Battle casualty survival with emergency tourniquet use to stop limb bleeding.

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.

[1]  J. Pillgram-Larsen,et al.  [Not a tourniquet, but compressive dressing. Experience from 68 traumatic amputations after injuries from mines]. , 1992, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[2]  Harris Js,et al.  National Association of Emergency Medical Technicians. , 1975 .

[3]  M. Costello,et al.  Evaluation of possible battlefield tourniquet systems for the far-forward setting. , 2000, Military medicine.

[4]  John F Kragh,et al.  Practical use of emergency tourniquets to stop bleeding in major limb trauma. , 2008, The Journal of trauma.

[5]  J. Kirkup.  Fracture care of friend and foe during World War I , 2003, ANZ journal of surgery.

[6]  C. Llewellyn,et al.  Tactical combat casualty care in the assault on Punta Paitilla Airfield. , 2006, Military medicine.

[7]  W. Godwin.  Article in Press , 2000 .

[8]  Lisa Pearse,et al.  Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006. , 2008, The Journal of trauma.

[9]  Dominique J. Greydanus,et al.  Physiological evaluation of the U.S. Army one-handed tourniquet. , 2005, Military Medicine.

[10]  T. Walters,et al.  A large animal fatal extremity hemorrhage model and evaluation of a polymeric dressing (fatal extremity hemorrhage). , 2006, The Journal of trauma.

[11]  R. Bellamy.  The causes of death in conventional land warfare: implications for combat casualty care research. , 1984, Military medicine.

[12]  T. Walters,et al.  Effectiveness of Self-Applied Tourniquets in Human Volunteers , 2005, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[13]  T. Wisborg,et al.  Prehospital tourniquets: there should be no controversy. , 2004, The Journal of trauma.

[14]  Jose Salinas,et al.  Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma , 2009, Annals of surgery.

[15]  Beecher Hk,et al.  The internal state of the severely wounded man on entry to the most forward hospital. , 1947 .

[16]  J. Feltis JM.  Surgical experience in a combat zone. , 1970, American journal of surgery.

[17]  S. D. Gross.  A Manual of Military Surgery , 2009 .

[18]  H. Beecher.  Early care of the seriously wounded man. , 1951, Journal of the American Medical Association.

[19]  B. Newsom.  A manual of military surgery. , 1988, Journal of the South Carolina Medical Association.

[20]  J. Holcomb,et al.  Efficacy of a dry fibrin sealant dressing for hemorrhage control after ballistic injury. , 1998, Archives of surgery.

[21]  T. Walters,et al.  Issues related to the use of tourniquets on the battlefield. , 2005, Military medicine.

[22]  The internal state of the severely wounded man on entry to the most forward hospital. , 1947, Surgery.

[23]  P E Pepe,et al.  Prospective MAST study in 911 patients. , 1989, The Journal of trauma.

[24]  David G Baer,et al.  Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. , 2008, The Journal of trauma.

[25]  E. B. Reeve,et al.  Observations on the general effects of injury in man, with special reference to wound shock. , 1951, Special report series (Medical Research Council (Great Britain)).

[26]  Major C. P. Emerson,et al.  A STUDY OF SHOCK IN BATTLE CASUALTIES: MEASUREMENTS OF THE BLOOD VOLUME CHANGES OCCURRING IN RESPONSE TO THERAPY , 1945, Annals of surgery.

[27]  D. E. Perkins,et al.  United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. , 2000, The Journal of trauma.

[28]  Charles E. Wade,et al.  Causes of Death in U.S. Special Operations Forces in the Global War on Terrorism: 2001–2004 , 2007, Annals of surgery.

[29]  G. Lin,et al.  Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. , 2003, The Journal of trauma.

[30]  R. Zajtchuk,et al.  Anesthesia and perioperative care of the combat casualty , 1995 .

[31]  F. Moore.  Tourniquets: another adjunct in damage control? , 2009, Annals of surgery.

[32]  F. Sumner.  The Treatment of Fractures , 1905, The Indian medical gazette.

[33]  R. Mabry.  Tourniquet use on the battlefield. , 2006, Military medicine.

[34]  Michael A Dubick,et al.  Radial Pulse Character Relationships to Systolic Blood Pressure andTrauma Outcomes , 2005, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[35]  J. Clasper,et al.  The Military Tourniquet , 2007, Journal of the Royal Army Medical Corps.

[36]  J. Holcomb,et al.  Comparison of hemorrhage control agents applied to lethal extremity arterial hemorrhages in swine. , 2005, The Journal of trauma.

[37]  K L Mattox,et al.  Mortality from isolated civilian penetrating extremity injury. , 2005, The Journal of trauma.