Approaches to providing first aid to children with massive bleeding from the extremities: regulatory framework and world experience

Massive hemorrhage is one of the leading causes of trauma-related mortality in children, particularly in the context of armed conflict and emergency situations. Despite the availability of numerous international guidelines on bleeding control, the safety and efficacy of tourniquet use in pediatric populations remain controversial. This systematic review aimed to analyze the current regulatory framework, international clinical recommendations, and scientific evidence regarding the use of tourniquets in children of various age groups in prehospital settings. The review was conducted in three stages: analysis of Ukrainian Ministry of Health regulations and international protocols; a targeted literature search in the PubMed database using predefined inclusion criteria; and synthesis of findings based on child age, tactical conditions, availability of medical supplies, and responder training level. Eight relevant studies were included, evaluating different commercial tourniquet models (e.g., CAT, SWAT-T, MAT, CRMT) on simulation models and in clinical scenarios. Findings indicate that tourniquet effectiveness is highly dependent on the child’s age, limb circumference, and device type. In infants, direct pressure and wound packing remain the primary methods of hemorrhage control, while in older children, commercial tourniquets may be used effectively if anatomically appropriate. Ethical constraints limit large-scale studies on uninjured children, yet military experience—particularly from Iraq, Afghanistan, and Ukraine — supports the integration of tourniquets into pediatric trauma care protocols. Conclusions. This review highlights the need to adapt national guidelines to account for pediatric anatomical and physiological differences, as well as tactical realities. Further research is essential to refine prehospital hemorrhage control strategies and improve outcomes for children with life-threatening bleeding. The authors declare no conflict of interest.