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Tourniquet use in the prehospital setting: Are they being used appropriately?

Kevin M. Duignan, MS, EMT-B, Laura C. Lamb, MD, Monica M. DiFiori, BS, John Quinlavin, BS, James M. Feeney, MD, FACS

Abstract


Objective: The objective of this study was to evaluate tourniquet use in the Hartford prehospital setting during a 34-month period after the Hartford Consensus was published, which encouraged increasing tourniquet use in light of military research.

Design: This was a retrospective review of patients with bleeding from a serious extremity injury to determine appropriateness of tourniquet use or omission.

Setting: Level II trauma center between April 2014 and January 2017.

Participants: Eighty-four patients met inclusion criteria and were stratified based on tourniquet use during prehospital care.

Main Outcome Measures: Five of the 84 patients received a tourniquet. All five of those tourniquets (100 percent of the group, 6.0 percent of the population) were not indicated and deemed inappropriate. Three of the 84 patients did not receive a tourniquet when one was indicated (3.8 percent of the group, 3.6 percent of the population) and these omissions were also deemed inappropriate. Total error rate was 9.5 percent (8/84).

Results: There was a significant association between Mangled Extremity Severity Score (MESS) and likelihood of requiring a tourniquet (p = 0.0013) but not between MESS and likelihood of receiving a tourniquet (p = 0.1055). There was also a significant association between wrongly placed tourniquets and the type of providers who placed them [first responders, p = 0.0029; Emergency Medicine Technicians (EMTs), p = 0.0001].

Conclusions: Tourniquets are being used inappropriately in the Hartford prehospital setting. Misuse is associated with both EMTs and first responders, highlighting the need for better training and more consistent protocols.


Keywords


tourniquet, hemorrhagic shock, emergency medical services, Hartford Consensus

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References


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DOI: http://dx.doi.org/10.5055/ajdm.2018.0286

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