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Groundbreaking Research on Tourniquet Usage in Kids Could Save Lives in School Shootings

The purpose of the military’s Combat Application Tourniquet (CAT) is to stop arterial blood flow from an injured limb in adults. In a first-of-its-kind published in Pediatrics, researchers from Nemours Children’s Health System found that this tourniquet is also effective for use on school-age children.

The Pediatric Trauma Society already supported the use of tourniquets on children in severe extremity trauma, but this is the first prospective study looking at the safety of adult tourniquets in kids. The results could save children’s lives in international war zones, where bleeding out from gunshot injuries is the leading cause of death in kids, and during school shootings, which feel increasingly commonplace.

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The scope of this study extended to 60 volunteers ages 6 to 16 years old. The study sample was reflective of U.S. school populations. It included 36 boys and 24 girls, with body mass index (BMI) ranging from underweight to obese. The application of the CAT to the upper arm and thigh was done under the manufacturer’s guidelines. A Doppler — a vascular ultrasound used to estimate the blood flow through blood vessels — simultaneously monitored the subject’s peripheral pulse. To do so, a sonographer pressed a transducer to the limb in the CAT. The ultrasound showed that the tourniquet successfully controlled blood flow in 100 percent of cases involving upper extremities and 93 percent for lower extremities.

Even with these promising results, though, tourniquets must be used with caution on children, especially those who are young with small limbs and soft bones, to prevent further injury. This study allowed no more than three turns of the tourniquet windlass — the stick and strap inside the outer sleeve that applies the pressure of the CAT.

The three-turn maximum avoided causing pain to uninjured participants and was enough for all upper extremities and all but three lower extremities. These cases were in older, obese adult-sized subjects (BMI > 30), and the research team anticipates that extra windlass turns, if this were an actual trauma situation, would’ve safely stopped blood flow. Ultimately, the number of turns required to occlude blood flow depends on injury severity, but the bigger the arm and thigh circumference, the more turns will be necessary.

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While the study primarily affects pre-hospital care, providers working in pediatrics should still be familiar with its results and tourniquet use in children. Why? They’re the best equipped to educate the public about how children’s bodies respond to trauma.

“Firearm injuries and death are unfortunately not uncommon,” said study author H. Theodore (Ted) Harcke, MD, in a statement. “We need an effective tool for treating extremity hemorrhage in children in traumatic situations.”

Thanks to funding from a federal grant and Nemours’ resources, there’s finally a safe solution.

Last updated on 10/2/19.

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