Craig Goolsby1, Elizabeth Rouse2, Luis Rojas3, Eric Goralnick4, Matthew J Levy5, Thomas Kirsch3, Alexander L Eastman6, Arthur Kellermann7, Kandra Strauss-Riggs3, Nicole Hurst8. 1. Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: craig.goolsby@usuhs.edu. 2. Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD. 3. National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. 4. Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 5. Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD; Howard County Department of Fire and Rescue Services, Columbia, MD. 6. Rees-Jones Trauma Center, Parkland Hospital, Dallas, TX; Division of Burns, Trauma and Critical Care, The University of Texas Southwestern Medical Center, Dallas, TX. 7. School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. 8. Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Abstract
BACKGROUND: Although the survivability of military extremity hemorrhage is well documented, equivalent civilian data are limited. We analyzed statewide autopsy records in Maryland to determine the number of hemorrhagic deaths that might have been potentially survivable with prompt hemorrhage control. Similar analyses of battlefield deaths led to life-saving changes in military medical practice. STUDY DESIGN: This is a retrospective study of decedent records. The objective is to estimate the number of hemorrhagic deaths that might have been prevented by prompt placement of an extremity tourniquet. Maryland autopsy records from 2002 to 2016 were selected using the following search terms: amputation, arm/arms, avulsion, exsanguination, extremity/extremities, leg/legs. The records were analyzed by applying a checklist of previously developed military criteria to characterize deaths as potentially survivable or nonsurvivable with prompt use of a tourniquet. Suicides and decedents less than 18 years old were excluded. The study did not use information about living participants. Two expert reviewers independently evaluated and scored the death records. Deaths were classified as either potentially survivable or nonsurvivable. A third reviewer broke any ties. RESULTS: There were 288 full autopsy records included in the final analysis. Of the eligible decedents reviewed during the 14-year period, 124 of 288 had potentially survivable wounds; 164 had nonsurvivable wounds. CONCLUSIONS: Over the 14-year study interval, 124 Maryland decedents-an average of 9 per year-might have been saved with prompt placement of a tourniquet. If extrapolated, approximately 480 people in the US might be saved per year. These results provide evidence to support educating and equipping the public to provide bleeding control. Published by Elsevier Inc.
BACKGROUND: Although the survivability of military extremity hemorrhage is well documented, equivalent civilian data are limited. We analyzed statewide autopsy records in Maryland to determine the number of hemorrhagic deaths that might have been potentially survivable with prompt hemorrhage control. Similar analyses of battlefield deaths led to life-saving changes in military medical practice. STUDY DESIGN: This is a retrospective study of decedent records. The objective is to estimate the number of hemorrhagic deaths that might have been prevented by prompt placement of an extremity tourniquet. Maryland autopsy records from 2002 to 2016 were selected using the following search terms: amputation, arm/arms, avulsion, exsanguination, extremity/extremities, leg/legs. The records were analyzed by applying a checklist of previously developed military criteria to characterize deaths as potentially survivable or nonsurvivable with prompt use of a tourniquet. Suicides and decedents less than 18 years old were excluded. The study did not use information about living participants. Two expert reviewers independently evaluated and scored the death records. Deaths were classified as either potentially survivable or nonsurvivable. A third reviewer broke any ties. RESULTS: There were 288 full autopsy records included in the final analysis. Of the eligible decedents reviewed during the 14-year period, 124 of 288 had potentially survivable wounds; 164 had nonsurvivable wounds. CONCLUSIONS: Over the 14-year study interval, 124 Maryland decedents-an average of 9 per year-might have been saved with prompt placement of a tourniquet. If extrapolated, approximately 480 people in the US might be saved per year. These results provide evidence to support educating and equipping the public to provide bleeding control. Published by Elsevier Inc.
Authors: Kandra Strauss-Riggs; Thomas D Kirsch; Erik Prytz; Richard C Hunt; Carl-Oscar Jonson; Jon Krohmer; Ira Nemeth; Craig Goolsby Journal: AEM Educ Train Date: 2020-04-16
Authors: Craig A Goolsby; Keke Schuler; Raphaelle Rodzik; Nathan Charlton; Vidya Lala; Kevin Anderson; Jeffrey L Pellegrino Journal: West J Emerg Med Date: 2021-06-29
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