The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock

@article{Scerbo2017TheTC,
  title={The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock},
  author={Michelle H. Scerbo and John B. Holcomb and Ethan Taub and Keith S Gates and Joseph D. Love and Charles E. Wade and Bryan A. Cotton},
  journal={Journal of Trauma and Acute Care Surgery},
  year={2017},
  volume={83},
  pages={1165–1172}
}
BACKGROUND To date, no civilian studies have demonstrated that pre-hospital (PH) tourniquets improve survival. We hypothesized that late, trauma center (TC) tourniquet use would increase death from hemorrhagic shock compared to early (PH) placement. METHODS All patients arriving to a Level 1, urban TC between October 2008 and January 2016 with a tourniquet placed before (T-PH) or after arrival to the TC (T-TC) were evaluated. Cases were assigned the following designations: indicated (absolute… 
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TLDR
It is suggested that PH and ED tourniquets are used safely and appropriately in civilians with major limb trauma that occur via blunt and penetrating mechanisms.
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TLDR
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TLDR
Tourniquet use when shock was absent was strongly associated with saved lives, and prehospital use was also stronglyassociated with lifesaving.
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TLDR
Tourniquet use in the civilian sector is associated with a low rate of complications and with the low complication rate and high potential for benefit, aggressive use of this potentially lifesaving intervention is justified.
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TLDR
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TLDR
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