Prehospital tourniquet placement in extremity trauma

Jonathan Gushing; Scott G Blair; Roxie M Albrecht; Zoona Sawar; Kenneth Stewart; Curtis Knoles; Cooper Little; Celia Y Quang

doi:10.1016/j.amjsurg.2023.08.007

Prehospital tourniquet placement in extremity trauma

Am J Surg. 2023 Dec;226(6):901-907. doi: 10.1016/j.amjsurg.2023.08.007. Epub 2023 Aug 12.

Authors

Jonathan Gushing¹, Scott G Blair², Roxie M Albrecht³, Zoona Sawar⁴, Kenneth Stewart⁵, Curtis Knoles⁶, Cooper Little⁷, Celia Y Quang⁸

Affiliations

¹ University of Oklahoma College of Medicine, Oklahoma City, OK, USA. Electronic address: Jonathan-gushing@ouhsc.edu.
² Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. Electronic address: Scott-blair@ouhsc.edu.
³ Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. Electronic address: Roxie-albrecht@ouhsc.edu.
⁴ Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. Electronic address: Zoona-sawar@ouhsc.edu.
⁵ Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. Electronic address: Kenneth-Stewart@ouhsc.edu.
⁶ Department of Pediatrics, Section Pediatric Emergency Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. Electronic address: Curtis-Knoles@ouhsc.edu.
⁷ University of Oklahoma College of Medicine, Oklahoma City, OK, USA. Electronic address: cooper-little@ouhsc.edu.
⁸ Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK, USA. Electronic address: Celia-quang@ouhsc.edu.

PMID: 37596184
DOI: 10.1016/j.amjsurg.2023.08.007

Abstract

Background: Extremity tourniquets (ET) use has increased in trauma systems to manage traumatic hemorrhage. This study aims to evaluate prehospital ET placement.

Methods: This is a retrospective review of a prospectively collected cohort of 211 adult patients who underwent prehospital ET placement over 3 ½ years. Data regarding ET placement was analyzed regarding ET applier, reported indications, extremity appearance at arrival and outcomes.

Results: A total of 211 patients had completed data sheets. Of these patients, 63.2% had no other intervention prior to ET placement. On arrival, nearly 1/3 of the patients had palpable pulses with ET in place and less than ½ had arterial bleeding upon ET release.

Discussion/conclusions: This study shows that ET are frequently used as the initial intervention in the field. It is of paramount importance that we adapt our first responders training to teach wound assessment and appropriate steps in management of extremity hemorrhagic trauma.

Keywords: Extremity hemorrhage; Outcome; Pre-hospital; Tourniquet.

MeSH terms

Adult
Emergency Medical Services*
Extremities / injuries
Hemorrhage / etiology
Hemorrhage / therapy
Humans
Retrospective Studies
Tourniquets* / adverse effects