An Evidence-based Prehospital Guideline for External Hemorrhage Control: American College of Surgeons Committee on Trauma
ABSTRACT Abstract This report describes the development of an evidence-based guideline for external hemorrhage control in the prehospital setting. This project included a systematic review of the literature regarding the use of tourniquets and hemostatic agents for management of life-threatening extremity and junctional hemorrhage. Using the GRADE methodology to define the key clinical questions, an expert panel then reviewed the results of the literature review, established the quality of the evidence and made recommendations for EMS care. A clinical care guideline is proposed for adoption by EMS systems. Key words: tourniquet; hemostatic agents; external hemorrhage.
- Journal of Trauma and Acute Care Surgery 07/2014; 77(1):1-8. DOI:10.1097/TA.0000000000000257 · 1.97 Impact Factor
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ABSTRACT: Background. Inguinal bleeding is a common and preventable cause of death on the battlefield. Four FDA-cleared junctional tourniquets (Combat Ready Clamp [CRoC], Abdominal Aortic and Junctional Tourniquet [AAJT], Junctional Emergency Treatment Tool [JETT], and SAM Junctional Tourniquet [SJT]) were assessed in a laboratory on volunteers in order to describe differential performance of models. Objective. To examine safety and effectiveness of junctional tourniquets in order to inform the discussions of device selection for possible fielding to military units. Methods. The experiment measured safety and effectiveness parameters over timed, repeated applications. Lower extremity pulses were measured in 10 volunteers before and after junctional tourniquet application aimed at stopping the distal pulse assessed by Doppler auscultation. Safety was determined as the absence of adverse events during the time of application. Results. The CRoC, SJT, and JETT were most effective; their effectiveness did not differ (p > 0.05). All tourniquets were applied safely and successfully in at least one instance each, but pain varied by model. Subjects assessed the CRoC as most tolerable. The CRoC and SJT were the fastest to apply. Users ranked CRoC and SJT equally as performing best. Conclusion. The CRoC and SJT were the best-performing junctional tourniquets using this model.Prehospital Emergency Care 12/2014; 19(3). DOI:10.3109/10903127.2014.980478 · 1.81 Impact Factor
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ABSTRACT: Death from exsanguinating hemorrhage remains a priority in the management of combat casualties and civilian trauma patients with truncal and junctional injuries. Appropriate use of hemostatic agents and dressings in the prehospital setting may allow for earlier control and an improved survival rate. Third-generation chitosan-based hemostatic agents and dressings appear to be equally efficacious to the dressing currently deployed by the US military forces in the management of hemorrhage not amenable to tourniquet placement. Unfortunately, a lack of clinical trials places a heavy reliance on anecdotal reports and laboratory studies in agent selection and application. Efficacy of currently available hemostatic agents and dressings appears to have plateaued in recent years although new agents and delivery mechanisms under development may improve control in cases of severe hemorrhage.Current Opinion in Anaesthesiology 02/2015; 28(2). DOI:10.1097/ACO.0000000000000166 · 2.53 Impact Factor