Page 34 - Journal of Special Operations Medicine - Fall 2015

is a vascular clamp that was the third FDA-cleared JT. sponsor approached the FDA in 2009. Preliminary
The JETT was cleared for difficult inguinal bleeding; it training experience with prototype JTs came from a mix
is not restricted to the battlefield, as are the CRoC and of corporate and military medical personnel, many of
the AAJT. The JETT is not currently cleared for pelvic whom were experienced in special operations. For exam-
fracture stabilization, but the sponsoring company says ple, Chris Murphy, of Combat Medical Systems, was a
that such evidence is in review. The JETT has a belt and prior US Army Special Operations Command ( USASOC)
two pressure pads with threaded T handles, allowing medical combat developer who worked with MSG John
unilateral or bilateral groin application. Other evidence Steinbaugh, then the USASOC medical combat devel-
supportive of JETT use includes case reports in theater oper, to develop prototypes; and one set of prototype
and in Houston, Texas, where limited applications in assessors included LTC Bob Mabry (US Army Medical
the field have occurred; however, only one use has been Department Center and School [AMEDDC&S]), LTC
formally reported. 11,14,24 (Ret) Don Parsons (AMEDDC&S), COL John Kragh
(USAISR), and Dr. Michael A. Dubick (USAISR). Pre-
SAM Junctional Tourniquet liminary experience showed that a number of device
The SAM Junctional Tourniquet (SJT) (SAM Medical strategies were plausible from anatomic, mechanical,
®
Products; www.sammedical.com) is a vascular clamp fabrication, and production standpoints, but early in
that was the fourth FDA-cleared JT. The SJT was cleared this experience, a likely key to success appeared to be
for both difficult inguinal bleeding and pelvic fracture the quality of training of the user.
immobilization; the SJT was based on the SAM Pelvic
Sling II, a predicate device already cleared by the FDA for In 2010, the only military organizations that were pre-
pelvic fracture immobilization. The SJT has two target pared for training with JTs were some units of Special
compression devices, circular pneumatic discs that inflate Operations Forces (SOF). Stateside SOF training was
like sequential layers of a wedding cake. The SJT is not focused and intense for users to improve skill levels and
restricted to battlefield use, as are the CRoC and AAJT. familiarity. However, details of their experience were
The SJT was subsequently cleared for axilla bleeding. A not made widely known; instead, they were either expe-
recent case of groin use of an SJT had a distal pulse return rienced firsthand or passed around by word of mouth.
without loss of hemorrhage control; this case had only a The quality of training seemed excellent—a hallmark
single gunshot wound that was also packed. Other evi- trait of SOF medics. The ratio of trainers to trainees was
25
dence supportive of SJT use includes a manikin study, a high, and the latter had trainers who were very famil-
cadaver study, and a human volunteer study. 10,14,26 iar with their needs. Stepwise familiarization–practice–
rehearsal in a crawl–walk–run sequence was common.
The emphases were to master the basics and press the
Experiences in the US Military Emergency user to train to failure; that is, train to learn where the
Tourniquet Program: 2008–2009
device, the user, or the system fails, to better understand
The Emergency Tourniquet Program (the Program), a best-care practices and limits. Such knowledge aided
research and development program for out-of-hospital spiral development of the JTs’ designs.
hemorrhage control interventions in combat casualty
care at the US Army Institute of Surgical Research The first JT, the CRoC was cleared in 2010. Techni-
( USAISR), has gained broad experience in surveying cally, JTs were a reworking of an old idea, but to today’s
training of JT use over the years, beginning in 2008. researchers and users, JTs are new. In 2010, with one
27
The Program developed out of necessity to control hem- JT cleared by the FDA, CRoCs were sent into theater
orrhage after 11 September 2001 and was originally and users were trained there. At this time in 2010, the
focused on limb or regular tourniquets. Since 2009, only military organizations that sought training with
however, the emphasis within the Program has become JTs were SOF. The initial use of the first JT was for a
predominately on JTs. This small program with one full- detainee and cannot be reported further. The training
time person has been at or near the center of several re- that prepared such use was said to be successful and
search and development (R&D) activities either directly uneventful. High-quality training tailored to user needs
as a participant or indirectly as a consultant or reviewer. was a key to success.

In 2008, COL Lorne Blackbourne and other members of Early, limited application of JTs in the battlefield came
the Committee on Tactical Combat Casualty Care made through a war mechanism. A few JTs were distributed
junctional hemorrhage a research priority. By 2009, the to US Army Research and Development Command
28
main proponent of the R&D was the US Special Op- personnel, but the details are sparse. One user, SFC
erations Command, and medical developers within spe- Robert Tovmassian, a medic assigned to a helicopter
cial operations conducted their own R&D program that medical evacuation unit, noted the R&D enlisted person
aided in development of the initial JT, whose commercial brought the CRoC into theater and offered high-quality

22 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015