TOURNIQUET USE IN A CIVILIAN EMERGENCY MEDICAL SERVICES SETTING: A DESCRIPTIVE ANALYSIS OF THE BOSTON EMS EXPERIENCE
TOURNIQUET USE IN A CIVILIAN EMERGENCY MEDICAL SERVICES SETTING: A DESCRIPTIVE ANALYSIS OF THE BOSTON EMS EXPERIENCE
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DOI：
10.3109/10903127.2014.995842
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发表时间：
2015-07-01
影响因子：
2.4
通讯作者：
Dyer, Sophia
中科院分区：
文献类型：
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作者：
Kue, Ricky C.;Temin, Elizabeth S.;Dyer, Sophia
导论.尽管早期止血带在军事环境中用于控制失血性肢体出血的复苏，但其在民用紧急医疗服务（EMS）中的适当作用尚不清楚。Objective.描述在城市民用EMS环境中院前止血带使用的经验。方法.对2005年1月1日至2012年12月1日的EMS院前护理报告进行了回顾性审查。对数据进行描述性分析，包括院前止血带放置的持续时间、EMS现场时间、损伤机制和患者人口统计学。还审查了参与接收医院的结局数据。结果确定了98例院前止血带使用病例。最常见的受伤原因是穿透性枪伤或刺伤67.4%（66/98）; 7.1%（7/98）的病例是由于钝性创伤; 23.5%（23/98）的病例是由于与未控制的血液透析分流或伤口出血相关的非创伤性出血; 45.4%（44/97）的病例是下肢出血; 54.6%（53/97）放置在上肢，91%（87/95，95%CI：85.9-97.3%）的病例成功控制出血。平均院前止血带放置时间为14.9分钟。一半的止血带放置由基本生命支持提供者进行。96.9%（95/98）的病例可获得医院随访。其中，3.2%（3/95）的患者通过EMS、54.7%（52/95）的患者在急诊室或31.6%（30/95）的患者在手术室（OR）取出止血带;这些OR病例中有46.7%（14/30）记录了需要修复的血管损伤。确定了10例有医院随访数据的死亡，其中没有一例是由于使用止血带所致。1例前臂麻木可能是由于神经损伤，1例潜在血管并发症，总体并发症发生率为2.1%（2/95）。结论在城市平民EMS环境中早期使用止血带治疗肢体出血似乎是安全的，并发症很少发生。
Introduction. Despite the resurgence of early tourniquet use for control of exsanguinating limb hemorrhage in the military setting, its appropriate role in civilian emergency medical services (EMS) has been less clear. Objective. To describe the experience of prehospital tourniquet use in an urban, civilian EMS setting. Methods. A retrospective review of EMS prehospital care reports was performed from January 1, 2005 to December 1, 2012. Data, including the time duration of prehospital tourniquet placement, EMS scene time, mechanisms of injury, and patient demographics, underwent descriptive analysis. Outcomes data for participating receiving hospitals were also reviewed. Results. Ninety-eight cases of prehospital tourniquet use were identified. The most common causes of injury were penetrating gunshot or stabbing wounds (67.4%, 66/98); 7.1% (7/98) of cases were due to blunt trauma; 23.5% (23/98) of cases were from non-traumatic hemorrhage related to uncontrolled hemodialysis shunt or wound bleeding; 45.4% (44/97) of cases were placed on a lower extremity; 54.6% (53/97) were placed on an upper extremity Placement was successful in hemorrhage control in 91% (87/95, 95%CI: 85.9-97.3%) of cases. The average prehospital tourniquet placement time was 14.9 minutes. Half of all tourniquet placements were performed by basic life support providers. Hospital follow-up was available for 96.9% (95/98) of cases. Of these, the tourniquet was removed by EMS in 3.2% (3/95), the emergency department in 54.7% (52/95), or in the operating room (OR) in 31.6% (30/95) of the time; 46.7% (14/30) of these OR cases had a documented vascular injury needing repair. Ten deaths with hospital follow-up data were identified, none of which were due to tourniquet use. There was one case of forearm numbness potentially due to nerve injury and one case with potential vascular complication, representing an overall complication rate of 2.1% (2/95). Conclusion. The early use of tourniquets for extremity hemorrhage in an urban civilian EMS setting appears to be safe, with complications occurring infrequently.