Administration and Leadership, Patient Care

Maryland Agency Tracks Tourniquet Use to Measure Success in Managing Uncontrolled Bleeding

When a man in Prince George’s County, Maryland severely injured his foot while sawing down a tree in his yard, the first on-scene Prince George’s County Police Officer accessed a Tactical Emergency Casualty Care (TECC) Kit in his vehicle, applied a tourniquet to the wound, and controlled the excessive bleeding to save the man’s life.

That casualty care kit was supplied by the Prince George’s County Fire/Emergency Medical Services Department through an Urban Area Security Intelligence Program (UASI) grant to equip public safety officials with tools to prepare for and act against terrorism. Throughout 2016, the Fire/EMS agency equipped first responder vehicles with the kits to treat multiple patients, while law enforcement and fire administrator vehicles received single-patient use kits.

Prince George’s County, located in the expansive National Capital Region (NCR) near Washington D.C., is a 500 square mile area with a population of just under 1 million and an annual call volume of 147,000 emergency calls in 2017. NCR is considered to be one of 10 high-threat, high-density urban areas in the United States.

Originally intended to prepare first responders to control excessive bleeding as a result of mass casualty events, the agency found the kit elements – a tourniquet, Celox Rapid (a quick blood clotting agent), chest seal, needle decompression needles, “H” bandages, patient litters, and other items – were accessed regularly to address a number of civilian trauma events unrelated to mass or terrorist events. A typical price range for kits including these tools vary between $150-200 per kit.

Single-patient kits attach to vehicle headrests for quick access.

As part of the agency’s continuous efforts to improve patient care, Assistant Fire Chief Brian Frankel wanted to know how frequently these kits, and specifically the tourniquets included, were used. But there was one caveat: the agency did not have an efficient method for tracking tourniquet use.

Frankel found that any data collected was often inaccurate and time-consuming to identify. The agency solved that problem by collaborating with FirstWatch, a software firm that aids them with data analytics and situational awareness. The FirstWatch Solutions Team supported Frankel by creating a tourniquet “trigger” which scans all electronic patient care records to identify and track every time a tourniquet is used from the TECC Kits within the Region.

Once data was available, the total number of activations including tourniquet use was found to be significant. The data showed that it was not only Fire/EMS personnel implementing bleeding control techniques–law enforcement and even civilians were using the tourniquets.

According to Frankel, the data collected through this trigger shows the impact these kits have had, how frequently they were used, and helps him provide information to first responders and civilians about the significant effect tourniquet use can have on bleeding control to save lives.

In 2017 alone, Frankel noted there were 70 documented cases of tourniquets applied in a pre-hospital environment. Law enforcement applied 19 tourniquets, while Fire/EMS responders applied 35 and civilians used 16. Of these 70 documented cases, only three patients died at the hospital.

Frankel said of Prince George’s County Fire/EMS using FirstWatch has provided the opportunity to deliver real-time feedback about patient care, patient transport and assessments, and overall system-wide performance. In addition, the ability to track the activation of these kits ensures confidence in the investment of the UASI grant funds.

“We’ve strived to transform our agency from a reactive-based QA program to an agency that now focuses on continuous improvement,” said Frankel. “Being able to access and study our own data has changed the way we improve our systems and has enhanced patient care.”

Prince George’s County Fire/EMS will continue to focus on saving lives by stopping uncontrolled bleeding from traumatic events. The agency has trained more than 8,000 residents in CPR and is implementing Stop the Bleed Day training courses to help bystanders learn methods to stop bleeding before first responders arrive. March 31 is national Stop the Bleed Day; learn more about the campaign at StoptheBleedDay.org  and access resources to educate the public and providers at BleedingControl.org.