Page 61 - Journal of Special Operations Medicine - Spring 2016

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arterial flow in the iliac artery. It is necessary to provide Table 1 Attendees’ Backgrounds
a suitable tool to ensure proper care for casualties. New Basic
devices were developed to address this problem: the SOF Medical
™
Junctional Emergency Treatment Tool (JETT ; North Nationality SOF Enablers Background Paramedic Nurse
American Rescue, http://www.narescue.com), the Com- NOR 6 28 21 12 1
™
bat Ready Clamp (CRoC ; Combat Medical Systems,
http://www.combatmedicalsystems.com), the Abdomi- NLD 2 22 16 8
nal Aortic and Junctional Tourniquet (AAJT ; Chinook ITA 7 7
™
Gear Inc., http://www.chinookmed.com), and the SAM USA 1 6 3 4
Junctional Tourniquet (SAM Medical Products, http:// BEL 3 2 4 1
www.sammedical.com/products) are some examples.
ROU 6 2 4
International Special Training Center (ISTC) Medi- DNK 1 1
cal Branch Special Operations Forces Advanced Medi- GBR 1 1
cal First Responder (SOF AMFR) course attendees are HRV 1 1 2
trained in accordance with Tactical Combat Casualty LVA 1 1
Care guidelines; severe external hemorrhage control,
by any means, is their first priority, as taught using the Data are given as number of attendees. SOF, Special Operations Forces;
BEL, Belgium; DNK, Denmark; GBR, Great Britain; HRV, Croatia;
MARCH ON drill. Our objective was to examine the ITA, Italy; LVA, Latvia; NOR, Norway; NLD, The Netherlands; ROU,
application time of the CRoC and the JETT tourniquets Romania; USA, United States of America.
and to assess the opinions of our students regarding the
efficacy of these tools, and then to examine how these simulated casualty’s groin at least four times in training
two parameters correlated. Our study analyzes both ob- combat scenarios over a period of 1 week and under the
jective and subjective criteria. The objective data were supervision of Medical Branch instructors. After that,
obtained by recording the effective application time each of the students, having been through a prescheduled
of these two junctional tourniquets in training com- event of intense physical stress, had to apply both devices
bat scenarios. The subjective data were obtained from on another student’s groin and effectively eliminate the
a relevant questionnaire that addressed several factors, distal pulse unilaterally with each device. The time for
including ease of use and practicality. 3 this application was measured by the instructors. The ap-
plication technique consisted of positioning oneself next
to the simulated casualty and applying one of the devices
Methods
over the common femoral artery until the pulse from ei-
Eighty-eight students from military units of 10 nations ther the dorsalis pedis or posterior tibialis was no longer
were trained on these tools at the ISTC Medical Branch palpable. The devices were disassembled, in their pouches
during the period February 2014 to November 2015. and on the ground, next to the simulated casualty. The
The students’ backgrounds varied from Soldiers with- instructors verified the proper and effective application of
out previous medical training to medics, paramedics, the devices. The sequence of each tool’s application dur-
and nurses (Table 1). The whole survey was realized ing the measurement phase of the survey was randomized
inside the scope of a 3-week SOF AFMR course. Inde- among the students. The students were informed about
pendent of their experience, the students’ qualifications the survey they would be participating in at free will and
were standardized after 3 weeks of identical training indicated in writing knowledge of any potential risks that
on the two devices. The students completed a relevant the procedures being taught might pose.
questionnaire at the end of the training. The question-
naire evaluated aspects/parameters of the JETT and the For the data to be statistically processed, the Z test was
4
CRoC such as comfort level with use, practicality, effec- used. The study also examined whether the objective
tiveness, and safety (Figure 1). data (time measurement) reaffirmed and corroborated
the students’ subjective evaluation on the two devices.
Not all questionnaires were completed properly and not
all students gave an evaluation on the last two param- Results
eters. After the exclusion of improperly completed ques-
tionnaires and the two categories with incomplete data, Table 2 and Figure 2 depict the mean score per question
75 questionnaires were analyzed. for each device. Both devices’ mean scores per question
were examined comparatively for statistical significance.
A group of 33 students provided the objective data of our
survey in the following way: after the initial demonstration, Figure 3 depicts the mean score per student, including
they had to train and apply both devices effectively on a all categories of the survey, for each device. Table 3 gives

SOF Testing of CRoC and JETT Tourniquets 45