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Military tourniquet practice 'saves lives and limbs in civilians'

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The use of military-style tourniquets to stanch early bleeding in arms and legs has been shown to improve a trauma patients chance of survival, according to US researchers.

They said that, for the first time, they had been able to demonstrate that the use of tourniquets improved survival in civilian trauma victims.

“This is the first time that we were actually able to prove the survival benefit”

Pedro Teixeira

Although the use of tourniquets in civilians had been previously studied, its survival benefit had remained unclear, they said in the Journal of the American College of Surgeons.

The researchers said that, in the past, tourniquets had “got a bad reputation” during conflicts, such as the two world wars and then during the Korean War in the 1950s.

However, they suggested much of the problem was that tourniquets had been left in place too long, cutting circulation to the extremity for many hours.

For their study, they evaluated 1,026 patients with vascular injuries of the arms or legs admitted to 11 urban Level I trauma centres in Texas from 2011 to 2016.

A prehospital tourniquet was used in 17.6% of the cases, although tourniquet use varied widely among individual centres, ranging from 62% to 1.4%.

“The ideal person to apply that tourniquet is the person who can do it the quickest”

Pedro Teixeira

Overall, 9.6% of the study patients had amputations, but more than one-third of them – 35.7% – had received a tourniquet.

Among the amputation patients, those who received a tourniquet had significantly lower mortality rates than those who did not – 2.9% versus. 7.9%.

The non-tourniquet group had almost six times greater odds of death, according to the researchers from the University of Texas at Austin.

Lead study author Dr Pedro Teixeira said: “This is the first time that we were actually able to prove the survival benefit of using the tourniquet in the civilian population.

“What we learned from more recent conflicts in the Middle East is that when tourniquets are applied early and removed in a timely fashion and the definitive repair is performed, also in a timely fashion, they actually have a significant role in preventing death from severe blood loss from an extremity injury,” he said.

“We would have bleeding control kits in public spaces, allowing application by someone who has had minimal training”

Pedro Teixeira

Dr Teixeira highlighted that the types of civilian settings in which tourniquets could be used were car and motorcycle accidents, stab wounds, and gunshot wounds.

“All these types of mechanisms that have a major haemorrhage coming from either an arm or a leg are amendable to having a tourniquet placed to stop that bleeding and allow that patient to survive long enough to reach a trauma centre and get taken care of,” he said.

Dr Teixeira also noted that tourniquets worked best when they were applied as early as possible at the site of the injury.

“The ideal person to apply that tourniquet is the person who can do it the quickest immediately after the wound is identified,” he said. “That scenario is the highest chance for the patient to survive.”

University of Texas at Austin

Military tourniquet practice could save lives and limbs in civilians

Pedro Teixeira

He suggested that tourniquets should be placed in public places, like railway stations, in the same way as defibrillators already were for patients that have a cardiac arrest.

“We would have bleeding control kits in public spaces too, allowing for tourniquet application by someone who has had minimal training for a patient that has an injury resulting in bleeding from a limb,” he said.

The study results were first presented in September 2017 at the annual meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery in Baltimore.

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