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

  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},
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… 
Prehospital tourniquet use in penetrating extremity trauma: Decreased blood transfusions and limb complications
It is demonstrated that prehospital tourniquet use could be safely used to control bleeding in major extremity penetrating trauma with no increased risk of major complications and may lead to improved long-term outcomes and increased survival in trauma patients.
Tourniquet Application for Bleeding Control in a Rural Trauma System: Outcomes and Implications for Prehospital Providers
Even with long transport times, early tourniqueet application for hemorrhage control in rural settings is safe with no significant attributable morbidity and mortality compared to published studies on urban civilian tourniquet use.
AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma
It is shown that prehospital tourniquets for major extremity trauma were associated with a threefold decreased incidence of arrival in shock without increased limb complications, providing further evidence that tournique use is being widely and safely adopted to improve outcomes in civilians with MET.
Implications of the national Stop the Bleed campaign: The swinging pendulum of prehospital tourniquet application in civilian limb trauma
Prehospital tourniquet application has become widely adopted in the civilian setting, frequently performed by civilian and nonemergency medical service personnel and over a quarter of PHTs were misapplied with notable associated morbidity.
The tight rope act: A multicenter regional experience of tourniquets in acute trauma resuscitation
Of 216 tourniquets placed in Chicago, 64% had no arterial injury and 38% were not arterial occlusive, while trained responders had high rates of superfluous and inadequate deployments.
Transport Time and Preoperating Room Hemostatic Interventions Are Important: Improving Outcomes After Severe Truncal Injury
Experience in the ongoing wars in Iraq and Afghanistan confirm that faster transport combined with effective prehospital interventions improves the outcomes of patients suffering hemorrhagic shock and whole blood transfusion.
Saving Lives with Tourniquets: A Review of Penetrating Injury Medical Examiner Cases
Among urban ME cases, both isolated extremity cases and concurrent extremity-central injuries exist that may be amenable to life-saving tourniquet use, and extrapolating the findings nationwide suggests that many lives could be saved with early tournique placement.
Tourniquets in the Era of “Stop the Bleed”—Are Simple Pressure Maneuvers Being Bypassed for Tourniquets in Non-arterial Bleeding?
In patients with a tourniquet, those with a GSW were 3.4 times as likely to have no arterial injury as other injury types; this data reflects a high frequency of prehospital tourniqueet application without arterials injury.
Tourniquet use for civilian extremity hemorrhage: systematic review of the literature.
TQ use in the civilian setting is associated with trauma-related injuries, most are single-site TQs applied for the most part to male adults with upper extremity injury, with few complications described.


Safety and Appropriateness of Tourniquets in 105 Civilians
  • Michelle H. Scerbo, J. P. Mumm, B. Cotton
  • Medicine
    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
  • 2016
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.
Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes.
It was hypothesized that prehospital tourniquet use decreased hemorrhage from extremity injuries and saved lives, and was not associated with a substantial increase in adverse limb outcomes, and analysis revealed that four of seven deaths were potentially preventable with functional pre Hospital Tourniquets placement.
Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma
Tourniquet use when shock was absent was strongly associated with saved lives, and prehospital use was also stronglyassociated with lifesaving.
Tourniquet use for civilian extremity trauma
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.
Emergency tourniquets for civilians: Can military lessons in extremity hemorrhage be translated?
The majority of TKTs were appropriately applied to civilians who had vascular injuries or required operative intervention for hemorrhage control and has a low rate of associated complications.
Mortality from isolated civilian penetrating extremity injury.
Although rare, death from isolated extremity injuries does occur in the civilian population and the cause of death in this series appears to have been exsanguination, although definitive etiology cannot be discerned.
Practical use of emergency tourniquets to stop bleeding in major limb trauma.
Morbidity risk was low, and there was a positive risk benefit ratio in light of the survival benefit, and education for early military tourniquet use should continue.