Page 105 - Journal of Special Operations Medicine - Summer 2015

casualties with the cause of death from vascular injury References
between the aortic bifurcation and the inguinal liga- 1. Kragh JF Jr, Parsons DL, Kotwal RS, et al. Testing of junctional
ment. These injuries were considered to be potentially tourniquets by military medics to control simulated groin hem-
survivable with more proximal control. The research- orrhage. J Spec Oper Med. 2014;14:58–63.
ers conclude that the use of groin junctional tourniquets 2. Lyon M, Shiver S, Greenfield E, et al. Use of a novel abdominal
would not provide adequate control and that there is a aortic tourniquet to reduce or eliminate flow in the common
need for devices that provide more proximal control. femoral artery in human subjects. J Trauma Acute Care Surg.
2012;73:S103–S105.
The abdominal or umbilical application of the AAJT 3. Taylor D, Parker P. The evaluation of an abdominal aortic
provides proximal control not provided by the groin ap- tourniquet for the control of pelvic and lower limb hemor-
plication of any of the other devices. 6 rhage. Mil Med. 2013;178.
4. Greenfield EM, McManus J, Cooke WH, et al. Safety and ef-
ficacy of a novel abdominal aortic tourniquet device for the
In the Discussion section, the authors state “the strength control of pelvic and lower extremity hemorrhage. Ann Emerg
of the present testing is that it offers a direct comparison Med. September 2009; S62
by military medics of the four currently FDA-approved 5. Kheirabadi BS, Terrazas IB, Miranda N, et al., Long-term ef-
junctional tourniquets. This strength fills a specific fects of Combat Ready Clamp application to control junctional
knowledge gap of junctional tourniquets on their dif- hemorrhage in swine. J Trauma Acute Care Surg. 77(Suppl 2).
ferential performance in the hands of medics. Such new 6. Walker NM, Eardley W, Clasper JC. UK combat-related pelvic
junctional vascular injuries 2008–2011: Implications for future
knowledge may aid decision-makers in choosing which intervention. Int J Care Injury. 2014;45:1585–1589.
one to provide medics in the future.” Given the method-
ological design flaws of this study, this statement should
not be made. Additionally, this study should not be used
to differentiate these devices.

In conclusion, the methodological problems and in-
herent bias in this study invalidate the results. For this
study’s findings to be valid, the AAJT data should be re-
moved from the analysis or the study should be repeated
using the inguinal placement of the AAJT.
Knowledge.
Disclosures
Dr Schwartz is a developer of the AAJT and has a finan- Experience.
cial interest. No other authors have a conflict of interest.
Excellence.

Richard B. Schwartz, MD
Chairman and Professor Department of
Emergency Medicine and Hospitalist Services
Georgia Regents University
Bradford Z. Reynolds, MD
Associate Professor Department of Emergency Medicine
Georgia Regents University
Richard D. Gordon Jr, MD
Assistant Professor Department of Emergency Medicine
Georgia Regents University
Stephen A. Shiver, MD
Professor Department of Emergency Medicine
Georgia Regents University
Matthew Lyon, MD The standard to validate the essential knowledge
Vice Chairman and Professor and critical thinking of the tactical paramedic
Department of Emergency Medicine operating in the TEMS environment.
Georgia Regents University
Steven B. Holsten, MD www.bcctpc.org
Associate Professor Department of Surgery
Georgia Regents University

Letter to the Editor 95