Page 48 - Journal of Special Operations Medicine - Spring 2014

Prehospital Emergency Care:
Evaluation of the Junctional Emergency Tourniquet Tool

With a Perfused Cadaver Model

Keith S. Gates, MD; Lisa Baer, MS; John B. Holcomb, MD

ABSTRACT
Objective: Junctional bleeding from the groin is a lead- limb exsanguination is no longer the leading cause of
ing cause of potentially preventable death on the battle- preventable prehospital death on today’s battlefield;
field. To address this problem, a novel device called the rather it is now hemorrhage from the groin. Increased
5
Junctional Emergency Treatment Tool (JETT ) was de- survival due to effective hemorrhage control devices,
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veloped. The JETT was designed to stabilize pelvic ring such as traditional extremity tourniquets, has demon-
fractures while controlling lower extremity bleeding strated that the right device used in the right way at the
sustained during high-energy traumatic events on the right time for the right casualty can result in decreased
battlefield and in the civilian environment. Our purpose morbidity and mortality. A junctional tourniquet is
3–7
was to assess the effectiveness of the JETT in the control a device used to control hemorrhage at the junctions
of simulated life threatening hemorrhage from proximal between the trunk and extremities too proximal for ef-
injuries in the groin of a perfused cadaver. fective placement of traditional extremity tourniquets.
Devices that can control junctional hemorrhage have
Methods: The JETT was compared with the standard the potential to increase survival on the battlefield.
issue combat tourniquet and a Food and Drug Admin-
istration (FDA)-cleared junctional hemorrhage control An analysis of 4,596 U.S. casualties who died in Iraq
clamp (CRoC ) in a perfused human cadaver model. or Afghanistan between October 2001 and June 2011
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The JETT’s ability to stop pulsatile flow at the common revealed that uncontrolled hemorrhage was the cause of
femoral artery was assessed through proximal aorta and death in great than 90% of potentially survivable deaths.
distal measurements of arterial flow rates and pressures. The site of lethal hemorrhage was truncal (67.3%), fol-
Results: In three cadavers, when the JETT or the CRoC lowed by junctional (19.2%) and peripheral extremity
was applied in the groin, there was an immediate cessa- (13.5%). Bleeding from the groin is the most common
tion of fluid flow from the common femoral artery while type of junctional hemorrhage where extremity tourni-
the inlet flow aortic pulsatile pressure was maintained. quets are not effective. Junctional hemorrhage deaths
8,9
However, the time to bilateral application of the JETT could be potentially mitigated by the deployment of
was faster (10 seconds vs. 68 seconds) than bilateral se- an effective prehospital junctional hemorrhage control
quential application of two CRoC devices. Conclusions: device.
The JETT is a single device capable of effectively and
quickly controlling bilateral lower extremity junctional In a collaboration between the University of Texas
hemorrhage at normal physiological blood pressures. Health Science Center for Translational Injury Research
and North American Rescue Products (www.narescue.
Keywords: hemorrhage, tourniquet, wounds and injuries, com), a novel device called the Junctional Emergency
junctional hemorrhage, combat casualty care, femoral artery Treatment Tool (JETT ) was developed. This rugged,
™
small, lightweight device was designed to stabilize pelvic
ring fractures while controlling lower extremity bleed-
ing sustained in high-energy traumatic events on the
Background/Significance
battlefield and in the civilian environment. This poten-
War has always advanced trauma care, and the present tially lifesaving device addresses a major gap in battle-
Global War on Terrorism is no exception. Of the many ad- field hemorrhage control.
vances, one of the most significant is the modern combat
tourniquet. The widespread use of this device has dem- The purpose was to assess the effectiveness of the JETT
1,2
onstrated a safe and effective way to stop compressible in the stopping pulsatile flow in the common femoral ar-
extremity hemorrhage. As a result of its effectiveness, tery at the groin of a perfused human cadaver compared
3,4

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