D. Shukla2, G. Shapiro3, R. Smith3, S. Kartiko1, B. Sarani1 1George Washington University School Of Medicine And Health Sciences, Surgery, Washington, DC, USA 2Albany Medical College, Albany, NY, USA 3George Washington University School Of Medicine And Health Sciences, Emergency Medicine, Washington, DC, USA
Introduction: The purpose of this study was to compare the use of tourniquets (TQ) and associated outcomes by police (PD) and emergency medical services (EMS). We hypothesize that tourniquets are over-utilized by law enforcement but there are no adverse consequences.
Methods: An IRB exempt, single center, retrospective study from 2016 – 2023 was done. All adult patients who had a TQ placed prior to arrival were included. Patients were divided into TQ placed by PD versus EMS. Demographic data, vital signs, location of TQ application, named vessel(s) injured, and recurrent bleeding and adverse events following TQ removal were collected. Adverse events were defined as limb ischemia, neuropraxia, or paralysis at discharge. Continuous variables were compared using the student t-test and categorical variables using the chi-square. Significant difference was defined as p<0.05.
Results: A total of 192 cases were reviewed, 119 (62%) EMS placed TQ and 73 (38%) PD placed TQ. Patients who had a TQ placed by PD were significantly younger (32 v 36 years old), less injured (ISS 6.5 v 9.4 and extremity AIS 1.9 v 2.4), more likely to have been shot (70% v 39%) as compared to EMS (Table). There was no difference in location of TQ placement or in the specific artery injured, but no blood vessel injury was significantly more likely with PD placed TQ (84% v 60%). PD placed TQ were more likely to be removed in the trauma bay (88% v 73%) and EMS placed TQ were more likely to be removed in the operating room (24% v 7%). There were no adverse events related to TQ use in either cohort.
Conclusion: PD are more likely that EMS to place a TQ unnecessarily. More education regarding arterial location or bleeding severity that necessitates a TQ is needed to optimize TQ use, especially for PD. There are no significant adverse events associated with TQ use, however.
