The state of the union: Nationwide absence of uniform guidelines for the prehospital use of tourniquets to control extremity exsanguination

The Journal of Trauma and Acute Care Surgery
Elie P RamlyDavid R King

Abstract

After the Sandy Hook shootings and the resulting Hartford Consensus, as well as the recent Boston Marathon bombing, the need for a uniform, detailed, and aggressive prehospital extremity exsanguination control protocol became clear. We hypothesized that most states within the United States lack a detailed uniform protocol. We performed a systematic nationwide assessment of emergency medical services (EMS) prehospital extremity exsanguination control protocols. An online search (updated February 7, 2015) identified state-, region-, or county-specific EMS protocols in all 50 states. If unavailable online, protocols were retrieved directly by contacting each state's Department of Public Health (or other appropriate agency). Two investigators independently screened each extremity exsanguination control protocol. Protocols were first grouped into three categories: I, tourniquet not mentioned; II, tourniquet mentioned, without specific guidance; III, tourniquet mentioned, with specific guidance related to type, indications, application technique, and safety concerns. Each protocol was then scored on a five-point scale for comparison. Forty-two states (84%) had statewide and 14 (28%) had at least one county-specific protocol. Seven st...Continue Reading

References

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Citations

Nov 1, 2016·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Michelle H ScerboBryan A Cotton
Oct 1, 2016·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Mazen J El SayedN Clay Mann
Nov 3, 2016·The Journal of Trauma and Acute Care Surgery·Charlotte BeaucreuxPierre Pasquier
Feb 13, 2018·The Journal of Trauma and Acute Care Surgery·David S KauvarJohn F Kragh
Jan 22, 2019·The Journal of Trauma and Acute Care Surgery·Tress GoodwinCraig Goolsby
Oct 4, 2019·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·C BonkS Hargarten
Feb 23, 2019·Trauma Surgery & Acute Care Open·Allison G McNickleJohn J Fildes
Jun 28, 2019·The Journal of Trauma and Acute Care Surgery·Tress GoodwinCraig Goolsby
Feb 23, 2017·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Jeffry L KashukYoram Kluger

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