Page 51 - Journal of Special Operations Medicine - Spring 2014

the pelvis from below the inguinal ligament and begins a cleared for civilian and military use on 3 January 2013,
superficial course immediately distal to the inguinal liga- and thus it can be used in the civilian prehospital envi-
ment. The inguinal ligament is easily located and has an ronment. Subsequent to FDA clearance, it has recently
overlying land mark (the inguinal fold) that should be been used to rapidly control major extremity hemor-
quickly recognized by the field provider. When the CFA rhage in both civilian and military patients.
is compressed, the major blood supply to the lower ex-
tremity is effectively eliminated. The JETT’s trapezoidal Study Limitations
compression pads are ideally suited to fit just below the As in previous tourniquet research, it is important to
inguinal fold and are wide enough to span the anterior note that we made no attempt to simulate field condi-
thigh. By mechanically compressing the CFA and the as- tions. Potential interactions with combat equipment
sociated tissues, the JETT rapidly controls catastrophic and field conditions were not the objectives of this
bleeding in either unilateral or bilateral lower extremity study. Nor did we attempt to compare the JETT with all
injury. It is an intuitive, simple, lightweight, and small available junctional tourniquets. The perfused cadaver
device that can be easily applied by both medical and model does not perfectly replicate live tissue bleeding.
nonmedical first responders. Because it is applied to the Although the cadavers were of adequate size and stat-
femoral artery in the area just below the inguinal liga- ure, they may have had concomitant pathology that
ments, it will not interfere with splanchnic blood flow or would likely not be prevalent in the age group found on
respiratory effort, as do devices that are applied directly the current battlefield. However, the cadaver model did
to the abdomen or the aorta. Additionally, there is a high allow us to demonstrate the effectiveness of two junc-
frequency of unstable open-book pelvic ring fractures tional devices in the area of the groin.
associated with the proximal battlefield amputations.
These injuries increase the complexity and severity of in-
juries and result in increased mortality. 17,18 In comparison Conclusions
to most other devices, the JETT has a configuration that We conclude that the JETT is a low-cost device capable
surrounds the pelvis with a circumferential binder/belt of controlling junctional hemorrhage in an anatomic
combination, enclosing the associated tissues securely in area (the groin) where traditional extremity tourni-
an inwardly compressive manner, and thus further stabi- quets are ineffective. This device reliably and quickly
lizing the pelvis during transport. This feature will likely compresses the common femoral artery, decreasing dis-
obviate the need to apply an additional pelvic binder in tal flow to 0. With a single device, the JETT is capable
the event of an unstable pelvic fracture. of rapidly controlling bilateral common femoral artery
flow in the range of normal physiological blood pres-
We were able to demonstrate the effectiveness of both sures in a perfused human cadaver model.
junctional tourniquet devices at controlling very proximal
hemorrhage in a perfused human cadaver models. The
JETT is equally effective at stopping hemorrhage com- Disclosures
pared with the CRoC (see Figures 3 and 4). However, the Both Drs. Gates and Holcomb are co-inventors of the
main difference between the two devices is the bilateral JETT and have received royalties from the sale of the
nature of the JETT and the increased time to application device in addition to royalties paid to the University of
of the CRoC. The JETT is much lighter than the CRoC Texas Health Science Center at Houston. Grant funding
(651g vs. 1598g for bilateral application). Finally, the for these studies provided by North American Rescue
CRoC is significantly more expensive than the JETT. The Products, LLC, 35 Tedwall Court, Greer, SC 29650-
JETT is priced at $220 for a single device that provides bi- 4791 (NAR) and the State of Texas Emerging Technol-
lateral control. The CRoC is priced at $423 per unilateral ogy Fund. This device is marketed and sold by North
device for a total cost of $846 to achieve bilateral control. American Rescue (NAR). Both Drs. Gates and Holcomb
have fully disclosed their relationship with NAR as a
The JETT addresses critical gaps in battlefield hemor- potential conflict of interest.
rhage control and meets the Department of Defense
Combat Casualty Care Research Program of the Medi- Data were presented at the Committee for Tactical
cal Research and Materiel Command (USAMRMC) Combat Casualty Care meeting, Ft. Lauderdale, FL, Au-
requirements for junctional tourniquets. This device is gust 2012; however, the manuscript was not presented
capable of controlling difficult bleeding affecting the in its entirety.
entire lower extremity. It is a simple, nonpneumatic,
mechanical device that can be easily applied to a patient
in the supine position. There is no risk of catastrophic References
failure from an air bladder rupture from decomposition 1. Williamson K, Ramesh R, Grabinsky A. Advances in pre-
or inadvertent fragment damage. The JETT was FDA hospital trauma care. Int J Crit Illn Inj Sci. 2011;1:44–50.

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