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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prehospital tourniquets: there should be no controversy.J Trauma. 2004; 56: 214-215
- War surgery field manual.Third World Network, Penang, Malaysia1995
- Practical use of emergency tourniquets to stop bleeding in major limb trauma.J Trauma. 2008; 64: S38-S50
- Survival with emergency tourniquet use to stop bleeding in major limb trauma.Ann Surg. 2009; 249: 1-7
- Tourniquet use on the battlefield.Mil Med. 2006; 171: 352-356
- Prehospital tourniquet use in Operation Iraqi Freedom: Effect on Hemorrhage control.J Trauma. 2008; 64: S28-S37
- The causes of death in conventional land warfare: implications for combat casualty care research.Mil Med. 1984; 149: 55-62
- Efficacy of a dry fibrin sealant dressing for hemorrhage control after ballistic injury.Arch Surg. 1998; 133: 32-35
- Evaluation of possible battlefield tourniquet systems for the far-forward setting.Mil Med. 2000; 165: 379-384
- Mortality from isolated civilian penetrating extremity injury.J Trauma. 2005; 59: 217-222
- Issues related to the use of tourniquets on the battlefield.Mil Med. 2005; 170: 770-775
- Physiological evaluation of the U.S. Army one-handed tourniquet.Mil Med. 2005; 170: 776-781
- Effectiveness of self-applied tourniquets in human volunteers.Prehosp Emerg Care. 2005; 9: 416-422
- version, 6th edn. PHTLS prehospital trauma life support: military. St. Louis, MO: Mosby2007
- Radial pulse character relationships to systolic blood pressure and trauma outcomes.Prehosp Emerg Care. 2005; 9: 423-428
- The early treatment of war wounds.Oxford University Press, London1919
- Fracture care of friend and foe during World War I.Aust N Z J Surg. 2003; 73: 453-459
- Prospective MAST study in 911 patients.J Trauma. 1989; 29 (; discussion 1111–2): 1104-1111
- A large animal fatal extremity hemorrhage model and evaluation of a polymeric dressing (fatal extremity hemorrhage).J Trauma. 2006; 61: 1107-1112
- Early care of the seriously wounded man.JAMA. 1951; 145: 193-200
- The internal state of the severely wounded man on entry to the most forward hospital.Surgery. 1947; 22: 672-711
- A study of shock in battle casualties: measurements of the blood volume changes occurring in response to therapy.Ann Surg. 1945; 122: 745-772
- Battle casualties: incidence, mortality and logistic considerations.Charles C Thomas, Springfield, IL1952
- Observations on the general effects of injury in man: with special reference to wound shock (Medical Research Council Special Report Series No. 277).HM Stationery Office, London1951
- Extremity injuries.in: Zajtchuk R. Grande C.M. Anesthesia and perioperative care of the combat casualty. Part IV of surgical combat casualty care in the textbook of military medicine series. Office of the Surgeon General, Falls Church, Virginia1995: 499-520
- United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield.J Trauma. 2000; 49 (discussion 528–9): 515-528
- Causes of death in U.S. special operations forces in the Global War on Terrorism: 2001–2004.Ann Surg. 2007; 245: 986-991
- Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003–2004 versus 2006.J Trauma. 2008; 64 (discussion S26–7): S21-S26
- Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience.J Trauma. 2003; 54: S221-S225
- Tactical combat casualty care in the assault on Punta Paitilla airfield.Mil Med. 2006; 171: 687-690
- Tourniquet problems in war injuries.Bull U S Army Med Dep. 1945; 87: 77-84
- Not a tourniquet, but compressive dressing.Tidsskr Nor Laegeforen. 1992; 112: 2188-2190
- Surgical experience in a combat zone.Am J Surg. 1970; 119: 275-278
- The treatment of fractures, vol 1.in: Tretter H. Luchini H.B. Kreuz F. Russe O.A. Bjornson R.G.B. trans. Grune & Stratton, New York1956
- A manual of military surgery.West & Johnston, Richmond, VA1861
- Comparison of hemorrhage control agents applied to lethal extremity arterial hemorrhages in swine.J Trauma. 2005; 59 (discussion 874–5): 865-874
- Seal!.Pocket Books, New York1994
- Tourniquets: another adjunct in damage control?.Ann Surg. 2009; 249: 8-9
- The military tourniquet.J R Army Med Corps. 2007; 153: 10-12
- The wounded from Alamein: observations on wound shock and its treatment.Army Med Dep Bull. 1943; : 1-32
Article info
Publication history
Published online: September 01, 2009
Accepted:
July 10,
2009
Received in revised form:
May 11,
2009
Received:
October 28,
2008
Footnotes
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.
Identification
Copyright
Published by Elsevier Inc.
