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is immediately asserted upon placement on the intended References
location through the vertical arm, then threading the 1. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battle-
device. Consequently, both devices would benefit from field (2001–2011): implications for the future of combat ca-
faster threading mechanisms. sualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):
S431–S437.
Considering that no adverse effects were reported dur- 2. Douma M, Brindley PG. Abdominal aortic and iliac artery
ing or after the CRoC or the JETT application, both compression following penetrating trauma: a study of feasibil-
ity. Prehosp Disaster Med. 2014;29:299–302.
devices are safe to use. 3. Kotwal RS, Butler FK, Gross KR, et al. Management of junc-
tional hemorrhage in Tactical Combat Casualty Care: TCCC
Guidelines—proposed change 13-03. J Spec Oper Med. 2013;
Conclusion 13:85–93.
4. Katsougiannopoulos V. Basic medical statistics. Thessaloniki,
The JETT and the CRoC were developed to address Greece: Kiriakides Bros; 1998:185–205.
junctional hemorrhage control. Even though the JETT 5. Blaivas M, Shiver S, Lyon M, et al. Control of hemorrhage
might receive better evaluations by military medical pro- in critical femoral or inguinal penetrating wounds—an ultra-
viders in terms of practicality and features, the CRoC sound evaluation. Prehosp Disaster Med. 2006;21:379–382.
still has merits, especially regarding its efficacy to oc- 6. Kunio NR, Riha GM, Watson KM, et al. Chitosan based ad-
clude arterial flow from the femoral artery. vanced hemostatic dressing is associated with decreased blood
loss in a swine uncontrolled hemorrhage model. Am J Surg.
2013;205:505–510.
Exsanguination from a femoral artery wound can oc- 7. Bulger EM, Snyder D, Schoelles K, et al. An evidence-based
cur in seconds. A time exceeding 54 seconds to stop prehospital guideline for external hemorrhage control: Ameri-
6
inguinal bleeding is too long, considering that wound- can College of Surgeons Committee on Trauma. Prehosp Emerg
packing time with hemostatic dressings can be less than Care. 2014;18:163–173.
7
50 seconds. Therefore, the immediate actions for ingui-
nal bleeding control should still be direct pressure and
wound packing. The JETT and the CRoC are good tools 1LT Theodoridis, MAJ Kafka, SFC Perez, SFC Curlee,
that can be used as a supplement to maintain or increase ADJ Yperman, MSG Oppermann, CPT Holmstroem,
pressure on a packed wound at inguinal areas or to oc- SGT Niegsch, LTC Mannino, and LTC Ramundo are af-
clude blood flow from the femoral artery. Considering filiated with the International Special Training Center Medical
that the CRoC and the JETT can be applied in as little Branch, Pfullendorf, Germany. Dr Theodoridis and Dr Ra-
as 37 and 29 seconds, respectively, users should be ef- mundo can be contacted at tel: +30 210 776 2440 and +49
fectively trained and entirely proficient on either device 7552 405 2160, respectively; by mail at the Hellenic Army
to justify their election as the primary countermeasure 13th Special Operations Command, Stratopedo Fakinou,
to hemorrhage not amenable to regular tourniquets. 11527, Athens, Hellas, and International Special Training
Center Medical Branch, Kasernenstr.20, 88630, Pfullendorf,
Germany, respectively; and by email at c.a.theodoridis@army
Disclosures .gr and nicolaramundo@bundeswehr.org.
The authors have nothing to disclose.

50 Journal of Special Operations Medicine Volume 16, Edition 1/Spring 2016