WV Is the First State to Develop Statewide EMS Tourniquet Removal Protocols

In a recent press release, the West Virginia Department of Health announced that West Virginia is the first state in the country to develop statewide tourniquet removal or in medical speak ‘tourniquet takedown’ protocols for Emergency Medical Services (EMS.) After one year of measurable success in the field, West Virginia’s tourniquet protocols for  providers, are  becoming the model for tourniquet training nationwide. A tourniquet is a device used to apply pressure to a limb in the effort to control severe bleeding, in injuries such as gunshot wounds or severe lacerations.

West Virginia’s new tourniquet protocols were developed by Acting State Health Officer Dr. P.S. Martin alongside Dr. Greg Schaefer, a trauma surgeon at West Virginia University. They recognized that, although tourniquet use in pre-hospital trauma care is well-documented in controlling hemorrhage and improving surgical outcomes, limited data existed about the success of and the potential risks of tourniquet removal in the field by EMS providers.  Dr. Martin found that there were cases in which tourniquets had been applied as part of routine pre-hospital care that could have been reassessed and removed but that was not done due to the guidelines then in place. “There is this taboo in the medical community surrounding tourniquet takedown,” Dr. Martin explained. “Once one is in place a lot of hospitals do not want to remove it unless there is a vascular surgeon present. However, every minute a tourniquet is applied, there is a risk of tissue death and limb loss.”

Together, Dr. Martin and Dr. Schaefer developed statewide tourniquet removal protocols, which allow EMS providers two chances to remove the tourniquet. Upon receiving patients with tourniquets, providers will assess the device by first making sure it has been properly placed and replacing it if not. Then, they will expose the wound, apply a properly packed wound dressing, and wait approximately three to five minutes while slowly releasing the tourniquet’s pressure. If bleeding resumes, they will re-tighten the tourniquet and repack the wound with one more chance for removal after 15 minutes, unless they have already arrived at the hospital. Since June 15, 2024, Dr. Martin has been evaluating cases where a tourniquet was applied and subsequently removed in the field. Comparative analysis showed no statistically significant difference in patient outcomes between takedown and non-takedown groups, although the takedown group exhibited a higher proportion of clinical improvement at 64.7%. Additionally, no patients in the takedown group experienced deterioration, while 2.9% of non-take down patients worsened, suggesting that tourniquet takedown, when performed by trained EMS personnel, may be associated with clinical improvement. “Tourniquets can be extremely helpful in saving lives, but they can also be overused,” says Dr. Martin. He went on to say this is true especially since the new protocols might offer the same life protection with less chance of losing a limb.

The National Association of State Emergency Medical Services Officials (NASEMSO) recognize West Virginia as the first state to provide patient data on tourniquet takedown conversion. They, along with the National EMS Quality Alliance will use that data as they work to build national tourniquet takedown protocols.