Introduction: Tourniquet (TQ) use for hemorrhage control is a core skill for many law enforcement officers (LEO) and all emergency medical services (EMS) providers. However, LEO TQ training is not as intensive as EMS. Overuse of TQ can result in over triage. We hypothesize that LEO are more liberal than EMS with TQ placement.
Methods: A seven-year retrospective, single center study of adult patients who had a TQ placed in the field was conducted. Data were stratified by provider who placed the TQ. Patient demographics, body location where the TQ was placed, hospital location where the TQ 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 t-test and Chi-square tests.
Results: 192 patients had 197 TQ placed (LEO 77 (40%) and EMS 120 (63%). Most TQ 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 v 6.5, p = 0.03) and extremity abbreviated injury severity score (2.4 v 1.9, p = 0.007). LEO placed TQ were more commonly removed in the trauma bay (83% v 73%, p = 0.03). EMS placed TQ were more likely to require operative control of bleeding (23% v 6%, p = 0.003). There were no complications related to TQ use in either arm.
Conclusions: LEO are more likely than EMS to place tourniquets without injury to a named vessel or the presence of severe bleeding. LEO need better training to determine when a TQ is needed. EMS should be allowed to remove TQ if appropriate. Studies on the impact of over triage based on TQ use are needed.
Level of evidence: Therapeutic/Care Management, Level III.
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