Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

VOLUME 8 , ISSUE 1 ( January-April, 2019 ) > List of Articles

Original Article

Tourniquets in the Era of “Stop the Bleed”—Are Simple Pressure Maneuvers Being Bypassed for Tourniquets in Non-arterial Bleeding?

William Rothstein, Kristine Kenning, Karen Shipman, Rob Lawrence, Alan Rossi, Edgar Rodas

Keywords : Emergency medical services, Extremity trauma, Hemorrhage, Prehospital, Tourniquet

Citation Information : Rothstein W, Kenning K, Shipman K, Lawrence R, Rossi A, Rodas E. Tourniquets in the Era of “Stop the Bleed”—Are Simple Pressure Maneuvers Being Bypassed for Tourniquets in Non-arterial Bleeding?. Panam J Trauma Crit Care Emerg Surg 2019; 8 (1):56-60.

DOI: 10.5005/jp-journals-10030-1237

License: CC BY-NC 4.0

Published Online: 04-04-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: Tourniquets are a well-studied method of temporary hemostasis for life-threatening bleeding. Previous studies place the rate of true arterial injuries among applied tourniquets in civilian populations between 44% and 70.1%. Materials and methods: We conducted a single center, retrospective, case-control study of all patients with prehospital applied tourniquet between May 2016 and November 2017. Criteria for true arterial injury were traumatic amputation or arterial injury requiring immediate surgery. We pooled reported civilian data to be utilized as a reference population. Results: In an 18-month period, 66 patients presented with tourniquets. True arterial injury existed in 36% vs 53% in the reference population (chi square = 7.3, p = 0.0068). There was no significant difference between blunt vs penetrating mechanism (35% vs 37%, p = 0.85). Gun-shot wounds (GSW) were more likely to have no arterial injury than all other injury types (81% vs 56%, p = 0.046, OR = 3.4). There was no significant difference in tourniquet application between paramedics and other first responders (74% vs 75%, p = 0.48). Conclusion: Injury type appears to be a factor; in patients with a tourniquet, those with a GSW were 3.4 times as likely to have no arterial injury as other injury types. This data reflects a high frequency of prehospital tourniquet application without arterial injury. Multi-institutional, prospective studies are necessary to evaluate tourniquet utilization.

  1. Tien HC, Jung V, et al. An evaluation of tactical combat casualty care interventions in a combat environment. J Am Coll Surg 2008;207: 174–178. DOI: 10.1016/j.jamcollsurg.2008.01.065.
  2. Kragh Jr JF, Walters TJ, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009;249:1–7. DOI: 10.1097/SLA.0b013e31818842ba.
  3. Kragh Jr JF, O'Neill ML, et al. Minor morbidity with emergency tourniquet use to stop bleeding in severe limb trauma: research, history, and reconciling advocates and abolitionists. Mil Med 2011;176:817–823. DOI: 10.7205/milmed-d-10-00417.
  4. Scerbo MH, Mumm JP, et al. Safety and appropriateness of tourniquets in 105 civilians. Prehosp Emerg Care 2016;20:712–722. DOI: 10.1080/10903127.2016.1182606.
  5. Inaba K, Siboni S, et al. Tourniquet use for civilian extremity trauma. J Trauma Acute Care Surg 2015;79:232–7;quiz 332–333. DOI: 10.1097/TA.0000000000000747.
  6. Kauvar DS, Dubick MA, et al. Systematic review of prehospital tourniquet use in civilian limb trauma. J Trauma Acute Care Surg 2018;84:819–825. DOI: 10.1097/TA.0000000000001826.
  7. Ross EM, Redman TT, et al. Stop the bleed: the effect of hemorrhage control education on laypersons’ willingness to respond during a traumatic medical emergency. Prehosp Disaster Med 2018;33: 127–132. DOI: 10.1017/S1049023X18000055.
  8. Duignan KM, Lamb LC, et al. Tourniquet use in the prehospital setting: are they being used appropriately? Am J Disaster Med 2018;13:37–43. DOI: 10.5055/ajdm.2018.0286.
  9. Gupta K, Aggarwal N, et al. Re-emphasizing the importance of tourniquet time: severe myocardial depression following tourniquet deflation. Acta Anaesthesiol Scand 2008;52:873. DOI: 10.1111/j.1399- 6576.2008.01663.x.
  10. Randall PE. Medical antishock trousers (MAST): a review. Injury 1986;17:395–398.
  11. Mattox K. Medical anti-shock trousers: blind faith, poor judgment and patient jeopardy. Prehosp Disaster Med. Cambridge University Press, 1989; p. 39–41, vol. 4.
  12. Roberts I, Blackhall K, et al. Medical anti-shock trousers (pneumatic anti-shock garments) for circulatory support in patients with trauma. Cochrane Database Syst Rev. John Wiley & Sons, Ltd; 1999; available: CD001856/abstract
  13. Lateef F, Kelvin T. Military anti-shock garment: historical relic or a device with unrealized potential? J Emerg Trauma Shock 2008;1: 63–69. DOI: 10.4103/0974-2700.43181.
  14. Kragh Jr JF, O'Neill ML, et al. Survey of the indications for use of emergency tourniquets [Internet]. ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX; 2011. Available: http://www.
  15. Scerbo MH, Holcomb JB, et al. The trauma center is too late: major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock. J Trauma Acute Care Surg 2017;83:1165–1172. DOI: 10.1097/TA.0000000000001666.
  16. Callaway DW, Robertson J, et al. Law enforcement-applied tourniquets: a case series of life-saving interventions. Prehosp Emerg Care 2015;19:320–327. DOI: 10.3109/10903127.2014.964893.
  17. Schroll R, Smith A, et al. A multi-institutional analysis of prehospital tourniquet use. J Trauma Acute Care Surg 2015;79:10–14; discussion
  18. DOI: 10.1097/TA.0000000000000689.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.