Page 52 - Journal of Special Operations Medicine - Spring 2016

Testing of Junctional Tourniquets by Medics of the
Israeli Defense Force in Control of Simulated Groin Hemorrhage

Jacob Chen, MD, MHA, MSc*; Avi Benov, MD, MHA*;
Roy Nadler, MD; Geva Landau, MD; Alex Sorkin, MD; James K. Aden 3rd, PhD;
John F. Kragh Jr, MD; Elon Glassberg, MD, MHA

ABSTRACT

Background: Junctional hemorrhage is a common cause hemorrhage (i.e., bleeding from wounds at the junction
of battlefield death but little is known about testing of of the trunk and its appendages, including the groin, the
junctional tourniquet models by medics. The purpose of buttocks, the axilla, the shoulder girdle, or the neck).
1–3
the testing described herein is to assess military experience In two studies of US battlefield casualties who died and
4,5
in junctional tourniquet use in simulated prehospital care. underwent autopsy (either killed in action out of hospi-
Methods: Fourteen medics were to use the following four tal or died of wounds after hospital admission), about
junctional tourniquets: Combat Ready Clamp (CRoC), 20% of preventable deaths were attributed to junctional
Abdominal Aortic Junctional Tourniquet (AAJT), Junc- hemorrhage. Such deaths before or after reaching a sur-
tional Emergency Treatment Tool (JETT), and SAM Junc- gical facility might be preventable by better hemorrhage
tional Tourniquet (SJT). The five assessment categories control interventions. As late as 2009, the Committee
2,3
were safety, effectiveness, time to effectiveness, and two on Tactical Combat Casualty Care recommended only
categories of user preference: (1) by all models assessed, manual compression with a hemostatic dressing to man-
and (2) by only the model most preferred. Users ranked age out-of-hospital junctional hemorrhage, because no
preference by answering, “If you had to go to war today other treatment options had been shown superior. In
5
and you could only choose one, which tourniquet would 2011, Blackbourne et al. described junctional hemor-
6
you choose to bring?” Results: All tourniquet uses were rhage as being compressible but unsuitable for tourni-
safe. By the time the first five testers were done, all three quet application because a limb tourniquet cannot fit
AAJT models had been broken. CRoC and AAJT had the body areas that are junctional.
highest percentage effectiveness as their difference was not
statistically significant. SJT and JETT had fastest mean The possible benefits of a junctional tourniquet were
times to effectiveness as their difference was not signifi- assessed by Kragh et al. in US military war casualties
1
cant. For preference, using each user’s ranking of all mod- who arrived alive to a hospital from 2001 to 2010. They
els assessed, SJT and AAJT were most preferred as their considered casualties with potentially survivable injuries
difference was not significant. For each user’s most pre- (23%) and the percentage of those who had junctional
ferred model, SJT, AAJT, and JETT were most preferred wounds and died (20%); none of these casualties with
as their difference was not significant. Conclusion: In the junctional wounds was treated with a junctional tour-
five assessment categories, multiple tourniquet models niquet. They calculated that if all 20% with junctional
performed similarly well; SJT and AAJT performed best wounds were potentially savable with a junctional tour-
in four categories, JETT was best in three, and CRoC was niquet, then by this one estimate, the yield of optimal
best in two. Differences between the top-ranked models in use of such a device could have been three lives saved
each category were not statistically significant. per month. Kragh et al. also detected a large increase
1
in the annual percentage of junctional wounding among
Keywords: tourniquets; hemorrhage; resuscitation; groin; the casualties who arrived alive to a hospital; the find-
inguinal; medical device; injuries; and wounds ing indicated the need for junctional hemorrhage con-
trol rose 14-fold. 1

To address the need for junctional hemorrhage control,
Introduction
novel and effective junctional tourniquets have been de-
A common cause of death on the battlefield among ca- veloped recently. As of October 2014, four models of
sualties with potentially survivable injuries is junctional junctional tourniquet have been developed commercially

*These authors contributed equally.

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