• Maarten Philip Cornelissen, Anne Brandwijk, Linda Schoonmade, Georgios Giannakopoulos, Stefan van Oostendorp, and Leo Geeraedts.
• Department of Surgery, Section Trauma Surgery, Amsterdam University Medical Centers, Location VUmc Amsterdam, De Boelelaan, 1117, 1081 HV, Amsterdam, The Netherlands. maartenpcornelissen@gmail.com.
• Eur J Trauma Emerg Surg. 2020 Jun 1; 46 (3): 531-538.

ObjectiveThe increased incidence of mass casualty incident (MCI) with penetrating injuries in the civilian setting creates a call for implementing devices, such as a tourniquet (TQ), in civilian first aid. Bystanders could act as immediate responders after an MCI in order to prevent a victim from exsanguination using direct pressure or commercial tourniquets (C-TQ). Reports have shown that immediate access to C-TQs was not available and bystanders used objects available at the trauma scene to make an improvised tourniquet (I-TQ). The aim of this systematic review of literature was to summarize the existing literature on designs, efficacy and safety of I-TQs.MethodsA systematic review of the literature was performed. Bibliographic databases PubMed, EMBASE.com and Cochrane Library were searched. All types of original studies about I-TQ's were included. Review studies, exempts from textbooks or studies with TQs applied during elective surgeries were excluded.ResultsTwenty studies were included. In both simulated experiments and real-life situations, I-TQs outperformed commercial TQs (C-TQ) regarding success rate. Of the I-TQs, the band and windlass design performed most consistently. Although lacking any statistical analysis, there was no reported difference in adverse events between I-TQs and C-TQs.ConclusionThe use of- and training in I-TQ by civilian immediate responders is not recommended because of limited efficacy and safety concerns; direct pressure is a viable alternative. However, I-TQs may save lives when applied correctly with proper objects; therefore, future studies regarding the best design and training in application of effective and safe I-TQs should be encouraged.

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