The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock

BACKGROUNDTo date, no civilian studies have demonstrated that pre-hospital (PH) tourniquets improve survival. We hypothesized that late, trauma center (TC) tourniquet use would increase death from hemorrhagic shock compared to early (PH) placement.METHODSAll patients arriving to a Level 1, urban TC