Prehosp Emerg Care. 2020 Jul-Aug;24(4):494-499. doi: 10.1080/10903127.2019.1676344. Epub 2019 Dec 3.
After numerous recent mass casualty events, civilian hemorrhage control has taken a militaristic approach with aggressive and early use of tourniquets. While military literature has demonstrated the utility of tourniquets in preventing battlefield deaths from extremity injuries, there is limited understanding of their role in civilian penetrating trauma deaths. The purpose of this study is to review medical examiner (ME) autopsy records in a defined population to determine the incidence of preventable deaths from extremity wounds amenable to tourniquet placement. : This is a retrospective review of ME cases from one urban county with a descriptive analysis of the demographics, mechanisms of injuries, and causes of death of homicide cases from 2003 to 2017. Mechanism of injury and wound patterns were reviewed to determine the overall occurrence of extremity injuries and amenability of tourniquet placement. A total of 1,804 homicide cases were reviewed with 1,521 (84.3%) resulting from penetrating trauma. Isolated extremity injuries were present in 22 (1.45%) of the penetrating cases, all of which were amenable to tourniquet placement. There were 409 (26.9%) concurrent extremity and central penetrating injuries. The vast majority of extremity wounds were amenable to tourniquet placement (92.1%). Extrapolating nationally to 16,187 annual penetrating injury related homicides in 2016, an estimated 235 (1.45%) isolated extremity injury related deaths could be prevented and an additional estimated 4,354 (26.9%) concurrent extremity and central injury related deaths could potentially receive enhanced care with early tourniquet placement. Among urban ME cases, both isolated extremity cases and concurrent extremity-central injuries exist that may be amenable to life-saving tourniquet use. Extrapolating our findings nationwide suggests that many lives could be saved with early tourniquet use. Considering these findings, tourniquet availability and early placement may have a prominent role in reducing injury deaths from penetrating trauma.
在最近发生的多起大规模伤亡事件后，民用止血已采取军事策略，积极及早使用止血带。虽然军事文献已经证明了止血带在防止战场上因四肢受伤而死亡的实用性，但对于其在民用穿透性创伤死亡中的作用知之甚少。本研究的目的是回顾特定人群中法医尸检记录，以确定可通过使用止血带来预防的四肢创伤死亡的发生率。
这是对一个城市县法医案例的回顾性研究，对 2003 年至 2017 年凶杀案的人口统计学、损伤机制和死亡原因进行了描述性分析。审查了损伤机制和伤口模式，以确定四肢损伤的总体发生率和使用止血带的适宜性。
共回顾了 1804 例凶杀案，其中 1521 例（84.3%）为穿透性创伤。在穿透性病例中，有 22 例（1.45%）存在孤立的四肢损伤，所有这些损伤都可以使用止血带。有 409 例（26.9%）同时存在四肢和中央穿透性损伤。绝大多数四肢伤口都可以使用止血带（92.1%）。全国范围内推算，2016 年每年有 16187 例与穿透性损伤有关的凶杀案，估计有 235 例（1.45%）孤立的四肢损伤相关死亡可以得到预防，另外还有 4354 例（26.9%）同时存在四肢和中央损伤相关死亡可能会因早期使用止血带而得到更好的治疗。
在城市法医案例中，既存在孤立的四肢病例，也存在可能需要救命止血带使用的四肢-中央同时损伤病例。全国范围内推断，早期使用止血带可以挽救许多生命。考虑到这些发现，止血带的可用性和早期放置可能在减少穿透性创伤所致伤害死亡方面发挥重要作用。
