Page 37 - Journal of Special Operations Medicine - Fall 2015

and middle finger under the compressive device to fine are provided the opportunity to familiarize themselves
tune the accuracy of targeting before final tightening, with and handle each model. Due to cost, few devices
helped improve the effectiveness percentage; this tech- are available at the skill stations. Further, with all four
nique came to the users with experience in the mid to devices available for purchase by deploying units, CPM
latter portions of the study. However, normal volunteers has impressed upon students the need to seek guidance
have a palpable pulse whereas casualties in shock may from their Brigade Surgeon’s office concerning the exact
not. The users ascertained that the order of the steps device(s), if any, that the brigade did or may purchase:
was identical to the importance of the steps and their that is the device on which to train for their deployment.
execution: the decision to use, the correct anatomic During CPM training, no data were collected on JT use.
placement, the removal of all slack, the maintenance of Further, there have been few end-of-course critiques
accurate targeting of the pressure point, and the final with comments about the JT models. A few student
compression of the artery. Also, suboptimal step execu- critiques have identified the benefit of displaying and
tion mortgaged the next step, and further suboptimal allowing students to become familiarized with the JT
execution of steps compounded the mortgage. For ex- models. Anecdotal student preference is for the SAM
ample, by not removing all slack from the belt of a tour- and JETT. Instructors observe that students sometimes
niquet, additional pumping cycles were needed to inflate tangle or twist the JETT straps. CRoC use challenges
the tourniquet. If the tourniquet were malpositioned many students, especially if the simulated casualty is on
prior to inadequate slack removal, then its use might be uneven ground or surfaces, or if the casualty is moved.
ineffective. The worse the execution of any given step, The AAJT and SAM are both simple to apply and use,
then the higher was the risk of ineffectiveness. but the AAJT takes longer to inflate.

The fourth component in this sequence was not a re- US Air Force Center for
search study but a report of user preference. US Army Sustainment of Trauma and
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Medics were trained in JT use on the manikin of the Lu- Readiness Skills Experience, 2013
nati et al. study. These 10 Medics used the devices on The US Air Force conducted a study wherein Medics of
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each other. Medics represented the intended user and all all skill levels were trained on JTs in a classroom setting.
10 were active instructors at the USAMEDDC&S. The Medics then used the JTs in a tactical medical exercise. In-
Medics found that the SJT and the CRoC were equally structors filmed Medic applications and observed closely
effective, fast, and preferred. They also found that tar- for opportunities to improve training. Key observations
geting the underlying common femoral artery in each and training points for each device included the following:
other was harder than in the manikin, and the palpation
of the femoral pulse aided in accurate device placement. • AAJT: the belt and windlass must be fully tightened
The three common mistakes noted in the Lunati et al before inflating the bladder
study were also seen in the Medic study. Removing • CRoC: the device must be carried in a fully preassem-
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slack was usually inadequate in the first attempts until bled configuration, the vertical bar must be placed
users understood its importance to mechanical advan- against the side of the hip first before adjusting the
tage: the coarse adjustment was the slack removal and horizontal bar, and Medics frequently did not cor-
the fine adjustment was the final tightening. An early rectly locate the femoral pulse
use or “rookie” mistake was to put the devices on too • JETT: the device must be prepared with handles com-
high—above the level of the greater trochanters. The pletely unscrewed, the belt must be fully tightened
point of palpation of the femoral pulse (common femo- before tightening the pressure pads, and Medics fre-
ral artery) in clinical examination at the femoral triangle quently forgot to secure the handles after tightening
in the inguinal area is the correct pressure point; this and had difficulty correctly positioning the pressure
point is also at the level of the palpable greater trochan- plates over the femoral pulse
ter of the femur that is nearby and lateral to the pressure • SJT: the Medics’ preferred technique was to remove
point targeted. the air bladders (attached by Velcro) and then place
the belt above the greater trochanter, followed by in-
USAMEDDC&S Experience sertion of the air bladders under the belt over the fem-
Within the USAMEDDC&S, an assessment on JT train- oral artery. All tourniquets had durability problems
ing by instructors at the Tactical Combat Medicine in a training environment and no one JT stood out as
Course and Brigade Combat Tactical Trauma Training superior in a survey of Medic preference.
has been made. The Center for Prehospital Medicine
(CPM) courses have used four JT models in their educa- Scandinavian Military Experiences with JT Training:
tional programs. CPM established a skill station where 2013–2014
the CRoC, JETT, SJT, and AAJT are demonstrated. Fol- Scandinavian SOF Medics tested their preference in use
lowing the instructional demonstration, the students of the JT models. The USAISR sent the test plan and the

Junctional Tourniquet Training Experience 25