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Saving Lives with Tourniquets: A Review of Penetrating Injury Medical Examiner Cases. Prehosp Emerg Care 2020;24(4):494-499



Pubmed ID




Scopus ID

2-s2.0-85075948546 (requires institutional sign-in at Scopus site)   9 Citations


Background: After numerous recent mass casualty events, civilian hemorrhage control has taken a militaristic approach with aggressive and early use of tourniquets. While military literature has demonstrated the utility of tourniquets in preventing battlefield deaths from extremity injuries, there is limited understanding of their role in civilian penetrating trauma deaths. The purpose of this study is to review medical examiner (ME) autopsy records in a defined population to determine the incidence of preventable deaths from extremity wounds amenable to tourniquet placement. Methods: This is a retrospective review of ME cases from one urban county with a descriptive analysis of the demographics, mechanisms of injuries, and causes of death of homicide cases from 2003 to 2017. Mechanism of injury and wound patterns were reviewed to determine the overall occurrence of extremity injuries and amenability of tourniquet placement. Results: A total of 1,804 homicide cases were reviewed with 1,521 (84.3%) resulting from penetrating trauma. Isolated extremity injuries were present in 22 (1.45%) of the penetrating cases, all of which were amenable to tourniquet placement. There were 409 (26.9%) concurrent extremity and central penetrating injuries. The vast majority of extremity wounds were amenable to tourniquet placement (92.1%). Extrapolating nationally to 16,187 annual penetrating injury related homicides in 2016, an estimated 235 (1.45%) isolated extremity injury related deaths could be prevented and an additional estimated 4,354 (26.9%) concurrent extremity and central injury related deaths could potentially receive enhanced care with early tourniquet placement. Conclusion: Among urban ME cases, both isolated extremity cases and concurrent extremity-central injuries exist that may be amenable to life-saving tourniquet use. Extrapolating our findings nationwide suggests that many lives could be saved with early tourniquet use. Considering these findings, tourniquet availability and early placement may have a prominent role in reducing injury deaths from penetrating trauma.

Author List

Bonk C, Weston BW, Davis C, Barron A, McCarty O, Hargarten S


Stephen W. Hargarten MD, MPH Professor in the Emergency Medicine department at Medical College of Wisconsin
Benjamin Weston MD, MPH Associate Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Coroners and Medical Examiners
Emergency Medical Services
Retrospective Studies
Wounds, Penetrating