Tourniquet use at the Boston Marathon bombing

King, David R.; Larentzakis, Andreas; Ramly, Elie P.

doi:10.1097/ta.0000000000000561

Cited by 131 publications

(88 citation statements)

References 16 publications

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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%

“…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%

“…70 Recent civilian mass casualties events, with war-like mechanisms of injury, have resulted in the consideration of tourniquet use for traumatic hemorrhage management in the civilian community. 71 The Hartford Consensus, which created a "National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter Events," advocated for the use of tourniquets and other bleeding control measures to save lives in such civilian events. 72 The Hartford Consensus proposed the colocation of automatic external defibrillator and bleeding control bags, which include tourniquets to treat hemorrhage.…”

Section: Tourniquets In Traumamentioning

confidence: 99%

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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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Section: Tourniquets In Traumamentioning

confidence: 99%

Section: Tourniquets In Traumamentioning

confidence: 99%

Section: Tourniquets In Traumamentioning

confidence: 99%

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Research in Review: Driving Critical Care Practice Change

Bridges

McNeill

Munro

2016

American Journal of Critical Care

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“…All the authors have a background in the Norwegian Armed Forces and civilian pre‐hospital environment. Based on this experience it was suspected that the Army's 3‐week medic course makes soldiers better prepared to treat patients with penetrating injuries as opposed to the years of education and training an EMT goes through, despite this being part of the curriculum 6. If the soldiers are indeed better skilled it should be relatively easy to implement the short course into the EMT education.…”

mentioning

confidence: 99%

Performance of Norwegian civilian EMTs and army medics in penetrating trauma: a controlled simulation‐based assessment

Blix

Melau

Lund-Kordahl

2017

Acta Anaesthesiol Scand

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BackgroundPenetrating trauma kills rapidly. Thorough and efficient examination and aggressive hemorrhage control is important to save lives. The aim of this study was to assess the skills of civilian Emergency Medical Technicians (EMTs) in bleeding examination and control compared to Army Medics. Our hypothesis was that civilian pre‐hospital systems perform at a lower level compared to an expert group, and did not have sufficient focus on education and training in examination and treatment of penetrating injuries.Material and methodsWe included 60 volunteer Certified EMTs and Army Medics. First, the participants examined a wounded patient. Second, the participants were presented a patient with a penetrating injury on a pork side fixated to the thigh with an artificial arterial bleeding.ResultsThe EMTs took significantly shorter time examining, median 1 min 5 s vs. 3 min 58 s (P < 0.001). 5/30 (17%) of EMTs and 28/30 (93%) of army medics did an approved gauze wound packing of the penetrating injury (P < 0.001). EMTs took (median) 18 s and army medics 8 s to hemostasis regardless of approved packing or not (P < 0.001). Time spent on the packing was (median) 1 min 50 s vs. 5 min 47 s respectively (P < 0.001). Increasing time spent on the procedure showed significantly better chance of a successful procedure.ConclusionThe EMTs had lower accuracy in examination but used significantly shorter time than the Army Medics. The treatment part of the study showed poor EMT performance compared to the Army Medics. This study indicates that more wound packing training needs to be incorporated into initial and ongoing civilian EMT training.

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“…Studies have shown improvised tourniquets, such as belts, cravats, or wire, are likely to be "futile" due to insufficient force generated. 20 Through bringing Stop the Bleed to the Johns Hopkins University (JHU) Homewood Campus, we hope to heighten awareness about the importance of rapid recognition and intervention of life threatening hemorrhage, provide training in how to control severe bleeding, and to improve access to bleeding control kits. We also hope that this program can serve as a model for others to follow.…”

mentioning

confidence: 99%