Clinical Effectiveness of Stop the Bleed–Based Hemorrhage Control Interventions in Prehospital Trauma: A Systematic Review Across Civilian, Law Enforcement, and Military Settings

This systematic review aims to evaluate the clinical effectiveness of hemorrhage control interventions derived from the Stop the Bleed initiative when applied in prehospital trauma settings across civilian, law enforcement, and military contexts. Uncontrolled external hemorrhage remains one of the leading preventable causes of death after traumatic injury. Over the past two decades, principles derived from military Tactical Combat Casualty Care have been translated into civilian practice through the Stop the Bleed campaign, promoting early application of tourniquets, wound packing, direct pressure, and hemostatic agents. Although these interventions are widely implemented, the magnitude of their clinical benefit across different operational environments has not been comprehensively synthesized. The primary objective of this review is to determine the impact of Stop the Bleed–based interventions on clinically relevant outcomes, including mortality (prehospital and in-hospital), time to hemorrhage control, transfusion requirements, and complication rates (e.g., limb ischemia, compartment syndrome, nerve injury). Secondary objectives include exploring whether effectiveness differs between civilian, law enforcement, and military prehospital trauma settings. This review will include randomized controlled trials and observational studies reporting clinical outcomes associated with prehospital hemorrhage control strategies aligned with Stop the Bleed principles. A structured search strategy will be conducted in major biomedical databases. Risk of bias will be assessed using validated methodological tools appropriate to study design. Where feasible, meta-analysis will be performed; otherwise, findings will be synthesized narratively with structured comparative analysis across contexts. The expected outcome of this project is to provide a comprehensive and methodologically rigorous synthesis of available evidence regarding the real-world clinical impact of Stop the Bleed–derived interventions. The findings may inform trauma system protocols, prehospital care guidelines, and future research priorities in both civilian and tactical environments.