Law Enforcement Officer Placed Tourniquets: An Important Tool with Opportunities to Improve - A Multi-Center Study

A previous single center study suggested that both law enforcement officers (LEO) and emergency medical services (EMS) clinicians over-utilize tourniquets (TQs), which has the potential to result in over triage and even harm patients. The aim of this study was to assess the differences in utilization of TQs by LEO versus EMS in a multi-center, multicity review to see if the findings of the previous study are generalizable to the LEO and EMS communities at-large.

This was an 11-year retrospective, multi-center study of adult patients who had a prehospital TQ placed by LEO or EMS. Data were stratified by responder type. Patient demographics, extremity location where the TQ was placed, location where the TQ was removed, incidence of recurrent bleeding, need for operative control of bleeding, and name of injured vessel were recorded. Data were analyzed using Student's t and χ² tests.

In total, 956 patients had TQs placed (LEO, 333 (35%); EMS, 623 (65%)). Most were placed on the thigh. There was no difference in body mass index, but the EMS cohort had a higher Injury Severity Score (9.5 vs. 7.3, p < 0.0001) and extremity Abbreviated Injury Scale severity score (2.0 vs. 1.8, p = 0.002). LEO-placed TQs were less likely to involve a major (named) vessel injury (27% vs. 35%, p = 0.02). There were no patient complications clearly attributable to TQ use.

The LEO-applied TQs were less likely to have a major vascular injury, and removal was less likely associated with recurrent bleeding compared to TQs applied by EMS. Protocols that allow for TQ conversion by EMS may decrease over-triage and trauma resource utilization.