Page 66 - Journal of Special Operations Medicine - Fall 2014
P. 66
Testing of Junctional Tourniquets by
Military Medics to Control Simulated Groin Hemorrhage
John F. Kragh Jr., MD; Donald L. Parsons, PA-C; Russ S. Kotwal, MD;
Bijan S. Kheirabadi, PhD; James K. Aden III, PhD; Robert T. Gerhardt, MD;
David G. Baer, PhD; Michael A. Dubick, PhD
ABSTRACT
Background: Junctional hemorrhage is a common cause from junctional wounds—those at the junction of the
of death on the battlefield, but there is no documented trunk and its appendages. Not only has the rate of
1,2
direct comparison for the use of junctional tourniquet junctional hemorrhage risen, but also junctional hemor-
models by US medics. The purpose of this testing is to as- rhage itself is often lethal even with adjuncts that in-
sess military medic experience with the use of junctional clude the use of QuikClot Combat Gauze (http://www
™
®
tourniquets in simulated out-of-hospital trauma care. .z-medica.com/healthcare/Products). Junctional bleed-
3–5
Methods: Nine medics (seven men and two women) used ing is a common preventable cause of death on the bat-
four different junctional tourniquets: Combat Ready tlefield. In a survey of US military war casualty data,
4,6
Clamp (CRoC ; http://www.combatmedicalsystems junctional wounds amenable to junctional tourniquets
™
™
.com), Abdominal Aortic and Junctional Tourniquet increased 14-fold over a decade among 833 casualties;
™
(AAJT ; http://www.compressionworks.net), Junctional 145 of the 833 died of wounds, but none had a junc-
™
Emergency Treatment Tool (JETT ; http://www.narescue tional tourniquet placed. 5
™
.com), and SAM Junctional Tourniquet (SJT ; http://
®
®
www.sammedical.com/products). These medics also acted Tai and Dickson of Great Britain’s military medical ser-
as simulated casualties. Effectiveness percentages, as vices introduced the term “junctional zone trauma” in
measured by stopped distal pulse by Doppler auscul- 2009 when describing a gap in the care of challenging
tation, and time to effectiveness were recorded in two wounds. Efforts to address this capability gap in hem-
7
tests per tourniquet (72 total tests). Tourniquet users orrhage control on the battlefield have led to the de-
ranked their preference of model by answering the ques- velopment of junctional tourniquets, four of which are
tion: “If you had to go to war today and you could only currently approved for use in the United States by the US
choose one, which tourniquet would you choose to Food and Drug Administration. Feasible procedures
5,8
bring?” Results: All tourniquets used were safe under for removing such deficiencies have been outlined. 9–15
the conditions of this study. Both the SJT and the CRoC However, evidence did not exist that would distinguish
had high effectiveness percentages; their rate difference the tourniquets. To provide such evidence, the current
was not statistically significant. The SJT and the CRoC study used medics in a simulated out-of–hospital situa-
had fast times to effectiveness; their time difference was tion to compare multiple junctional tourniquets.
not statistically significant. Users preferred the SJT and
the CRoC; their ranked difference was not statistically
significant. Conclusion: The SJT and the CRoC were Methods
equally effective and fast and were preferred by the A US Army Institute of Surgical Research (USAISR) pro-
participants. tocol was approved by the dean of the US Army Medical
Department Center & School under the guidance of the
Keywords: tourniquets, hemorrhage, resuscitation, groin, US Army Human Research Protection Office (Customer
inguinal, medical device, injuries and wounds Assessment by US Military Medics for User Preference
Testing of Junctional Tourniquets in Simulated Out-of-
Hospital Care). This test plan deliberately involved oper-
ators who were similar to the end-users: North Atlantic
Introduction
Treaty Organization (NATO) medics. The two test as-
Since publication of the book Black Hawk Down, which sessors were an experienced clinician-scientist with ex-
describes the US military experience in Mogadishu, So- pertise in tourniquets and a master instructor for the US
malia, in 1993, the US military has become increasingly Army combat medics. All testers (medics) were from the
aware of the clinical problem of controlling hemorrhage Army and were mid-grade enlisted noncommissioned
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