Page 60 - Journal of Special Operations Medicine - Summer 2015

Table 3 shows various time frames associated with the Figure 2 Hemostatic gauze injury location.
study. Injury-to-intervention time was defined as time
from 911 call to on-scene arrival. The transport time
was defined as time from departure from scene or facil-
ity to arrival at the destination center. Intervention-in-
use time was defined as the time from when a tourniquet
or hemostatic gauze was placed until arrival at the des-
tination center.

Table 3 Timeframe for Tourniquet and Hemostatic Gauze Use
Hemostatic
Time, min Tourniquet Gauze
Injury to intervention, 8 (2–95) 17 (1–198)
median (range)
Transport, median 9 (1–74) 12 (3–162)
(range)
Intervention in use, 19 (1–145) 21 (2–181) junctional hemorrhage is common in battlefield injuries,
median (range) they are relatively rare in civilian injuries. There was a
wide variety of MOIs, with the “other” category includ-
Table 4 Tourniquet and Hemostatic Gauze Use and Success ing postoperative axillary hemorrhage, tonsillar hemor-
rhage, and vaginal hemorrhage (Table 2).
Tourniquet, Hemostatic
n (%) Gauze, n (%)
Table 3 describes the time frames associated with he-
Prior to our arrival 16 (22) 0 (0)
mostatic gauze use, and the definitions are the same as
On scene 52 (71) 46 (88) with tourniquet use. As seen in Table 4, no hemostatic
En route 5 (7) 6 (12) dressings were applied PTA because, at the time of the
Successful hemostasis 76 (99) 59 (95) study, no other prehospital program in the tri-state area
carried hemostatic dressings. The majority (88%) were
placed on scene.
Table 4 explains who placed the tourniquet and when
it was placed, as well as if the agent was successful. If a Hemostatic gauze was highly successful at stopping
tourniquet was placed prior to our arrival (PTA), it was bleeding, with 59 of 62 injuries (95%) achieving hemo-
either by another EMS team, firefighter, law enforce- stasis. A total of 62 hemostatic dressings were used for
ment officer, another hospital, or bystander. The major- the 52 patients, as eight patients required more than
ity of tourniquets (71%) were placed on scene. one roll, but only one roll was needed per wound loca-
tion. According to our prehospital protocol, hemostatic
Overall, 98.7% (76 of 77) of the CAT tourniquets were gauze was only applied after standard compression ban-
successful in stopping arterial bleeding. While 77 tour- dages were unsuccessful. As for the three (5%) that were
niquets were used for 73 patients, only one was used unsuccessful, one injury occurred to the scalp, face, and
on the same extremity, due to incorrect application of extremity, respectively.
the first tourniquet at an outside emergency department
(ED). The other patients who required more than one Combined Tourniquet and Hemostatic Gauze Use
tourniquet only needed one tourniquet per injury loca- Interestingly, in seven instances, a patient required both
tion. Of note, once a tourniquet was placed, our pro- a tourniquet and hemostatic gauze. Four patients had
tocol is to leave it in place until arrival at the ED or successful simultaneous placement without issue. Two
operating room (OR). All three improvised tourniquets patients had a tourniquet placed properly PTA of our
used PTA were unsuccessful. prehospital personnel, with initial success in stopping
arterial bleeding, but were augmented 12 and 48 min-
Hemostatic Gauze utes later with hemostatic gauze to control venous
In the hemostatic gauze study group, the majority were bleeding. One use of hemostatic gauze was initially un-
male patients (mean age, 49 years) who were transported successful; however, a tourniquet was applied success-
from the scene of injury via ground transport (Table 1). fully afterwards, with resulting hemostasis.
Half of the wounds involved the head and neck, with
the other 50% involving the rest of the body (Figure 2). One prehospital death occurred during our experience.
Only four patients had a junctional injury (two neck This patient had a hemodialysis shunt malfunction in
and two axilla/groin) requiring hemostatic gauze. While his left upper extremity with massive hemorrhage. Upon

50 Journal of Special Operations Medicine Volume 15, Edition 2/Summer 2015