@article{ref1,
title="The state of the union: nationwide absence of uniform guidelines for the pre-hospital use of tourniquets to control extremity exsanguination",
journal="Journal of trauma and acute care surgery",
year="2016",
author="Ramly, Elie P. and Runyan, Gem and King, David R.",
volume="80",
number="5",
pages="787-791",
abstract="BACKGROUND: Following the Sandy Hook shootings and the resulting Hartford Consensus, as well as the recent Boston Marathon bombing, the need for a uniform, detailed, aggressive, pre-hospital extremity exsanguination control protocol became clear. We hypothesized that most states within the United States lack a detailed, uniform protocol. <br><br>METHODS: We performed a systematic, nationwide assessment of Emergency Medical Services (EMS) pre-hospital extremity exsanguination control protocols. An online search (updated 02/07/2015) identified state, region, or county-specific EMS protocols in all 50 states. If unavailable online, protocols were retrieved directly by contacting each state's Department of Public Health (or other appropriate agency). Two investigators independently screened each extremity exsanguination control protocol. Protocols were first grouped into three categories: I - Tourniquet not mentioned; II - Tourniquet mentioned, without specific guidance; III - Tourniquet mentioned, with specific guidance related to type, indications, application technique, and safety concerns. Each protocol was then scored on a 5-point scale for comparison. <br><br>RESULTS: Forty-two (84%) states had statewide and 14 (28%) had at least one county-specific protocol. Seven states (16%) had no statewide protocol but at least one county-specific protocol (range 1-10). Mississippi had neither statewide nor county-specific protocols. Of statewide protocols, 4 (9.5%) were in Category I, 23 (54.8%) in Category II, and 15 (35.7%) in Category III. The average score for statewide tourniquets was 2.4/5 (SD 1.25; range 0-5). Thirteen (31%) statewide protocols referred to &quot;commercial&quot; or &quot;approved&quot; tourniquets; only 3 (7%) recommended a particular commercial device. The average score for the county-specific protocols of states with no statewide protocol was 3.10 (SD 1.56; range 0-5) CONCLUSIONS: Throughout the United States there is considerable variability in EMS protocols for the management of extremity exsanguination and an alarming absence of specific guidance for tourniquet use. Most states do not have a uniform, detailed, aggressive, pre-hospital extremity exsanguination control protocol. LEVEL OF EVIDENCE: III.<p /> <p>Language: en</p>",
language="en",
issn="2163-0755",
doi="10.1097/TA.0000000000000988",
url="http://dx.doi.org/10.1097/TA.0000000000000988"
}