Page 12 - Journal of Special Operations Medicine - Summer 2014

Table 1 SJT Data Figure 3 Pull the brown handles away from each other until
the buckle secures. An audible click will be heard when the
SAM Junctional SAM Medical Products, buckle secures.
®
Tourniquet manufacturer Wilsonville, OR
National Stock Number 6515-01-618-7475
(NSN)
U.S. Food and Drug
Administration clearance 24 July 2013; No. K131561
date and number
Difficult inguinal bleeds;
Indication labeling difficult axilla bleeds; pelvic From SAM Medical Products
fracture immobilization
Cost (USD, estimated for $292.50
the U.S. Government)

Figure 4 Use the hand pump to inflate the TCD until
hemorrhage stops.
Figure 1 Slide the belt underneath the patient, positioning
the target compression device (TCD) over the area to be
compressed.

From SAM Medical Products From SAM Medical Products

Case Presentation
In January 2014, an Afghan National Army (ANA) sol-
Figure 2 Hold the TCD in place and connect the belt using dier (approximately 20 years old) sustained a gunshot
the buckle. wound to his left proximal thigh during a firefight with
insurgents near a village in Afghanistan. After the fire-
fight ended, he was transported by ground vehicle to
the Afghan side of the Combined United States–Afghan
National Army Aid Station for further treatment. The
From SAM Medical Products and significant pain. A makeshift cloth bandage and a
casualty was alert and oriented but with mild hypoxia

Combat Application Tourniquet (C-A-T , Composite
®
Resources, Rock Hill, SC, USA; http://compositere-
sources.com) were applied directly over the casualty’s
entry wound. The casualty’s pants were soaked in blood
with minimal bleeding seen near the edges of the C-A-T.
The ANA soldiers who transported him to the Aid Sta-
• Pull the brown handles away from each other until tion reported that the time of injury was 1 hour before
the buckle secures. An audible click will be heard arrival but did not know the time when the C-A-T was
when the buckle secures (Figure 3). placed. After maximal exposure was achieved, the loca-
• Fasten excess belt in place by pressing it down on the tion of the wound was seen as too proximal on his leg to
Velcro. allow the C-A-T to be placed above the wound.
• A second audible click may be heard once the belt is
secure. Because of concern that the C-A-T would not be able
• Use the hand pump to inflate the TCD until hemor- to prevent additional blood flow to the wound, it was
rhage stops (Figure 4). removed after QuikClot Combat Gauze (Z-Medica,
®
™
• Monitor patient during transport for hemorrhage Wallingford, CT, USA; www.z-medica.com/healthcare)
control and adjust the device if necessary. and roll gauze dressings were prepared. Within seconds
• To remove the tourniquet, unbuckle the belt. of removal of the C-A-T, a stream of bright red blood

2 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014