BACKGROUND: Among civilians, emergency tourniquet (TKT) use is infrequent because of concern for TKT-related complications. In large part because of positive reports from the military on emergency TKT use, all ambulances serving Mecklenburg County, which includes the city of Charlotte, North Carolina, were equipped with commercial TKTs in September 2012. This study compares the outcomes of emergency TKT use with conservative hemorrhage control in an urban civilian setting and evaluates outcomes related to appropriate TKT placement. METHODS: Emergency medical service and hospital records from September 2012 to November 2013 were reviewed. Injury characteristics, clinical interventions, outcomes, and TKT-related complications were reported, and appropriateness of TKT use was assessed. Primary analysis compared all TKT patients with non-TKT patients who received other hemorrhage control measures. Secondary analysis compared all appropriate TKT patients with those who had delayed/missed TKTs. RESULTS: Fifty-six patients met inclusion criteria (24 TKT, 32 non-TKT). Four patients died (three TKT, one non-TKT) (7.1%). There were no reported TKT-related complications. Of all the patients, 46.4% (16 of 56) demonstrated signs of shock in the prehospital or emergency department setting. Seventy-five percent (12 of 16) of the patients in shock had a vascular injury (p = 0.023). Of the non-TKT patients, 9.4% (3 of 32) should have received a TKT and were classified as "missed." One "missed" patient died in the emergency department. Among TKT patients, 62.5% (15 of 24) of TKTs were appropriate, 20.8% (5 of 24) were inappropriate, and 16.7% (4 of 24) were "delayed." Overall, there was a delayed/missed TKT rate of 12.5% (7 of 56). Patients with delayed/missed TKTs had higher incidences of shock (85.7% vs. 60%), inpatient admission (100% vs. 76.9%), and blood transfusions (71.4% vs. 40%). CONCLUSION: The majority of TKTs were appropriately applied to civilians who had vascular injuries or required operative intervention for hemorrhage control. With appropriate indications, an emergency TKT is a valuable instrument for hemorrhage control in the civilian prehospital setting and has a low rate of associated complications. LEVEL OF EVIDENCE: Therapeutic study, level IV.
BACKGROUND: Among civilians, emergency tourniquet (TKT) use is infrequent because of concern for TKT-related complications. In large part because of positive reports from the military on emergency TKT use, all ambulances serving Mecklenburg County, which includes the city of Charlotte, North Carolina, were equipped with commercial TKTs in September 2012. This study compares the outcomes of emergency TKT use with conservative hemorrhage control in an urban civilian setting and evaluates outcomes related to appropriate TKT placement. METHODS: Emergency medical service and hospital records from September 2012 to November 2013 were reviewed. Injury characteristics, clinical interventions, outcomes, and TKT-related complications were reported, and appropriateness of TKT use was assessed. Primary analysis compared all TKTpatients with non-TKTpatients who received other hemorrhage control measures. Secondary analysis compared all appropriate TKTpatients with those who had delayed/missed TKTs. RESULTS: Fifty-six patients met inclusion criteria (24 TKT, 32 non-TKT). Four patients died (three TKT, one non-TKT) (7.1%). There were no reported TKT-related complications. Of all the patients, 46.4% (16 of 56) demonstrated signs of shock in the prehospital or emergency department setting. Seventy-five percent (12 of 16) of the patients in shock had a vascular injury (p = 0.023). Of the non-TKTpatients, 9.4% (3 of 32) should have received a TKT and were classified as "missed." One "missed" patient died in the emergency department. Among TKTpatients, 62.5% (15 of 24) of TKTs were appropriate, 20.8% (5 of 24) were inappropriate, and 16.7% (4 of 24) were "delayed." Overall, there was a delayed/missed TKT rate of 12.5% (7 of 56). Patients with delayed/missed TKTs had higher incidences of shock (85.7% vs. 60%), inpatient admission (100% vs. 76.9%), and blood transfusions (71.4% vs. 40%). CONCLUSION: The majority of TKTs were appropriately applied to civilians who had vascular injuries or required operative intervention for hemorrhage control. With appropriate indications, an emergency TKT is a valuable instrument for hemorrhage control in the civilian prehospital setting and has a low rate of associated complications. LEVEL OF EVIDENCE: Therapeutic study, level IV.
Authors: Ronald Chang; Erin E Fox; Thomas J Greene; Brian J Eastridge; Ramyar Gilani; Kevin K Chung; Stacia M DeSantis; Joseph J DuBose; Jeffrey S Tomasek; Gerald R Fortuna; Valerie G Sams; S Rob Todd; Jeanette M Podbielski; Charles E Wade; John B Holcomb Journal: J Trauma Acute Care Surg Date: 2017-07 Impact factor: 3.313
Authors: Michelle H Scerbo; Jacob P Mumm; Keith Gates; Joseph D Love; Charles E Wade; John B Holcomb; Bryan A Cotton Journal: Prehosp Emerg Care Date: 2016-05-31 Impact factor: 3.077
Authors: Itamar Ashkenazi; Roger Sevi; Fernando Turégano-Fuentes; Michael S Walsh; Oded Olsha; William P Schecter; Ricardo Alfici Journal: Eur J Trauma Emerg Surg Date: 2018-09-27 Impact factor: 3.693
Authors: Ryan M Corrick; Huiyin Tu; Dongze Zhang; Aaron N Barksdale; Robert L Muelleman; Michael C Wadman; Yu-Long Li Journal: Front Physiol Date: 2018-03-20 Impact factor: 4.566