Joseph J. Zubak MD

Orthopaedic Surgery Shannon Clinic

Field Tourniquets

• Tourniquet uses

• Army Field Data

• Application

Learning Objectives

Local case June 9, 2012

Local case – July 30, 2012

Army Field Data

• Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma

• Kragh, et al • J Trauma 2008;64:S38-S50

Army Field Data

• Prospective study in 2006 over 7 months • Baghdad, Iraq • 232 Patients had 428 tourniquets on 309

injured limbs

Military Case

Military Case

Field Data

• Tourniquet Effectiveness – Emergency Medical Tourniquet - 92% – Combat Application Tourniquet – 79% – Improvised Tourniquet – 25%

– Effectiveness

• Did tourniquet stop bleeding? • Did it stop the distal pulse?

Field data

• Indications – Medically – if the postoperative determination

was that the injury justified tourniquet use. – Tactically – care under fire. All but 12 tourniquets out of 428 were indicated

• 3 superficial wounds not surgical • 9 Surgical wounds with no vessel injury • No morbidities

Field Data

• Morbidity – Difficult to determine – Overall much less than expected even for times

> 3 hours. – Misplaced tourniquets definitely resulted in

increased morbidity.

Practical Recommendations

• Tourniquet use before shock onset saves more lives than after shock; use them before extraction or transport

• Use scientifically designed, laboratory tested ans clinically validated tourniquets

• The goal of emergency tourniquet use is to stop bleeding and stop the distal pulse

Practical Recommendations continued

• Side by side use is useful to rid distal pulses and stop bleeding if one is ineffective

• Clothing about the tourniquet should be removed at the first opportunity to detect all wounds

• Materials under a tourniquet should be removed at the first opportunity to avoid looseness.

Thank you