Page 62 - Journal of Special Operations Medicine - Fall 2016

with a verbal pain score ranging from 1 = no pain, to Table 1 Mean Scores for Ease of Use, Subjective Time to
5 = unbearable pain (Figure 5). The average pain scores Effectiveness, Effort Required, and Stability Average of the
for the CRoC and the SJT did not differ (p = .53); how- CRoC and SJT
ever, the SOFTT-NH was considered more painful than t Test
CRoC or SJT (p < .001). Parameter CRoC SJT p Value
Ease of use
Figure 4 Time to effectiveness. (mean: 1 = very easy, 2.19 1.97 .13
to 5 = very difficult)
Subjective time to
effectiveness 2.42 1.79 .0002
(mean: 1 = very short,
to 5 = very long)
Effort required
(mean: 1 = no effort, 2.44 2.37 .66
to 5 = extreme effort)
Stability
(mean: 1 = very stable, 2.17 1.58 .001
to 5 = very unstable)
CRoC, Combat Ready Clamp; SJT, SAM Junctional Tourniquet. CRoC, Combat Ready Clamp; SJT, SAM Junctional Tourniquet.
Figure 5 Pain score average.
SJT and of the CRoC was similar (respectively, 100%
and 94%; no significant difference). In a second study,
14
Kragh et al. compared the four devices on 10 healthy
volunteers and reported similar results: the effectiveness
rate of the SJT and of the CRoC was, respectively, 93%
and 97%, which did not differ significantly. These two
studies also showed that the SJT and the CRoC were
more effective than the Junctional Emergency Treatment
®
™
Tool (JETT ; North American Rescue; http://www
.narescue.com) and the Abdominal Aortic and Junc-
™
®
tional Tourniquet (AAJT ; Compression Works; http://
CRoC, Combat Ready Clamp; SJT, SAM Junctional Tourniquet.
compressionworks.com).
Then, the questionnaire assessed the ease of use, the time
to effectiveness, the effort required when applying the de- The original aspect of our study was to evaluate the two
vices, and the stability of two devices (Table 1). From the devices, CRoC and SJT, in a situation approximating
users point of view, the SJT seemed significantly more sta- battlefield conditions as closely as possible. The vol-
ble (p = .001) and faster to apply (p = .0002). Clinically, unteers performed the study in battle dress just after a
the SJT seemed to be easier to use than the CRoC, but the physical exercise, testing their strength and lucidity in
difference was not statistically significant (p = .13). The the use a self-applied tourniquet. This physical exer-
effort required to use the junctional tourniquet did not cise also allowed us to approach a Combat situation,
seem to differ between the two models (p = .66). which, to our knowledge, has never been evaluated in
published studies. Under our test conditions, we were
Safety surprised to notice that only 12% of volunteers properly
The CRoC and the SJT were equally safe; no adverse used the tourniquet. This could be due to the use of the
events were noticed during or after the study. self-applied tourniquet, rather than having it applied by
another Soldier in Combat conditions.

Discussion
Even if no statistical correlation was found, the two de-
In healthy volunteers, the results of our study indicate vices seem more difficult to apply to subjects with high
almost 90%effectiveness for both devices in the groin BMI and/or a high blood pressure profile. Cotte et al.
15
area. The effectiveness did not differ statistically be- evaluated CRoC effectiveness on 30 healthy volunteers,
tween CRoC and SJT, used with SOFTT-NH or alone. with Doppler auscultation. In this study, the use of the
These results are concordant with two published com- CRoC was reported to be easy in 83.3% of cases. Vol-
parative clinical studies. Kragh et al. evaluated the four unteers among whom the use of the CRoC was consid-
13
devices approved by the US Food and Drug Administra- ered difficult were significantly heavier (90.4kg versus
tion on nine military medics. The effectiveness of the 71.5kg; p = .001).

44 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2016