title: Survey of the indications for use of emergency tourniquets.
abstract: Indications and evidence are limited, multiple and complex for emergency tourniquet use. Good recent outcomes challenge historically poor outcomes. Optimal tourniquet use in trauma care appears to depend on adequate devices, modern doctrine, refined training, speedy evacuation, and performance improvement. Challenges remain in estimation of blood loss volumes, lesion lethality, and casualty propensity to survive hemorrhage.
  
  
  BACKGROUND
  Evidence gaps persist regarding emergency tourniquet use indications in prehospital and emergency department settings as indication data are rarely reported.
  
  
  METHODS
  Data on emergency tourniquet use was analyzed from a large clinical study (NCT00517166 at ClinicalTrials.gov). The study included 728 casualties with 953 limbs with tourniquets. The median casualty age was 26 years (range, 4-70). We compared all other known datasets to this clinical study.
  
  
  RESULTS
  Tourniquet use was prehospital in 671 limbs (70%), hospital only in 104 limbs (11%), and both prehospital and hospital in 169 limbs (18%).Major hemorrhage was observed at or before the hospital in 487 (51%) limbs and minor hemorrhage was observed at the hospital in 463 limbs (49%). Anatomic lesions indicating tourniquets included open fractures (27%), amputations (26%), soft tissue wounds (20%), and vascular wounds (17%). Situations, as opposed to anatomic lesions, indicating tourniquets included bleeding from multiple sites other than limbs (24%), hospital mass casualty situations (1%), one multiple injury casualty needed an airway procedure, and one casualty had an impaled object.
  
  
  CONCLUSIONS
  The current indication for emergency tourniquet use is any compressible limb wound that the applier assesses as having possibly lethal hemorrhage. This indication has demonstrated good outcomes only when devices, training, doctrine, evacuation, and research have been optimal. Analysis of emergency tourniquet indications is complex and inadequately evidenced, and further study is prudent. Prehospital data reporting may fill knowledge gaps.
authors: John F
authors: JF
authors: Kragh
authors: Michelle L
authors: ML
authors: O'Neill
authors: Dorothy F
authors: DF
authors: Beebe
authors: Charles J
authors: CJ
authors: Fox
authors: Alec C
authors: AC
authors: Beekley
authors: Jeffrey S
authors: JS
authors: Cain
authors: Donald L
authors: DL
authors: Parsons
authors: Robert L
authors: RL
authors: Mabry
authors: Lorne H
authors: LH
authors: Blackbourne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D014111:Tourniquets / Q000009:adverse effects / Q000706:statistics & numerical data; D055815:Young Adult