Page 58 - Journal of Special Operations Medicine - Summer 2015

Prehospital Use of Hemostatic Bandages and Tourniquets:
Translation From Military Experience to
Implementation in Civilian Trauma Care

John M. Zietlow, BA; Scott P. Zietlow, MD; David S. Morris, MD;
Kathleen S. Berns, MS, RN, CNS; Donald H. Jenkins, MD

ABSTRACT

Background: While the military use of tourniquets emergency tourniquets and hemostatic gauze in mili-
and hemostatic gauze is well established, few data ex- tary populations has been thoroughly documented, the
ist regarding civilian emergency medical services (EMS) same cannot be said for civilian populations. Despite
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systems experience. Methods: A retrospective review the effectiveness of tourniquets and hemostatic gauze
was performed of consecutive patients with prehospi- in military populations and the recommendation from
tal tourniquet and hemostatic gauze application in a Advanced Trauma Life Support, the use of tourniquets
5
single ground and rotor-wing rural medical transport and hemostatic gauze in the civilian emergency medical
service. Standard EMS registry data were reviewed for services (EMS) community is not widespread. Mayo
6,7
each case. Results: During the study period, which in- Clinic’s prehospital providers, Gold Cross Ambulance
cluded 203,301 Gold Cross Ambulance and 8,987 and Mayo One Medical Transport, were trained to use
Mayo One Transport records, 125 patients were treated tourniquets (beginning in 2009) and hemostatic agents
with tourniquets and/or hemostatic gauze in the prehos- (in 2011) via computer-based didactic training with
pital setting. Specifically, 77 tourniquets were used for hands-on practice, in an effort to use these agents for
73 patients and 62 hemostatic dressings were applied to improved patient outcomes.
52 patients. Seven patients required both interventions.
Mechanisms of injury (MOIs) for tourniquet use were The purpose of this project was to determine if the success
blunt trauma (50%), penetrating wounds (43%), and for tourniquets (Combat Application Tourniquet [CAT ];
®
uncontrolled hemodialysis fistula bleeding (7%). Tour- Composite Resources Inc.; http://combattourniquet.com)
niquet placement was equitably distributed between up- and hemostatic gauze (QuikClot Combat Gauze ; Z-
®
per and lower extremities, as well as proximal and distal Medica LLC; www.z-medica.com/healthcare/Products)
locations. Mean tourniquet time was 27 minutes, with in the military could be translated to civilian use. While
98.7% success. Hemostatic bandage MOIs were blunt these interventions are effective in a military population
trauma (50%), penetrating wounds (35%), and other that is predominantly composed of young men with
MOIs (15%). Hemostatic bandage application was head few comorbidities, it is unknown if they would be as
and neck (50%), extremities (36%), and torso (14%), effective in a civilian population composed of all ages,
with a 95% success rate. Training for both interventions both sexes, and individuals with multiple comorbidi-
was computer-based and hands-on, with maintained ties. Based on the training completed by Gold Cross
proficiency of >95% after 2 years. Conclusion: Civil- and Mayo One Medical Transport, the effectiveness and
ian prehospital use of tourniquets and hemostatic gauze proficiency was also reviewed in conjunction with the
is feasible and effective at achieving hemostasis. Online retrospective study.
and practical training programs result in proficiency of
skills, which can be maintained despite infrequent use.
Methods
Keywords: dressing, hemostatic; tourniquet; trauma care,
prehospital civilian Setting
The Gold Cross Ambulance and the Mayo One Medical
Transport service provide medical transportation within
the tri-state area of Iowa, Minnesota, and Wisconsin. In
Introduction
a typical year, Gold Cross provides 60,000 ground trans-
Uncontrolled hemorrhage is a leading cause of pre- ports with 60 ambulances in 12 locations, while Mayo
hospital mortality in military trauma and the second One provides 2,000 air transports with four helicopters
leading cause after civilian trauma. While the use of in three sites (Eau Claire, Wisconsin; and Mankato and
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