Page 59 - Journal of Special Operations Medicine - Fall 2016

Evaluation of Two Junctional Tourniquets
Used on the Battlefield

Combat Ready Clamp versus SAM Junctional Tourniquet
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Jean-Guillaume Meusnier, MD; Charles Dewar, MD; Erti Mavrovi, MD;
Frédéric Caremil, MD; Pierre-François Wey, MD; Jean-Yves Martinez, MD

ABSTRACT
Background: Junctional hemorrhage (i.e., between the no longer the most common cause of preventable death.
trunk and limbs) are too proximal for a tourniquet and Junctional hemorrhage—bleeding from body regions
difficult to compress. These hemorrhages are respon- where the trunk and its appendages join—has become
sible for 20% of preventable deaths by bleeding on the the most common cause of death from bleeding. These
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battlefield. The majority of these involve the groin area. junctional body regions are too proximal for a regular
Devices allowing a proximal compression for arterial limb tourniquet to fit adequately. These areas include
axes have been recently developed. Objective: The pur- the groin, buttocks, pelvic area, perigenital area, cla-
pose of this study was to compare the use of two junc- vicular area, axilla, and neck. These junctional hemor-
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tional-tourniquet models, the Combat Ready Clamp rhages are responsible for 20% of preventable deaths by
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(CRoC ) and the SAM Junctional Tourniquet (SJT), bleeding on the battlefield, with the majority associ-
7,8
in simulated out-of-hospital trauma care when tourni- ated with the groin area. 9
quets were ineffective to stop the arterial flow. Methods:
During our clinical study, 84 healthy volunteers wear- The increase of junctional hemorrhages is due to sev-
ing battle dress performed a physical exercise to come eral factors. There has been increased use of explosive
approximate the operational context. The volunteers agents, such as improvised explosive devices, which are
were randomly divided into two groups according to responsible for multiple, severe, disabling, and lethal
the device (the CRoC or SJT) used as supplement to a injuries, which often leads to complete limb amputa-
tourniquet self-applied to the root of the thigh. The pri- tions. Evolution of body armor still has left junctional
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mary study end point was the complete interruption of areas free of any protective covering (allowing facilitate
popliteal arterial flow, measured with Doppler ausculta- mobility soldier); thus they are more exposed to poten-
tion. Time to effectiveness and subjective questionnaire tial wounding than the other areas.
data to evaluate the devices’ application were also col-
lected. Results: Junctional device effectiveness was al- The US Tactical Combat Casualty Care Committee has
most 90% for both the CRoC and the SJT, and did not made junctional tourniquets a research priority. 5,11 Since
differ between them, either used with a tourniquet (p = 2010, four devices that allow a proximal compression
.36) or alone (p = .71). The time to effectiveness of the for arterial axes have been developed. All the devices
SJT was significantly shorter than that of the CRoC (p = have been validated to control junctional hemorrhages
.029). Conclusion: The SJT and the CRoC were equally and limb hemorrhages when tourniquets are ineffective.
effective. The SJT was faster to apply and preferred by The first experimental studies of these devices are prom-
the users. Our study provides objective evidence to the ising; they proved their reliability in stopping bleeding
French Tactical Casualty Care Committee for improving in a relatively short time. 12
junctional hemorrhage treatment.
To date, very few controlled clinical studies of such de-
Keywords: junctional tourniquet; hemorrhage; groin; medi- vices have been published in medical journals. 13,14 The
cal device; Combat Ready Clamp; SAM Junctional Tourniquet purpose of this testing was to compare the effective-
ness of two devices in healthy volunteers—the Com-
bat Ready Clamp (CRoC; Combat Medical Systems;
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Introduction http://www.combatmedicalsystems.com) and the SAM
Junctional Tourniquet (SJT; SAM Medical Products;
®
In modern warfare, regular tourniquets have been http://www.sammedical.com/products)—applied to the
widely used. The death rate due to hemorrhage at ex- groin area when tourniquets were ineffective to stop the
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tremities has decreased and this type of hemorrhage is distal arterial flow.

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