Original contribution
Battle Casualty Survival with Emergency Tourniquet Use to Stop Limb Bleeding

https://doi.org/10.1016/j.jemermed.2009.07.022Get rights and content

Abstract

Background

In a previous study conducted at a combat support hospital in Iraq, we reported the major lifesaving benefits of emergency tourniquets to stop bleeding in major limb trauma. Morbidity associated with tourniquet use was minor.

Study Objectives

The objective of this study is to further analyze emergency tourniquet use in combat casualty care.

Design and Setting

This report is a continuation of our previous study of tourniquet use in casualties admitted to a combat support hospital (NCT00517166 at www.ClinicalTrials.gov).

Methods

After verifying comparable methodologies for the first study and the current study, we compared patient results for these two time periods and then pooled data to analyze outcomes with a larger sample size.

Results

The total study population was 499 (232 in the previous study and 267 in the current study). In all, 862 tourniquets were applied on 651 limbs. Survival was 87% for both study periods. Morbidity rates for palsies at the level of the tourniquet were 1.7% for study 1 and 1.5% for study 2; major limb shortening was 0.4% for both. Survival was associated with prehospital application (89% vs. 78% hospital, p < 0.01) and application before the onset of shock (96% vs. 4% after).

Conclusions

This study shows consistent lifesaving benefits and low risk of emergency tourniquets to stop bleeding in major limb trauma.

Introduction

Despite recent positive reports of the use of emergency tourniquets from studies conducted at United States (US) combat support hospitals in Iraq, these devices are still considered controversial by some providers (1, 2). We recently reported major lifesaving benefits and minor morbidity risks with emergency tourniquet use to stop bleeding in major limb trauma (3, 4). Our goal was to see if our preliminary findings would hold true as the war progressed and tourniquets continued to be used. The fielding of tourniquets during the current war and the number of casualties permitted us to study and continue to evaluate performance (5, 6). Improving prehospital hemorrhage control is vital to military and civilian trauma care, and we continue our efforts to fill knowledge gaps regarding first aid of limb-injured patients (7, 8, 9, 10, 11, 12, 13). There is no consensus on tourniquet use in civilian trauma, but an adequate collection of military data may help to change this. In our continued study of patients who had tourniquets applied in the field or in the emergency department (ED), our objective was to analyze use and possibly refine our understanding of when and if tourniquets should be used as first aid, to refine doctrine and training if indicated. Specifically, our objective was to assess morbidity and mortality associated with tourniquet use.

Section snippets

Study Design, Setting, and Participant Selection

The current report was designed to test the consistency of the findings of our previous reports on emergency tourniquet use (3, 4). The design was an observational study of patient care; there was no experiment or intervention. Before the study began we predetermined the data of interest, that is, possible morbidity as well as the mortality rates with the use of tourniquets. The study was approved by our institutional review board as part of an ongoing prospective performance improvement

Results

The two study periods were similar for the number of patients, deaths, palsies at the level of the tourniquet, and limbs with major shortening, so these data were consistent (Table 1), and therefore we pooled data for further analysis.

Discussion

The main finding of the present report is that the major lifesaving benefits of emergency tourniquet use were observed again, and the consistent finding reinforces the recommendation to consider tourniquets in similar care settings. Additionally, the minor morbidity risks were also consistent with the prior reports (3, 4). Despite different providers, patients, and site investigators, albeit at the same site using the same methods, the consistent findings increase the generalizability of the

Conclusions

Battle casualty survival rates are consistently high with emergency tourniquet use to stop bleeding, and morbidity rates remain low. Evidence indicates that when used at the right time in the right way, emergency tourniquets are lifesaving.

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    This study was performed at the 10th & 28th Combat Support Hospitals, US Army, (Ibn Sina Hospital, International Zone, Baghdad, Iraq). The trial number is NCT00517166 at www.ClinicalTrials.gov.

    The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or United States Government. The authors are employees of the US government. This work was prepared as part of their official duties and, as such, there is no copyright to be transferred.

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