Performance improvement in emergency tourniquet use during the Baghdad surge

• Published in: The American journal of emergency medicine Vol. 31; no. 5; pp. 873 - 875
• Main Authors: Kragh, John F., MD, Beebe, Dorothy F., RN, O'Neill, Michelle L., RN, Beekley, Alec C., MD, Dubick, Michael A., PhD, Baer, David G., PhD, Blackbourne, Lorne H., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2013; Elsevier Limited
• Subjects: Arm Injuries - therapy; Casualties; Emergency; Emergency medical care; Female; Health Care Surveys; Hemorrhage; Hospitals, Military - statistics & numerical data; Humans; Iraq; Iraq War, 2003-2011; Leg Injuries - therapy; Male; Tourniquets - utilization; United States; United States; Iraq; Baghdad Iraq; United States > US
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2012.11.030

The purposes of the present study are to (1) survey tourniquet use to fill knowledge gaps in casualty care in the current period and (2) compare results of the 3 periods to provide a model of implementing tourniquet use locally to civilian emergency medical systems. Prehospital use rate (%) 84 86 97 89 P < .0001 Use rate before shock onset (%) 96 96 99 97 P = .035 Appropriate wound indication rate (%) 96 99 99 98 P = .021 Tourniquet use rate distal to a proximal wound (%) 1 1 2 1 P = .5 Loose tourniquet use rate (%) 4 8 9 7 P = .03 Breakage or malfunction rate (%) 2 1 0 1 P = .05 Rate of limbs with only 1 tourniquet used (%) 66 74 89 76 P < .0001 Changes in tourniquet use Increased rate of tourniquets used per day Increased proportion of casualties with tourniquets per day Increased proportion of limbs with tourniquets per day Increased diversity of casualties with tourniquets (more nationalities and civilians represented) Increased proportion of indicated tourniquet use (decreased misses of indicated casualties) Increased proportion of casualties with prehospital tourniquets used Increased proportion of casualties with tourniquets used before shock onset Increased proportion of appropriately used tourniquets Increased proportion of loose tourniquets Increased proportion of commercial tourniquets used (decreased improvised tourniquets) Increased proportion of limbs with hemorrhage control by effective tourniquet use Increased proportion of limbs with only one tourniquet needed Decreased proportion tourniquet used with tourniquet breakage or malfunction