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CASE REVIEW results of their work:1 LEARNING POINT: Unexpected amputation and use of tourniquets. In certain victims with particular injuries to extremities, tourniquets may be lifesaving. “Prehospital tourniquet use is an effective means of establishing extremity hemorrhage control in military casual- ties. Tourniquet use is associated with low risk of ischemia- related complications or neurologic injury.” “Liberalized use of prehospital tourniquets as a fi rst-line treatment for extremity hemorrhage should continue.” “Prehospital providers and treating surgeons should be cognizant of the possibility of failure of the tourniquet to control hemorrhage, particularly at the above-knee level.” “To avoid rebleeding or bleeding through a prehospital tourniquet, hospital physicians should replace those tourniquets with pneumatic tourniquets as soon as possible after patient arrival to the medical center.” In the civilian trauma popula- tion, tourniquet use has been viewed cautiously. Civilian injuries occur in a wide population range—not the young, healthy population of military personnel. Most trauma injuries have bleeding that is easy to control with direct pressure. First aid classes have historically contained a section on tourniquet use, and it is common for EMS providers to remove tourniquets placed by members of the public on extremities that have relatively minor injuries. But there are certain extremity injuries that produce rapid bleeding that will be diffi cult for EMS providers to control, and a tourni- quet is an excellent tool to utilize for a short time. Applying a tourniquet causes pain in the conscious patient. More pain occurs when the tourniquet band is thin or places uneven pressure. Pain control is benefi cial in the conscious patient, especially one who has a major injury isolated to the single extremity and no distracting factors. Pain control for EMS providers typically is provided through narcotic medications. Medical control may be helpful in directing pain control medications in the patient with multiple injuries and when the patient is perfusing poorly. Early contact will allow the hospital to mobilize trauma resources and any equipment needed for immediate care on arrival. REFERENCES 1. Beekley AC, Sebesta JA, et al. Prehospital tourniquet use in Operation Iraqi Freedom: Effect on hemorrhage control and outcomes. J Trauma 64: S28–S37, 2008. 2. Husum H, Gilbert M, Wisborg T, Pillgram-Larsen J. Prehospital tourniquets: There should be no controversy. J Trauma 56: 214–215, 2004. James J. Augustine, MD, FACEP, is medical advisor for Washington Township Fire Department in the Dayton, OH, area. He is director of clinical operations at EMP Man- agement in Canton, OH, and a clinical associate professor in the Department of Emergency Medi- cine at Wright State University in Dayton. Contact him at email@example.com. EMERGENCY RESPONSE Specialized training can be tailored to meet your needs in: TEXAS ENGINEERING EXTENSION SERVICE/EMERGENCY SERVICES TRAINING Emergency Medical Services Operations NIMS / ICS Exercise / Drills Human Patient Simulator Rescue HazMat Fire WMD US&R Disaster Medical Specialist NEW EMS Leadership Blended Course Ambulance Strike Team Emergency Operations Training Center 6FKHGXOH WKHVH RU DQ\ RI RXU ZZZ RUJ HPV For More Information Circle 17 on Reader Service Card 32 SEPTEMBER 2011 | EMSWORLD.com See Us at EMS World Expo Booth #3119 FRXUVHV WRGD\