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Efficacy of Prehospital Application of Tourniquets and Hemostatic Dressings to Control Traumatic External Hemorrhage

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Efficacy of Prehospital Application of Tourniquets and Hemostatic Dressings to Control Traumatic External Hemorrhage EMERGING ISSUES IN EMS AND 911 Efficacy of Prehospital Application of Tourniquets and Hemostatic Dressings To Control Traumatic External Hemorrhage EMERGENCY DIGITAL EFFICACY DATA RESEARCH EVIDENCE- BASED RESILIENCE Disclaimer This publication is distributed by the U.S. Department of Transportation, National Highway Traffic Safety Administration, in the interest of information exchange. The opinions, findings and conclusions expressed in this publication are those of the author(s) and not necessarily those of the Department of Transportation or the National Highway Traffic Safety Administration. The United States Government assumes no liability for its contents or use thereof. If trade or manufacturer’s name or products are mentioned, it is because they are considered essential to the object of the publication and should not be construed as an endorsement. The United States Government does not endorse products or manufacturers. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Snyder D, Tsou A, Schoelles K. Efficacy of Prehospital Application of Tourniquets and Hemostatic Dressings to Control Traumatic External Hemorrhage. DOT HS 811 999b. Washington, DC: National Highway Traffic Safety Administration. May 2014. Available at: www.ems.gov. The majority of all road trauma deaths occur either at the scene of injury or in the prehospital setting. The World Health Organization has identified uncontrolled bleeding to be the leading cause of preventable traumatic death. Emergency Medical Services systems play a key role in helping to reduce motor vehicle-related fatalities by providing medical care at the crash scene and by quickly transporting injured patients to the most appropriate level of trauma care. This systematic review was used by the American College of Surgeons to develop an evidence-based guideline on external hemorrhage control in the prehospital setting and will help the National Highway Traffic Safety Administration (NHTSA) in its mission to save lives due to injuries from road traffic crashes. This document and the associated evidence-based guideline will help NHTSA meet its strategic goals to improve survivability from motor vehicle crashes and improve emergency care for persons injured in vehicle crashes. i Technical Expert Panel In designing the study questions and methodology at the outset of this report, ECRI Institute consulted several technical and content experts. Broad expertise and perspectives were sought. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who participated in developing this report follows: Eileen Bulger, M.D. Jay Johannigman, M.D. Professor of Surgery, University of Washington Associate Professor of Surgery Chief of Trauma, Chief, Division of Trauma/Critical Care Harborview Medical Center University of Cincinnati Medical Center Seattle, Washington Cincinnati, OH Frank Butler, MD, CAPT, MC, USN (ret) Christopher Kahn, M.D. M.P.H. Chairman, Department of Defense Committee Fellowship Director, EMS/Disaster Medicine on Tactical Combat Causalty Care Fellowship Director, Prehospital Trauma Care Division, University of California San Diego Medical Department of Defense Joint Trauma System Center Naval Hospital Pensacola San Diego, CA Pensacola, Florida Gregg Margolis, Ph.D., NREMT-P Drew Dawson, Director Director, Division of Health Systems and Health Office of Emergency Medical Services Care Policy National Highway Traffic Safety Administration Office of the Assistant Secretary for U.S. Department of Transportation Preparedness Response Washington, DC U.S. Department of Health and Human Services Washington, DC Mary Fallat, M.D. Professor and Chief, Pediatric Surgery University of Louisville School of Medicine Jeffrey P. Salomone, M.D. Louisville, KY NREMT-P Medical Director District Medical Group Detective Scott M. Harding, BS, NREMT-P Maricopa Medical Center Prehospital Trauma Life Support, Region 1 Phoenix, Arizona Coordinator National Association of Emergency Medical Technicians Columbus, OH ii Peter P. Taillac, MD Lynn J. White, M.S., CCRP Associate Professor, Surgery Director of Resuscitation and Accountable Care Division of Emergency Medicine American Medical Response University of Utah School of Medicine Research Consultant, Utah State EMS Medical Director, The Center for Medical Transport Research Bureau of EMS and Preparedness Columbus, Ohio Salt Lake City, UT Peer Reviewers Prior to publication of the final evidence report, ECRI Institute sought input from Peer Reviewers selected by the National Highway Traffic Safety Administration. However, the conclusions and synthesis of the scientific literature presented in this report does not necessarily represent the views of individual reviewers. Peer reviewers must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential non-financial conflicts may be retained. The list of peer reviewers follows. Frank Butler, MD, CAPT, MC, USN (ret) J. Stephen Higgins, Ph.D. Chairman, DoD Committee on Tactical Combat Office of Behavioral Safety Research Causalty Care National Highway Traffic Safety Administration Director, Prehospital Trauma Care Division, U.S. Department of Transportation, Joint Trauma System Washington, DC Mary Fallat, M.D. Professor and Chief, Pediatric Surgery Eddy Lang M.D., C.M., CCFP (EM), CSPQ University of Louisville School of Medicine Interim Faculty Department Head Committee on Trauma, American College of Department of Emergency Medicine Surgeons University of Calgary Louisville, KY Calgary, Alberta, Canada Cathy Gotschall, Sc.D. Peter Taillac, MD Office of Emergency Medical Services Utah Bureau of EMS and Preparedness National Highway Traffic Safety Administration University of Utah School of Medicine U.S. Department of Transportation, National Association of State EMS Officials Washington, DC Salt Lake City, UT iii Acknowledgments The authors gratefully acknowledge Cathy Gotschall, Sc.D., of the Office of Emergency Medical Services in the National Highway Traffic Safety Administration, who provided oversight of the project (Prepared under Subcontract No. S2013.104SC to Millennium Services 2000+ Incorporated, DTNH22-11-C-00223). We also acknowledge the contributions of Eileen Erinoff, M.S.L.I.S., Director of the Information Center and Kristy McShea, M.S.L.S., Medical Librarian, both of ECRI Institute, for designing and conducting the literature searches. iv Contents Abbreviations and Acronyms .................................................................................................................... viii 1. Introduction ............................................................................................................................................... 1 Background............................................................................................................................................... 1 Condition .............................................................................................................................................. 1 Treatment Strategies ............................................................................................................................. 2 Tourniquets ...................................................................................................................................... 2 Hemostatic Agents and Dressings ................................................................................................... 3 Wound Closure Device .................................................................................................................... 4 Scope and Key Questions ....................................................................................................................... 11 Scope of the Review ........................................................................................................................... 11 Key Questions .................................................................................................................................... 11 Use of Tourniquets ......................................................................................................................... 12 Use of Hemostatic Dressings ......................................................................................................... 12 Analytic Framework ...................................................................................................................... 12 2. Methods .................................................................................................................................................. 14 Literature Search Strategy .....................................................................................................................
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