Prehospital Tourniquet Use in Operation Iraqi Freedom: Effect on Hemorrhage Control and Outcomes

Abstract

We 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. Methods: This was an institutional review board-approved, retrospective review of the 31st combat support hospital for 1 year during Operation Iraqi Freedom. Inclusion criteria were any patient with a traumatic amputation, major extremity vascular injury, or documented prehospital tourniquet. Results: Among 3,444 total admissions, 165 patients met inclusion criteria. Sixty-seven patients had prehospital tourniquets (TK); 98 patients had severe extremity injuries but no prehospital tourniquet (No TK). Extremity Acute Injury Scores were the same (3.5 TK vs. 3.4 No TK) in both groups. Differences (p < 0.05) were noted in the numbers of patients with arm injuries (16.2% TK vs. 30.6% No TK), injuries requiring vascular reconstruction (29.9% TK vs. 52.5% No TK), traumatic amputations (41.8% TK vs. 26.3% No TK), and in those patients with adequate bleeding control on arrival (83% TK vs. 60% No TK). Secondary amputation rates (4 (6.0%) TK vs. 9 (9.1%) No TK); and mortality (3 (4.4%) TK vs. 4 (4.1%) No TK) did not differ. Tourniquet use was not deemed responsible for subsequent amputation in severely mangled extremities. Analysis revealed that four of seven deaths were potentially preventable with functional prehospital tourniquet placement. Conclusions: Prehospital tourniquet use was associated with improved hemorrhage control, particularly in the worse injured (Injury Severity Score >15) subset of patients. Fifty-seven percent of the deaths might have been prevented by earlier tourniquet use. There were no early adverse outcomes related to tourniquet use.

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Document Details

Document Type
Technical Report
Publication Date
Feb 01, 2008
Accession Number
ADA480327

Entities

People

  • Alec C. Beekley
  • David G. Baer
  • David S. Kauvar
  • Garth S. Herbert
  • James A. Sebesta
  • John B Holcomb
  • Lorne H Blackbourne
  • Philip S. Mullenix
  • Thomas J. Walters

Organizations

  • Madigan Army Medical Center

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Arteries
  • Blood
  • Cardiovascular Physiological Phenomena
  • Casualties
  • Combat Casualty Care
  • Combat Support Hospitals
  • Debridement
  • General Surgery
  • Health Services
  • Hemorrhage
  • Medical Personnel
  • Patient Care
  • Surgery
  • Traumatic Amputation
  • Upper Limb Amputations
  • Vascular System Injuries

Fields of Study

  • Medicine

Readers

  • Materials Science.
  • Neurotrauma and Rehabilitation Medicine.