Battle Casualty Survival with Emergency Tourniquet Use to Stop Limb Bleeding

Kragh, John F; Littrel, Michelle L.; Jones, John A.; Walters, James; Baer, David G.; Wade, Charles E.; Holcomb, John B.

doi:10.1016/j.jemermed.2009.07.022

Cited by 267 publications

(171 citation statements)

References 27 publications

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“…In terms of this latter concern, data suggest that tourniquets save lives most effectively when applied before the development of overt shock. 24 Studies also have shown that in cases of penetrating trauma, decreased time to definitive care is associated with improved survival outcomes. [25][26][27] Conclusions The current case series demonstrates the life-saving potential for law enforcement personnel trained and equipped under current TCCC/C-TECC tactical casualty care guidelines.…”

Section: Limitationsmentioning

confidence: 99%

A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015

Stiles

Cook²,

Sztajnkrycer³

2017

Prehosp. Disaster med.

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IntroductionBased upon military experience, law enforcement has developed guidelines for medical care during high-threat conditions. The purpose of the current study was to provide a descriptive analysis of reported outcomes of law enforcement medical interventions.MethodsThis was a descriptive analysis of a convenience sample of cases submitted to the Wisconsin Tactical Medicine Initiative (Wisconsin USA), after the provision of successful patient care, between January 2010 and December 2015. The study was reviewed by the Mayo Foundation Institutional Review Board (Rochester, Minnesota USA) and deemed exempt.ResultsNineteen agencies submitted information during the study period. Of the 56 episodes of care reported, four (7.1%) cases involved care provided to injured officers while 52 (92.9%) involved care to injured civilians, including suspects. In at least two cases, on-going threats existed during the provision of medical care to an injured civilian. Law enforcement rendered care prior to Emergency Medical Services (EMS) arrival in all but two cases.ConclusionsThe current case series demonstrates the life-saving potential for law enforcement personnel trained and equipped under current Tactical Combat Casualty Care (TCCC)/ Committee on Tactical Emergency Casualty Care (C-TECC) tactical casualty care guidelines. Although originally developed to save the lives of wounded combat personnel, in the civilian sector, the training appears more likely to save victims rather than law enforcement personnel.StilesCM, CookC, SztajnkrycerMD. A descriptive analysis of tactical casualty care interventions performed by law enforcement personnel in the State of Wisconsin, 2010-2015. Prehosp Disaster Med. 2017;32(3):284–288.

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Section: Limitationsmentioning

confidence: 99%

A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015

Stiles

Cook²,

Sztajnkrycer³

2017

Prehosp. Disaster med.

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“…On arrival, the left lower limb was edematous, cold, cyanotic, and pulseless ( Figures 1 and 2). A venous blood gas measurement showed pH 7.41, pCO 2 29 mm Hg, HCO 3 18 mEq/L, lactate 2.1 mmol/L, hemoglobin 112 g/L, and an international normalized ratio of 1.27. Plain radiography of the pelvis and left femur did not show a bullet or fracture.…”

Section: Case Reportmentioning

confidence: 99%

“…The first venous blood gas measurement showed a pH of 6.91, pCO 2 of 51 mm Hg, HCO 3 10 mEq/L, lactate 8.5 mmol/L, and hemoglobin 122 g/L. At 8:30 am, the repeat venous blood gas measurement showed pH 7.15, pCO 2 54 mm Hg, HCO 3 18 mEq/L, base excess of −9.2, and lactate 6.2 mmol/L. At 9:00 am, the patient was transported by fixed-wing air ambulance to our tertiary trauma care facility, 1633 km away.…”

Section: Case Reportmentioning

confidence: 99%

“…[1][2][3] Due to the potential for significant complications (including clots, myonecrosis, pain, palsy, abscess, blisters, contusions, abrasions, renal failure, compartment syndrome, and amputation) 4 and the paucity of evidence of its role in the non-military context, controversy persists regarding tourniquet use. We describe a civilian case in which improvised tourniquets were applied to an extremity for 17 hours following a penetrating lower limb injury in a remote area of Quebec.…”

Section: Introductionmentioning

confidence: 99%

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Prolonged prehospital tourniquet placement associated with severe complications: a case report

Malo

Bernardin

Nemeth

et al. 2015

CJEM

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“…71 In response to this review, Kue et al 77 pointed out that Boston Emergency Medical Service (EMS) has long used the rubber tubing/Kelly clamp tourniquet system introduced as a result of experiences in Vietnam, and it is likely that some of the patients had this type of tourniquet, which was skillfully applied by EMS personnel. However, improvised tourniquets have been reported to be ineffective in military casualties, 74,[78][79][80] and the article by King et al 71 calls for adoption of well-designed tourniquets.Although there is disagreement about what conclusions can be drawn from an analysis of the prehospital care, and the exact requirements for tourniquets, there is agreement on the civilian adoption of military methods for controlling extremity bleeding. 71,77,81 FINANCIAL DISCLOSURES None reported.…”

Section: Tourniquets In Traumamentioning

confidence: 99%

Research in Review: Driving Critical Care Practice Change

Bridges

McNeill

Munro

2016

American Journal of Critical Care

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During the past year, studies were published that will lead to practice change, address challenges at the bedside, and introduce new care strategies. This article summarizes some of this important work and considers it in the context of previous research and practice. Examples of research-based practice changes include the performance and assessment of septic shock resuscitation, and the integration of tourniquets and massive transfusions in civilian trauma. Care challenges addressed include ethical considerations in light of the Ebola epidemic, infection prevention associated with chlorhexidine bathing, bedside alarm management, evidence to enhance moral courage, and interventions to mitigate thirst in critically ill patients. Research that portends future care includes a discussion of fecal microbiota transplant for patients with refractory infection with Clostridium difficile.

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Battle Casualty Survival with Emergency Tourniquet Use to Stop Limb Bleeding

Cited by 267 publications

References 27 publications

A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015

A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015

Prolonged prehospital tourniquet placement associated with severe complications: a case report

Research in Review: Driving Critical Care Practice Change

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