The majority of studies in civilian prehospital setting have been performed in the military setting. Fewer studies on this subject have been performed in the civilian setting. These studies mainly come from the battlefield setting, however, changes in trauma mechanism and patient demographics (e.g., age, injuries and comorbidities) are changing the way trauma care is provided in the civilian setting. The use of junctional tourniquets in civilian prehospital setting is not in line with the recommended use in the military setting. Also, the use of junctional tourniquets in civilian prehospital setting is associated with a higher risk of iatrogenic injury and should be considered carefully. Decision support for the use of junctional tourniquets in civilian prehospital setting should be determined by a clinical consensus of an interdisciplinary panel of experts. A general recommendation for junctional tourniquets is to use them for junctional haemorrhage and more specifically for the control of junctional and truncal haemorrhage. However, it should be noted that junctional tourniquets have not been specifically studied in civilian prehospital setting. No recent publication on the use of junctional tourniquets in the civilian prehospital setting is available.
Clamp systems are widely used for junctional and truncal haemorrhage and act both as a direct pressure and a ligature. Injectable haemostatic sponges are available for bleeding in the trunk, extremities and pelvic region. Studies on the use of such sponges in civilian prehospital setting are currently lacking and clinical trials in the battlefield setting are yet to be performed. Airway control, junctional tourniquet, intra-abdominal/intrathoracic self-expanding foam and intra-abdominal gas insufflation are options that are considered to be most suitable to the civilian prehospital setting. A pelvic circumferential sheet is most commonly used to control junctional haemorrhage in the battlefield setting. The use of the pelvic circumferential sheet is also considered as best practice in the civilian setting.
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