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This was in JEMS , please note the credited author. This is a study on the use of TQ's and the positive outcome, yet so many agencies will still not use them. Here in Kenya even the MOH has acknowledge the positive use of TQ's but that the EMS still do not have or use. The word needs to get out and providers need the training so they feel comfortable about TQ use and the positive outcomes.


Characteristics and Outcomes of Prehospital Tourniquet Use for Trauma in the United States. Hashmi ZG, Hu PJ, Jansen JO, Butler FK, Kerby JD, Holcomb JB. Prehosp Emerg Care. 2022; Published on-line. DOI: 10.1080/10903127.2021.2025283

The use of tourniquets (TQs) is well studied and has proven life-saving in the military environment. As with many devices and procedures used for trauma patients during wartime, TQs have been incorporated into civilian practice without a great deal of academic rigor. While it seems intuitive that TQs should translate well into the civilian EMS and trauma care system, there are many factors that could potentially affect outcome, such as different wounding mechanisms.

This retrospective review study examined the use of TQs in civilian EMS. The authors accessed the National EMS Information System 2019 data base of EMS calls with data from 47 states and territories within the USA. They identified all trauma team activations and searched for patients who had tourniquets applied. They then matched these patients to similar patients who did not have one placed. The two groups were then compared for differences in outcome as well as trauma activation criteria.

Of over four and half million trauma activations, a total of 7,616 TQs were applied (1.6 applications per 1000 activations). The patients in the TQ application group were predominantly male, with the primary mechanism of injury of either gunshot or stab wound. The patients in the TQ group had a shorter response time, higher acuity level, lower scene times and greater survival to the hospital. Of note, there were 141,471 trauma victims with documented extremity injury and a shock index ≥ 1 and no tourniquet documented.

The authors concluded that “Prehospital tourniquet use by EMS in the United States is associated with lower scene-time and improved survivability to hospital. As a result, patients might benefit from wider tourniquet use in the civilian prehospital setting.”

This study is limited by the fact that the NEMSIS data base is not all inclusive and EMS participation is voluntary. In addition, the data set only includes hospital disposition data on approximately 50% of the patients, thus limiting reporting of long-term outcome.

This study provides an important contribution to the research on civilian TQ application, while also identifying a need for wider application of this intervention. To better define the benefits of TQ application, a study that allows for tracking of EMS patient data through to hospital discharge would beneficial. In addition, a study designed to look at different environments would help to better define the use of tourniquets in more rural environments and for prolonged transport.



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