• Leslie M Barnard, Sally Guan, Lori Zarmer, Brianna Mills, Jennifer Blackwood, Eileen Bulger, Betty Y Yang, Peter Johnston, Monica S Vavilala, Michael R Sayre, Thomas D Rea, and David L Murphy.
• From the Division of Emergency Medical Services Pubic Health Seattle & King County (L.M.B., S.G., J.B., T.D.R.), Seattle, Washington; Department of Neurobiology (L.Z.), University of California Los Angeles, Los Angeles, California; Harborview Injury Prevention and Research Center (B.M., M.S.V.), University of Washington, Seattle, Washington; Department of Epidemiology (B.M.), University of Washington, Seattle, Washington; Department of Surgery (E.B., P.J.), University of Washington, Seattle, Washington; Department of Emergency Medicine (B.Y.Y., M.R.S., D.L.M.), University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine (M.S.V.), University of Washington, Seattle, Washington; Seattle Fire Department (M.R.S.); and Department of Medicine (T.D.R.), University of Washington, Seattle, Washington.
• J Trauma Acute Care Surg. 2021 Jun 1; 90 (6): 1040-1047.

BackgroundThere is substantial investment in layperson and first responder training involving tourniquet use for hemorrhage control. Little is known however about prehospital tourniquet application, field conversion, or outcomes in the civilian setting. We describe the experience of a metropolitan region with prehospital tourniquet application.MethodsWe conducted a retrospective cohort study characterizing prehospital tourniquet use treated by emergency medical services (EMS) in King County, Washington, from January 2018 to June 2019. Emergency medical services and hospital records were abstracted for demographics, injury mechanism, tourniquet details, clinical care, and outcomes. We evaluated the incidence of tourniquet application, who applied the device (EMS, law enforcement, or layperson), and subsequent course.ResultsA total of 168 patients received tourniquet application, an incidence of 5.1 per 100,000 person-years and 3.48 per 1,000 EMS responses for trauma. Tourniquets were applied for penetrating trauma (64%), blunt trauma (30%), and bleeding ateriovenous fistulas (7%). A subset was critically ill: 13% had systolic blood pressures of <90 mm Hg, 8% had Glasgow Coma Scale score of <13, and 3% had cardiac arrest. Among initial applications, 48% were placed by law enforcement, 33% by laypersons, and 18% by EMS. Among tourniquets applied by layperson or law enforcement (n = 137), EMS relied solely on the original tourniquet in 45% (n = 61), placed a second tourniquet in 20% (n = 28), and removed the tourniquet without replacement in 35% (n = 48). Overall, 24% required massive transfusion, 59% underwent urgent surgery, and 21% required vascular surgery. Mortality was 3% (n = 4). At hospital discharge, the tourniquet limb was fully functional in 81%, partially functional in 10%, and nonfunctional in 9%; decreased function was not attributed to tourniquet application.ConclusionThe high rate of application, need for urgent hospital intervention in a subset, and low incidence of apparent complication suggest that efforts to increase access and early tourniquet use can provide public health benefit.Level Of EvidenceTherapeutic, level IV.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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