Tourniquet Application by Bystanders Fails to Improve Acuity

Area of Science:

• Emergency medicine
• Trauma care
• Public health

Background:

• Civilian prehospital tourniquet application (TA) has increased, potentially improving survival.
• Concerns exist regarding incorrect application or lack of indication for bystander TA.
• Effectiveness of bystander TA has not been evaluated nationally.

Purpose of the Study:

• Compare TA success and outcomes between emergency medical services (EMS)/first responders and civilian bystanders.
• Hypothesize that civilian TA yields less patient acuity improvement than EMS TA.

Main Methods:

• Utilized the 2017-2020 National Emergency Medical Services Information System database.
• Analyzed TA in patients aged ≥20 years, defining success as cessation of blood flow.
• Defined acuity improvement as a change from critical to emergent or lower status.

Main Results:

• 85% of 3003 prehospital TA cases were by EMS.
• Bystander TA success rate was lower (90%) than EMS/first responders (97%).
• Bystander TA was not associated with improved acuity (OR 1.1, p=0.12), while first responder TA was (OR 1.22, p=0.02).

Conclusions:

• EMS-administered TA is linked to improved patient acuity, unlike bystander TA.
• Lower success rates in bystander TA highlight the need for improved training and outreach.
• Trauma programs should enhance education for effective, indicated TA in civilian settings.