Tourniquet Application by Bystanders Fails to Improve Acuity

Civilian prehospital tourniquet application (TA) has increased over time, and prehospital TA may be associated with decreased hemorrhagic shock and improved survival. However, tourniquets may be placed incorrectly or without indication. No national study has evaluated the effectiveness of bystander TA.

This study sought to compare the success and short-term outcomes of prehospital TA by emergency medical services (EMS) or first responders vs. civilian bystanders, hypothesizing that civilian TA would lead to less improvement in patient acuity than EMS TA.

The 2017 to 2020 National Emergency Medical Services Information System database was queried for TA for patients aged ≥20 years. Acuity was reported in the database, and improvement was defined as a change from critical to emergent or lower acuity. Success was defined as the cessation of blood flow distal to the tourniquet site. Descriptive statistics and multivariable analyses were performed to determine the improvement in acuity.

A total of 3003 patients had prehospital TA; 85% of these were applied by EMS. The success rate of TA was lower among bystanders than among EMS and first responders (90% vs. 97%, p < 0.001). Placement of a tourniquet by a bystander was not associated with improvement in acuity (odds ratio, 1.1; 95% confidence interval, 0.97-1.25, p = 0.12). However, TA by first responders was associated with improved acuity (odds ratio, 1.22; 95% confidence interval, 1.01-1.44, p = 0.02).

TA by EMS is associated with improved patient acuity, whereas TA by bystander placement is not, in the context of a lower success rate of bystander TA. Trauma programs should expand outreach to ensure that those with hemorrhagic extremity injuries receive effective TA when indicated.