Army Field Data
• Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma
• Kragh, et al • J Trauma 2008;64:S38-S50
Army Field Data
• Prospective study in 2006 over 7 months • Baghdad, Iraq • 232 Patients had 428 tourniquets on 309
injured limbs
Field Data
• Tourniquet Effectiveness – Emergency Medical Tourniquet - 92% – Combat Application Tourniquet – 79% – Improvised Tourniquet – 25%
– Effectiveness
• Did tourniquet stop bleeding? • Did it stop the distal pulse?
Field data
• Indications – Medically – if the postoperative determination
was that the injury justified tourniquet use. – Tactically – care under fire. All but 12 tourniquets out of 428 were indicated
• 3 superficial wounds not surgical • 9 Surgical wounds with no vessel injury • No morbidities
Field Data
• Morbidity – Difficult to determine – Overall much less than expected even for times
> 3 hours. – Misplaced tourniquets definitely resulted in
increased morbidity.
Practical Recommendations
• Tourniquet use before shock onset saves more lives than after shock; use them before extraction or transport
• Use scientifically designed, laboratory tested ans clinically validated tourniquets
• The goal of emergency tourniquet use is to stop bleeding and stop the distal pulse
Practical Recommendations continued
• Side by side use is useful to rid distal pulses and stop bleeding if one is ineffective
• Clothing about the tourniquet should be removed at the first opportunity to detect all wounds
• Materials under a tourniquet should be removed at the first opportunity to avoid looseness.