Introduction: External hemorrhage is a leading preventable cause of death in prehospital settings. Despite established protocols and training, the application and outcomes of tourniquet use vary. Region 2 South, an area of four counties in southern Michigan containing 2.5 million people, implemented tourniquet application protocols and training programs. This study aims to analyze the effectiveness and accuracy of tourniquet applications. Methods: Retrospective analysis of tourniquets from October 2019 to December 2023 that included patients presenting to level 1 and level 2 trauma centers with pre-hospital tourniquet placement. Data collected included personnel applying tourniquets, mechanism of injury, appropriateness and correctness of indications, associated interventions, and complications. Results: 473 tourniquets were applied. EMS performed (218, 46.8%), followed by fire/police (196, 42.1%), and the ED (19, 4.1%), and bystander applied in 53 cases (11.3%). The mechanisms of injury were gunshots (185 cases, 39.5%), lacerations (59 cases, 12.6%), and stab wounds (45 cases, 9.6%). 78.3% of tourniquets met appropriate indications, and 89.3% were applied correctly. The odds of applying with appropriate indication were lower when bystanders performed the procedure (OR 0.33, 95% CI 0.18 - 0.60), as were the odds of correct application (OR 0.40, 95% CI 0.19 - 0.87). Data on interventions were missing (54.8%), but when available, it showed blood product administration in 7.8% of patients, suturing in 33.3%, vascular repair in 17.6%, and 27.1% of patients required multiple interventions. Complications related to tourniquets occurred in 2 (0.42%) cases. Conclusion: EMS and law enforcement are primary applicers of tourniquets, with a significant portion applied correctly and appropriately. There is a lower likelihood of proper application by bystanders. The study indicates tourniquets are generally applied correctly and effectively, with minimal complications. This underscores the importance of continued training and data collection improvements to enhance prehospital care outcomes, as well as the importance of providing continued and further training to the public.
Klausner et al. (Sun,) studied this question.