Page 17 - Journal of Special Operations Medicine - Winter 2014

Tactical Hemorrhage Control Case Studies
Using a Point-of-Care Mechanical Direct Pressure Device

Andrew W. Kirkpatrick, CD, MD, MHSC, FRCSC, FACS;
Jessica Lynn McKee, MSc

ABSTRACT
In 2012, a new hemorrhage control device entered the take time to apply, making them difficult to use in Care
market, and by May 2013, the iTClamp 50 had ac- Under Fire (CUF) scenarios, where there is currently an
™
quired US Food and Drug Administration approval. The unmet need to achieve rapid hemostasis. These findings
authors describe the use of the iTClamp 50 and present suggest that outside of traumatic amputation (which al-
two case studies in which the iTClamp 50 was success- ways requires tourniquet application), other lifesaving
fully used in the military environment to control poten- hemorrhage control options should be examined.
tially fatal hemorrhage.
In 2012, a new hemorrhage control device entered the
Keywords: hemorrhage control, prehospital care, iTClamp 50 market, and by May 2013, the iTClamp 50 had acquired
US Food and Drug Administration approval. Preclinical
studies have demonstrated the safety and effectiveness
Introduction
of the iTClamp 50 to control bleeding. In a lethal swine
Exsanguination has not only been established as respon- bleeding model (femoral artery injury), the iTClamp 50
sible for 50% to 90% of battlefield fatalities but also was 100% effective at controlling bleeding. Treatment
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been shown to be the leading cause of potentially pre- with the iTClamp 50 also improved survival rate, survival
ventable deaths worldwide. 1–3 Traditional methods to time, and external blood loss. A preclinical reperfused ca-
stop the bleeding such as packing and tourniquets, while daver study demonstrated that the iTClamp 50 was effec-
important modalities, are not without their issues. The tive at controlling blood loss from multiple compressible
efficacy of packing has been substantially improved with zones, including the scalp, neck, groin, and extremities. 23
hemostatic dressings ; however, this skill is still user de- This model involved reperfusing the cadaver with sterile
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pendent. The safety and effectiveness of tourniquet use water using a peristaltic pump to mimic blood flow. The
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are also well documented in literature, especially when function of the iTClamp 50 was unaffected by movement
applied in the military prehospital setting, before the on- of the cadaver. In both studies, there was no evidence of
set of shock and even for extended periods of time. 6–18 skin tearing or damage due to the device. Current data
Limb exsanguination has dropped from 9% in the Viet- also support its use in CUF given that the iTClamp can
nam conflict to 2% currently due to the implementation be (1) applied through two layers of uniform, (2) applied
of tourniquet use in battle, with the Israeli Defense Force in 5 to 9 seconds while wearing wet gloves, (3) applied by
reporting 0% life loss to limb exsanguination. 14 novice users with no instruction, and (4) created no tissue
damage after 6 hours of device application.
Tourniquets are, however, not without their reported
issues. Application of a tourniquet is not a benign in-
tervention, and the individual applying the device must Technique: Control difficult-to-control
be well trained in order for the tourniquet to be effec- hemorrhage with the iTClamp 50 Mechanical
tive. 14,19 Recent studies have shown that tourniquets Direct Pressure Device
exposed to the combat environment have decreased ef- 1. Open the package by pulling forward on the outer
ficacy and increased breakage. In addition, tourniquets tabs.
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applied in the field can be ineffective. A recent study 2. Remove the device from the package by lifting up,
demonstrated that 83% of tourniquets in place when taking care not to close the device until it has been
the patient arrived at a forward surgical team had a pal- applied to the wound.
pable distal pulse. In the case of major arterial injuries,
only 35% of patients presented with an effective arterial NOTE: Device seal will hold device open until broken
tourniquet. Also, tourniquets and hemostatic dressings (Figure 1).
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