Page 43 - Journal of Special Operations Medicine - Winter 2014

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Predisruption Versus Post-JETT Placement lower extremities and the pelvis. Such junctional injuries
Reduction occurred in both AP and transverse planes, are associated with massive and lethal hemorrhage. The
with the transverse differences being more dramatic. military is seeking devices to control junctional hemor-
7
These differences were measured at both the inlet and rhage. The JETT was developed to provide temporary
outlet of the pelvis in both planes. control of hemorrhage for difficult inguinal bleeding
and is based on a circumferential belt placed at the level
In cadaver 1, there was 2 to 3mm of overcorrection in of the greater trochanters, mimicking traditional pelvic
two of four parameters (Table 1). In cadaver 2, there sheets or binders. We hypothesized there would be sat-
was no overcorrection. A reduction in the AP diameter isfactory reduction of a severely disrupted and injured
from displaced, injured state to post-JETT placement pelvis post-JETT application compared with an intact
(fracture → JETT) of 6.5 ± 4.5mm occurred at the inlet pelvis. JETT compression nearly reduced the disruption
(84.5 ± 15.5%) and 17 ± 0mm at the outlet (60 ± 3%). and injury to normal. JETT application led to a reduc-
Transverse distance measured at the inlet was reduced tion that was adequately anatomic by approximating
22.5 ± 6.5mm (100.5 ± 22.5%). Transverse distance or even overcorrecting the inlet and outlet dimensions
measured at the outlet was reduced 4 ± 3mm (41.3 ± toward predisruption measurements. Such a degree of
28.8%) (Table 1). These measurement differences were reduction suggests that the JETT device may be suitable
within the ranges of actual injuries seen by the clinicians in the acute setting for provisional pelvic stabilization.
and radiologist, so we believe our model was suitable as We did not attempt to quantify the amount of volume
intended. reduction toward the goal of hemorrhage control as it is
evident that return of the pelvis to its preinjury dimen-
Table 1 Differences in Measurements Between (1) Normal, sions approaches maximum desirable volume reduction
Intact Pelvic Ring, (2) Pelvic Ring Disruption, Pre-JETT and that further reduction much beyond normal could
Placement, and (3) Pelvic Ring Disruption Post-JETT be detrimental.
Application
AP Transverse AP Transverse In addition to its capacity to compress the skeletal pelvis,
Inlet Inlet Outlet Outlet the JETT has compression pads, which provide potential
Cadaver 1 for control of bleeding in the inguinal regions and in the
proximal thigh through compression on either the exter-
Intact g JETT –2 –3 13 3
nal iliac artery or common femoral artery and the sur-
Fracture g JETT 2 16 17 7 rounding tissues. A JETT can be used either unilaterally
Cadaver 2 or bilaterally in such arterial compression; such hemor-
Intact g JETT 5 8 10 7 rhage control capability may be additionally beneficial to
patients with pelvic ring injuries that are associated with
Fracture g JETT 11 29 17 1
traumatic lower extremity amputations (Figure 5). Fur-
ther study may be useful to evaluate the efficacy of this
The small differences observed in measurement be- device in living patients with traumatic injuries, although
tween predisruption (intact) pelves and injured pelves, there are unpublished reports of inguinal arterial hemor-
post JETT placement (intact → JETT) demonstrates the rhage control with the JETT in patients without pelvic
reduction of the deformity toward normal, intact mor- disruption and injury in combat and in civilian patients.
phology after application of the JETT. These differences Additionally, there are published case reports of success-
were in the range of 2 to 13mm. This reduction to near ful inguinal hemorrhage control with similar junctional
anatomic alignment represents a significant decrease hemorrhage control devices. Interestingly, Joint Theater
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in distance that translates to a relative decrease in vol- Trauma System data summary of recent junctional TQ
ume and increase in pressure as well as stabilization of device use as captured from the Tactical Combat Casu-
formed clots. 3,7 alty Care After Action Reports in theater reports eight
Junctional TQ uses during the period of July to Septem-
ber 2013. These were six Afghan casualties and two US
Discussion
casualties; all uses were JETT, and six survived and two
Combat-related causalities are all too often injured by died. One of fatalities was in shock before the device was
IED blasts with resulting exsanguination from open pel- applied (LTC Jim Geracci/CAPT Frank Butler, personal
vic injuries coupled with lower extremity amputations. 6 communication, September 2013).
Bleeding from most traumatic amputations can be tem-
porarily controlled with tourniquet use, and such use The present study is the first to evaluate the JETT in its
has generally resulted in decreased mortality in a mili- potential to function as a circumferential pelvic binder.
4
tary population. However, ordinary tourniquets cannot Based on two cadaveric specimens, JETT showed prom-
fit proximal amputations at or near the junction of the ise for use as a temporary pelvic stabilizer for patients

JETT as a Pelvic Binder 33