From the Albany Medical College (D.S.), Albany, New York; and Operational Medicine (G.S.), Department of Emergency Medicine (E.R.S.), and Center for Trauma and Critical Care, Department of Surgery (B.S.), George Washington University, Washington, DC.
J Trauma Acute Care Surg. 2024 Oct 1;97(4):552-556. doi: 10.1097/TA.0000000000004349. Epub 2024 Apr 10.
Tourniquet use for hemorrhage control is a core skill for many law enforcement officers (LEOs) and all emergency medical services (EMS) providers. However, LEO tourniquet training is not as intensive as EMS. Overuse of tourniquet can result in overtriage. We hypothesize that LEOs are more liberal than EMS with tourniquet placement.
A 7-year retrospective, single-center study of adult patients who had a tourniquet placed in the field was conducted. Data were stratified by provider who placed the tourniquet. Patient demographics, body location where the tourniquet was placed, hospital location where the tourniquet was removed, incidence of recurrent bleeding and need for operative control of bleeding, and name of injured vessel were recorded. Data were analyzed using Student's t and χ 2 tests.
A total of 192 patients had 197 tourniquets placed (LEO, 77 [40%]; EMS, 120 [63%]). Most tourniquets were placed on the thigh. There was no difference in body mass index, but the EMS cohort had a higher Injury Severity Score (9.4 vs. 6.5, p = 0.03) and extremity Abbreviated Injury Scale severity score (2.4 vs. 1.9, p = 0.007). The LEO-placed tourniquets were more commonly removed in the trauma bay (83% vs. 73%, p = 0.03). The EMS-placed tourniquets were more likely to require operative control of bleeding (23% vs. 6%, p = 0.003). There were no complications related to tourniquet use in either arm.
Law enforcement officers are more likely than EMS to place tourniquets without injury to a named vessel or the presence of severe bleeding. Law enforcement officers need better training to determine when a tourniquet is needed. Emergency medical services should be allowed to remove tourniquet if appropriate. Studies on the impact of overtriage based on tourniquet use are needed.
Therapeutic/Care Management; Level III.
止血带在控制出血方面是许多执法人员（LEO）和所有紧急医疗服务（EMS）提供者的核心技能。然而，与 EMS 相比，LEO 的止血带培训并没有那么密集。过度使用止血带可能会导致过度分诊。我们假设 LEO 在使用止血带时比 EMS 更宽松。
对在现场放置止血带的成年患者进行了一项为期 7 年的回顾性、单中心研究。数据按放置止血带的提供者进行分层。记录患者人口统计学资料、止血带放置的身体部位、止血带去除的医院位置、再出血发生率和需要手术控制出血以及受伤血管的名称。使用学生 t 检验和 χ 2 检验对数据进行分析。
共有 192 名患者放置了 197 个止血带（LEO，77 [40%]；EMS，120 [63%]）。大多数止血带都放在大腿上。两组的体重指数没有差异，但 EMS 组的损伤严重程度评分（9.4 比 6.5，p = 0.03）和四肢简明损伤评分严重程度评分（2.4 比 1.9，p = 0.007）更高。在创伤室中，LEO 放置的止血带更常被去除（83%比 73%，p = 0.03）。EMS 放置的止血带更可能需要手术控制出血（23%比 6%，p = 0.003）。在两支手臂中，都没有与使用止血带相关的并发症。
与 EMS 相比，执法人员更有可能在没有伤害到指定血管或没有严重出血的情况下放置止血带。执法人员需要更好的培训来确定何时需要使用止血带。如果合适，应允许 EMS 移除止血带。需要研究基于止血带使用的过度分诊的影响。
治疗/护理管理；三级。
