Law Enforcement-applied Tourniquets: A Case Series of Life-saving Interventions

摘要

Although the epidemiology of civilian trauma is distinct from that encountered in combat, in both settings, extremity hemorrhage remains a major preventable cause of potential mortality. The current paper describes the largest case series in the literature in which police officers arriving prior to emergency medical services applied commercially available field tourniquets to civilian victims of violent trauma. Although all 3 patients with vascular injury arrived at the receiving emergency department in extremis, they were successfully resuscitated and survived to discharge without major morbidity. While this outcome is likely multifactorial and highlights the exceptional care delivered by the modern trauma system, tourniquet application appears to have kept critically injured patients alive long enough to reach definitive trauma care. No patient had a tourniquet-related complication. This case series suggests that law enforcement officers can effectively identify indications for tourniquets and rapidly apply such life-saving interventions. Isolated extremity hemorrhage remains the leading cause of potentially preventable death in combat. Hemorrhage is the second leading cause of death in civilian trauma behind head injury. Although the epidemiology of civilian trauma is distinct from that encountered in combat, in both settings, extremity hemorrhage remains a major preventable cause of potential mortality. Once a vilified technique, current data demonstrate that prehospital commercial tourniquet (TQ) application saves lives. Through aggressive Tactical Combat Casualty Care (TCCC) training and TQ fielding, mortality rates from isolated extremity hemorrhage have declined from approximately 9% in Vietnam to approximately 2% in Operations Iraqi and Enduring Freedom. Combat data indicate that successful mortality reduction requires a comprehensive trauma management system, with nonmedical personnel playing a critical role in initiating hemorrhage control - in essence, the first link in the "Trauma Chain of Survival." Additionally, survival benefits are greatest when tourniquets are applied prior to development of shock.