U.S. Military use of tourniquets from 2001 to 2010

Prehosp Emerg Care. 2015 Apr-Jun;19(2):184-90. doi: 10.3109/10903127.2014.964892. Epub 2014 Nov 24.


Objective: This study was conducted to associate tourniquet use and survival in casualty care over a decade of war in order to provide evidence to emergency medical personnel for the implementation and efficacy of tourniquet use in a large trauma system.

Methods: This survey is a retrospective review of data extracted from a trauma registry. The decade (2001-2010) outcome trend analysis of tourniquet use in the current wars was made in order to associate tourniquet use and survival in an observational cohort design.

Results: Of 4,297 casualties with extremity trauma in the total study, 30% (1,272/4,297) had tourniquet use and 70% (3,025/4,297) did not. For all 4,297 casualties, the proportion of casualties with severe or critical extremity Abbreviated Injury Scales (AIS) increased during the years surveyed (p < 0.0001); the mean annual Injury Severity Score (ISS) rose from 13 to 21. Tourniquet use increased during the decade by almost tenfold from 4 to nearly 40% (p < 0.0001). Survival for casualties with isolated extremity injury varied by injury severity; the survival rate for AIS 3 (serious) was 98%, the rate for AIS 4 (severe) was 76%, and the rate for AIS 5 (critical) was 0%. Survival rates increased for casualties with injuries amenable to tourniquets but decreased for extremity injuries too proximal for tourniquets.

Conclusions: Average injury severity increased during the decade of war for casualties with extremity injury. Both tourniquet use rates and casualty survival rates rose when injuries were amenable to tourniquets.

Keywords: emergency medical services; first aid; medical device; resuscitation; shock.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Extremities / injuries*
  • Hemorrhage / mortality
  • Hemorrhage / therapy*
  • Humans
  • Injury Severity Score
  • Military Medicine*
  • Registries
  • Retrospective Studies
  • Surveys and Questionnaires
  • Survival Rate
  • Tourniquets / statistics & numerical data*
  • United States
  • Warfare
  • Wounds and Injuries / mortality
  • Wounds and Injuries / therapy*