Battle casualty survival with emergency tourniquet use to stop limb bleeding

J Emerg Med. 2011 Dec;41(6):590-7. doi: 10.1016/j.jemermed.2009.07.022. Epub 2009 Aug 31.


Background: In a previous study conducted at a combat support hospital in Iraq, we reported the major lifesaving benefits of emergency tourniquets to stop bleeding in major limb trauma. Morbidity associated with tourniquet use was minor.

Study objectives: The objective of this study is to further analyze emergency tourniquet use in combat casualty care.

Design and setting: This report is a continuation of our previous study of tourniquet use in casualties admitted to a combat support hospital (NCT00517166 at

Methods: After verifying comparable methodologies for the first study and the current study, we compared patient results for these two time periods and then pooled data to analyze outcomes with a larger sample size.

Results: The total study population was 499 (232 in the previous study and 267 in the current study). In all, 862 tourniquets were applied on 651 limbs. Survival was 87% for both study periods. Morbidity rates for palsies at the level of the tourniquet were 1.7% for study 1 and 1.5% for study 2; major limb shortening was 0.4% for both. Survival was associated with prehospital application (89% vs. 78% hospital, p < 0.01) and application before the onset of shock (96% vs. 4% after).

Conclusions: This study shows consistent lifesaving benefits and low risk of emergency tourniquets to stop bleeding in major limb trauma.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Emergency Service, Hospital
  • Emergency Treatment / methods*
  • Extremities / injuries*
  • Female
  • Hemorrhage / mortality*
  • Hemorrhage / therapy*
  • Humans
  • Iraq / epidemiology
  • Male
  • Middle Aged
  • Military Personnel*
  • Survival Analysis
  • Tourniquets*
  • Young Adult

Associated data