Comparison of law enforcement officer- versus emergency medical services-placed tourniquets

Tourniquet use for hemorrhage control is a core skill for many law enforcement officers (LEOs) and all emergency medical services (EMS) providers. However, LEO tourniquet training is not as intensive as EMS. Overuse of tourniquet can result in overtriage. We hypothesize that LEOs are more liberal than EMS with tourniquet placement.

A 7-year retrospective, single-center study of adult patients who had a tourniquet placed in the field was conducted. Data were stratified by provider who placed the tourniquet. Patient demographics, body location where the tourniquet was placed, hospital location where the tourniquet was removed, incidence of recurrent bleeding and need for operative control of bleeding, and name of injured vessel were recorded. Data were analyzed using Student's t and χ 2 tests.

A total of 192 patients had 197 tourniquets placed (LEO, 77 [40%]; EMS, 120 [63%]). Most tourniquets were placed on the thigh. There was no difference in body mass index, but the EMS cohort had a higher Injury Severity Score (9.4 vs. 6.5, p = 0.03) and extremity Abbreviated Injury Scale severity score (2.4 vs. 1.9, p = 0.007). The LEO-placed tourniquets were more commonly removed in the trauma bay (83% vs. 73%, p = 0.03). The EMS-placed tourniquets were more likely to require operative control of bleeding (23% vs. 6%, p = 0.003). There were no complications related to tourniquet use in either arm.

Law enforcement officers are more likely than EMS to place tourniquets without injury to a named vessel or the presence of severe bleeding. Law enforcement officers need better training to determine when a tourniquet is needed. Emergency medical services should be allowed to remove tourniquet if appropriate. Studies on the impact of overtriage based on tourniquet use are needed.

Therapeutic/Care Management; Level III.