Prehospital limb hemorrhage

13 Dec 2021

Articles reviewed:

Levy MJ, Pasley J, Remick KN, Eastman AL, Margolis AM, Tang N, Goolsby CA. Removal of the Prehospital Tourniquet in the Emergency Department. The Journal of Emergency Medicine. 2021 Jan 1;60(1):98-102.

Henry R, Matsushima K, Ghafil C, Henry RN, Theeuwen H, Golden AC, Abramson TM, Inaba K. Increased Use of Prehospital Tourniquet and Patient Survival: Los Angeles Countywide Study. Journal of the American College of Surgeons. 2021 Apr 22.

Wyckoff MH, et al. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2021 Nov 11:S0300-9572(21)00448-2. doi: 10.1016/j.resuscitation.2021.10.040.

Gattere M, Scaffei N, Gozzetti L, Alessandrini M. Tourniquet Use on a Pediatric Patient. Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals. 2021 Jan 1;21(1):120-3.

James T, Izon-Cooper L, Collins S, Cole H, Marczylo T. The wash-in effect and its significance for mass casualty decontamination. Journal of Toxicology and Environmental Health, Part B. 2022 Apr 3;25(3):113-34.


Decontamination of skin by washing may increase dermal absorption, a phenomenon known as the wash-in effect. The wash-in effect is frequently discussed in studies investigating casualty decontamination where potentially life-saving interventions may enhance the dermal penetration of toxic chemicals, leading to an increase in incidence of morbidity and rates of mortality. However, the wash-in effect is seldom investigated within the context of mass casualty decontamination and real-life consequences are therefore poorly understood. This paper reviews the existing literature on the wash-in effect to highlight the proposed mechanisms for enhanced absorption and evaluate the wash-in effect within the context of mass casualty chemical decontamination.