use of tourniquets was considered to be obsolete due to the known side effects and complications. Tourniquet application was seen as a last resort to stop life-threatening extremity bleeding by placing “life before limb”. In the past the main reasons for complications were application errors and the use of poorly designed products.

Present situation

The actual loss of a limb due to tourniquet use is a rarity and now the positive experiences of the military conflicts in Iraq and Afghanistan are throwing a new light on this method to “stop the bleeding”. The SOP-based application of modern trusted and tested tourniquets by trained users for a period up to 2 h is considered to be a fast, safe and life-saving procedure.

Conclusions

This evidence is reflected by the current data; therefore, the civilian emergency services should be provided with commercially manufactured tourniquets. To prevent potential complications it is important that civilian medical personnel are regularly trained in the correct SOP-based use of tourniquets. Special police units should have personnel trained in tactical combat casualty care in the units who can control massive limb bleeding in a “care under fire” situation by tourniquet use before the civilian emergency medical services take over casualty care. In Germany the Tactical Rescue and Emergency Medicine Association (TREMA) has developed specific guidelines for tactical casualty care.

Keywords

Hemorrhagic shock Hemostyptic Multiple trauma Tactical casualty care Tactical combat casualty care 

Notes

Compliance with Ethics Guidelines

Conflict of interest

S.W. Hauschild, G. Nöldge-Schomburg and J. Hoitz declare that they have no conflict of interest.

This article does not contain any studies with human or animal subjects.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • S.W. Hauschild
    • 1
  • G. Nöldge-Schomburg
    • 1
  • J. Hoitz
    • 2
  1. 1.Klinik und Poliklinik für Anästhesiologie und operative IntensivtherapieUniversitätsmedizin RostockRostockDeutschland
  2. 2.Bundeswehrkrankenhaus HamburgHamburgDeutschland

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