title: Battle casualty survival with emergency tourniquet use to stop limb bleeding.
abstract: 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.
  
  
  OBJECTIVE
  The objective of this study is to further analyze emergency tourniquet use in combat casualty care.
  
  
  METHODS
  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.
authors.affiliation: US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Kragh
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Littrel
authors.forename: John A
authors.initials: JA
authors.lastname: Jones
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walters
authors.forename: David G
authors.initials: DG
authors.lastname: Baer
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005121:Extremities / Q000293:injuries*; D005260:Female; D006470:Hemorrhage / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D016019:Survival Analysis; D014111:Tourniquets; D055815:Young Adult