Emergency Tourniquet Use - Survival

## Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma

COL John F. Kragh, Jr., MC, USA, Thomas J. Walters, PhD, David G. Baer, PhD, LTC Charles J. Fox, MC, USA, Charles E. Wade, PhD, Jose Salinas, PhD, and COL John B. Holcomb, MC, USA

Annals of Surgery

Volume 249, Number 1, January 2009

#### Description with Key Points:

The purpose of this study at a combat support hospital in Baghdad was to determine if emergency tourniquet use saved lives.

- Tourniquets are saving lives on the battlefield.
- Improved survival when tourniquets were applied BEFORE casualties went into shock.
- 31 lives saved in this study by applying tourniquets prehospital rather than in the ED.
- In 5 casualties where a tourniquet was indicated but not used, there was a survival rate of 0% versus 87% for those casualties with tourniquet applications.​​

Key Chart:

Increase in survival rate by tourniquet use. By breaking down, the tourniquet use by whether the patient was prehospital or ED, whether there was shock present or absent at the time of application, and whether tourniquets were used or not, a comparison of raw differences in survival rates indicates that the survival benefit to tourniquet use is more strongly related to tourniquet use before the patient has progressed to shock than to prehospital use.

## Take Home Message:

An estimated 1000-2000 lives saved as of 2008 by tourniquets (data provided to Army Surgeon General via an internal communication).
Most importantly – apply tourniquets ASAP when they are needed.
Survival is improved if shock is prevented.