Kue Ricky C, Temin Elizabeth S, Weiner Scott G, Gates Jonathan, Coleman Melissa H, Fisher Jonathan, Dyer Sophia
Prehosp Emerg Care. 2015 Jul-Sep;19(3):399-404. doi: 10.3109/10903127.2014.995842. Epub 2015 Feb 9.
Despite the resurgence of early tourniquet use for control of exsanguinating limb hemorrhage in the military setting, its appropriate role in civilian emergency medical services (EMS) has been less clear.
To describe the experience of prehospital tourniquet use in an urban, civilian EMS setting.
A retrospective review of EMS prehospital care reports was performed from January 1, 2005 to December 1, 2012. Data, including the time duration of prehospital tourniquet placement, EMS scene time, mechanisms of injury, and patient demographics, underwent descriptive analysis. Outcomes data for participating receiving hospitals were also reviewed.
Ninety-eight cases of prehospital tourniquet use were identified. The most common causes of injury were penetrating gunshot or stabbing wounds (67.4%, 66/98); 7.1% (7/98) of cases were due to blunt trauma; 23.5% (23/98) of cases were from nontraumatic hemorrhage related to uncontrolled hemodialysis shunt or wound bleeding; 45.4% (44/97) of cases were placed on a lower extremity; 54.6% (53/97) were placed on an upper extremity. Placement was successful in hemorrhage control in 91% (87/95, 95%CI: 85.9-97.3%) of cases. The average prehospital tourniquet placement time was 14.9 minutes. Half of all tourniquet placements were performed by basic life support providers. Hospital follow-up was available for 96.9% (95/98) of cases. Of these, the tourniquet was removed by EMS in 3.2% (3/95), the emergency department in 54.7% (52/95), or in the operating room (OR) in 31.6% (30/95) of the time; 46.7% (14/30) of these OR cases had a documented vascular injury needing repair. Ten deaths with hospital follow-up data were identified, none of which were due to tourniquet use. There was one case of forearm numbness potentially due to nerve injury and one case with potential vascular complication, representing an overall complication rate of 2.1% (2/95).
The early use of tourniquets for extremity hemorrhage in an urban civilian EMS setting appears to be safe, with complications occurring infrequently.
尽管在军事环境中早期使用止血带控制肢体大出血的情况有所复苏，但其在民用紧急医疗服务（EMS）中的适当作用仍不太明确。
描述在城市民用EMS环境中院前使用止血带的经验。
对2005年1月1日至2012年12月1日的EMS院前护理报告进行回顾性分析。对包括院前止血带放置持续时间、EMS现场时间、损伤机制和患者人口统计学数据在内的数据进行描述性分析。还对参与接收医院的结果数据进行了审查。
确定了98例院前使用止血带的病例。最常见的损伤原因是穿透性枪伤或刺伤（67.4%，66/98）；7.1%（7/98）的病例是钝性创伤；23.5%（23/98）的病例是非创伤性出血，与未控制的血液透析分流或伤口出血有关；45.4%（44/97）的病例止血带置于下肢；54.6%（53/97）置于上肢。91%（87/95，95%CI：85.9 - 97.3%）的病例止血带放置成功控制了出血。院前止血带平均放置时间为14.9分钟。所有止血带放置中有一半是由基础生命支持人员进行的。96.9%（95/98）的病例有医院随访数据。其中，3.2%（3/95）的止血带由EMS移除，54.7%（52/95）由急诊科移除，31.6%（30/95）在手术室（OR）移除；这些手术室病例中有46.7%（14/30）记录有需要修复的血管损伤。确定了10例有医院随访数据的死亡病例，均非因使用止血带所致。有1例可能因神经损伤导致前臂麻木，1例有潜在血管并发症，总体并发症发生率为2.1%（2/95）。
在城市民用EMS环境中早期使用止血带控制肢体出血似乎是安全的，并发症发生率较低。
