Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma

Kragh, John F; Walters, Thomas J.; Baer, David G.; Fox, Charles J.; Wade, Charles E.; Salinas, José; Holcomb, John B.

doi:10.1097/ta.0b013e31816086b1

Cited by 281 publications

(232 citation statements)

References 27 publications

Supporting

Mentioning

223

Contrasting

Unclassified

Order By: Relevance

“…[1][2][3][4] Data from recent conflicts involving US military personnel confirmed the continued importance of improving prehospital hemorrhage control. 3,[5][6][7] In response, the US Army implemented a design, testing, training, and fielding program for battlefield tourniquets, 8 -11 resulting in policy that all military personnel in theater carry tourniquets.…”

mentioning

confidence: 95%

“…We found minor morbidity with emergency tourniquet use, and that is detailed in another work. 1 Limitations of the present study include its specific combat casualty setting and population, which may hamper generalization to the civilian trauma population. The study site, a combat support hospital, had an epidemic of severely injured coagulopathic casualties, a successful track record of performance improvement projects including emergency tourniquet use, providers rapidly exposed to large numbers of emergency tourniquets, and clinician-scientists with expertise with emergency tourniquets.…”

Section: Morbidity Risks From Tourniquet Use Was Limited In the Currementioning

confidence: 99%

“…1,8,16,26,29 However, there are only 2 retrospective cohort studies on emergency tourniquet use. 12,25 In the present study, the benefits far outweighed the risks with no limbs lost solely from tourniquet use.…”

Section: Morbidity Risks From Tourniquet Use Was Limited In the Currementioning

confidence: 99%

“…Some broke, leaked, malfunctioned, or were misused, a few were replaced after removal for temporary success with stopping bleeding, and some prehospital devices were exchanged for wider, safer hospital devices. 1 Patients were injured in complex events that could involve multiple mechanisms often in sequence resulting in complicated wounds. For example, some patients rode in vehicles that had roadside explosions causing blast overpressure, penetrating fragments, vehicle rollover with blunt trauma or crush injury, and then fire with burns.…”

Section: Patient Demographicsmentioning

confidence: 99%

See 3 more Smart Citations

Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma

Kragh¹,

Walters²,

Baer³

et al. 2009

Annals of Surgery

Self Cite

550

251

View full text Add to dashboard Cite

Objective: The purpose of this study was to determine if emergency tourniquet use saved lives. Summary Background Data: Tourniquets have been proposed as lifesaving devices in the current war and are now issued to all soldiers. Few studies, however, describe their actual use in combat casualties. Methods: A prospective survey of injured who required tourniquets was performed over 7 months in 2006 (NCT00517166 at ClinicalTrials.gov). Follow-up averaged 28 days. The study was at a combat support hospital in Baghdad. Among 2838 injured and admitted civilian and military casualties with major limb trauma, 232 (8%) had 428 tourniquets applied on 309 injured limbs. We looked at emergency tourniquet use, and casualties were evaluated for shock (weak or absent radial pulse) and prehospital versus emergency department (ED) tourniquet use. We also looked at those casualties indicated for tourniquets but had none used. We assessed survival rates and limb outcome. Results: There were 31 deaths (13%). Tourniquet use when shock was absent was strongly associated with survival (90% vs. 10%; P Ͻ 0.001). Prehospital tourniquets were applied in 194 patients of which 22 died (11% mortality), whereas 38 patients had ED application of which 9 died (24% mortality; P ϭ 0.05). The 5 casualties indicated for tourniquets but had none used had a survival rate of 0% versus 87% for those casualties with tourniquets used (P Ͻ 0.001). H emorrhage from injured extremities continues to be one of the leading sources of preventable death on the battlefield. 1-4 Data from recent conflicts involving US military personnel confirmed the continued importance of improving prehospital hemorrhage control. 3,[5][6][7] In response, the US Army implemented a design, testing, training, and fielding program for battlefield tourniquets, 8 -11 resulting in policy that all military personnel in theater carry tourniquets. As a result of this effort, tourniquets are now common on the battlefields of Iraq and Afghanistan, both in the hands of medical and nonmedical personnel.With the Tactical Combat Casualty Care initiative, the US military is not alone in establishing procedures and equipment for use of tourniquets in the prehospital environment by both medical and nonmedical personnel. 12,13 However, this renewed emphasis on tourniquets for prehospital hemorrhage control of extremity injuries is not agreed upon by all authors 14 -16 with some authors discouraging prehospital use of tourniquets altogether. [17][18][19][20] showed that tourniquet use is indicated in civilian trauma, albeit in a very small percentage of patients. However, the lifesaving capability of tourniquets has been unproven. Most of the controversy regarding the capacity of tourniquets to save lives versus tissue damage has been based more on speculation rather than actual data, as research in the human use of emergency tourniquets is limited. Clearly, the discussion would be better informed with actual data regarding these critical concerns. In 2003, we initiated data collection regarding e...

show abstract

mentioning

confidence: 95%

Section: Morbidity Risks From Tourniquet Use Was Limited In the Currementioning

confidence: 99%

Section: Morbidity Risks From Tourniquet Use Was Limited In the Currementioning

confidence: 99%

Section: Patient Demographicsmentioning

confidence: 99%

See 2 more Smart Citations

Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma

Kragh¹,

Walters²,

Baer³

et al. 2009

Annals of Surgery

Self Cite

550

251

View full text Add to dashboard Cite

show abstract

“…Tourniquet use has been clearly demonstrated to improve survival for patients with major limb trauma [5]. Improper use of a tourniquet has been associated with morbidity and mortality [11]. A tourniquet may be placed in the prehospital setting prior to evaluation of the wound by the emergency physician, general surgeon, or orthopedic surgeon.…”

Section: Orthopedic Evaluation and Extremity Triage Principlesmentioning

confidence: 99%

2014 Fort Hood, Texas, mass casualty incident: reviews and perspectives

Strommen

Waterman

Mitchell

et al. 2015

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

On April 2, 2014, in Fort Hood, Texas, an active shooter incident occurred where four active duty soldiers were tragically killed. Active shooter incidents are becoming alarmingly more frequent over the last decade in the USA. The authors provide a detailed account of the events that occurred within the hospital and an evaluation of the triage decisions made on that day. A detailed review of mass casualty preparedness and the general approach to triage processes are also described.

show abstract