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There is some e vidence that trauma patients with se v ere torso injuries ha v e a lo wer mortality when con v e yed to hospital <15 minutes after injury than those who arri v e between 15 and 30 mins, 9 supporting a more biologically intuiti v e h ypothesis that there is a continuum of survi v al adv antage with earlier sur gery (i.e., the earlier the better). Alarhayem A Q, Myers JG, Dent D, et al: T ime is the enemy: mortality in trauma patients with hemorrhage from torso injury occurs long before the "Golden Hour". C OMMENT AR Y MILIT AR Y MEDICINE, 186, 5/6:136, 2021 Wher e Do Sur g eons Belong on the Moder n Bat tlef ield? Marsden M, Carden R, Na v aratne L, et al: Outcomes follo wing trauma laparotomy for h ypotensi v e trauma patients: a UK military and ci vilian perspecti v e. J T rauma Acute Care Sur g 2018; 85(3): 620-5. 19. [Extracted from the article]

Background: Limb tourniquets have been used extensively during modern Middle Eastern conflicts. Despite its undeniable successes, the combat applied tourniquet (C-A-T) has some shortfalls, principally its inability to reliably control lower limb bleeding when applied to the mid-thigh. We tested two tourniquets which may represent an improvement to the combat applied tourniquet; the tactical mechanical tourniquet and the tactical pneumatic tourniquet.Methods: We recruited 12 healthy service personnel and applied the tactical mechanical tourniquet and tactical pneumatic tourniquet to both lower limbs in a randomly generated sequence. Tourniquets were tightened until popliteal artery occlusion. This was measured via a SonoSite portable ultrasound machine by a single consultant vascular radiologist familiar with its use. A longitudinal view of the popliteal artery was obtained, and Doppler waveform monitored. The tourniquets were tightened around volunteers' mid-thigh by a second researcher accustomed with their use. Time to complete occlusion, number of windlass revolutions, and pain scores were collected by a third researcher. Non-normally distributed data are present as median (interquartile range). Ordinal nonparametric data are analysed by Mann-Whitney U testing.Results: Participants had a median age of 32.5 (28-35). Both tourniquets demonstrated complete occlusion of the popliteal artery in all limbs (n = 24). The mechanical tourniquet achieved arterial occlusion after a median of 3.8 (3-4) turns, and 16 (12-20) seconds. No participants dropped out of the study because of intolerable pain, or any cause. Median pain scores for the mechanical tourniquets were 4.5 (3-7) (maximum pain) and 4.0 (2-7) (pain when locked). Median pain scores for the pneumatic tourniquet were 5 (2-6) (maximum pain) and 5 (2-6) (pain when fully applied). There was no statistical difference in maximum pain scores between the tactical mechanical tourniquet and the tactical pneumatic tourniquet (p = 0.75). No participant had any tourniquet applied for longer than 80 seconds.Conclusion: Both tourniquets completely occluded the popliteal artery in all participants within an acceptable pain threshold. Further testing is required before the presented tourniquets can be taken to the battlefield; particularly measures of self-application, and use on other anatomical areas. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experience of staying at a hospital as a trauma patient and relates it to his career as a junior doctor for the U.S. Army.