Page 63 - Journal of Special Operations Medicine - Fall 2016

In the Kragh et al. studies, the time to effectiveness of being moved during tactical medical evacuation. Finally,
the SJT and CRoC did not differ statistically. This re- we do not know the long-term effects on the patient of
sult contrasts with our study findings, which showed the these two devices.
SJT more quickly reached effectiveness. In the Kragh et
al. studies, devices were placed near the user open and Conclusion
ready for use; unlike the SJT, the CRoC requires time
to assemble; therefore, the difference would have been In healthy volunteers, new evidence of junctional tour-
stronger. More importantly, in our study, the devices niquet performance for difficult inguinal bleeding indi-
were applied by a physician–nurse pair, in comparison cates that the CRoC and SJT performed well. In our
with a single user in the Kragh et al. studies. Indeed, in study, the SJT and the CRoC were equally effective;
the dedicated French military training program entitled however, the SJT was faster and easier to use. Our study
“Sauvetage au Combat” (“forward Combat casualty provides objective arguments to the French Tactical Ca-
care”), the medical team with the physician–nurse pair sualty Care Committee. This committee discusses device
is deployed as close as possible to the casualty at the selection to equip the French military health service. In
point of injury, allowing forward medical care on the the near future, the SJT could be widespread in French
battlefield. Time to effectiveness could be influenced Role 1 medical treatment facilities and tactical medical
16
by the number of users. evacuations.

Concerning subjectively evaluated performance results, Disclaimer
SJT was preferred by users in our study. In the Kragh
et al. studies, users ranked CRoC and SJT equally as The opinions or assertions expressed herein are the pri-
performing better than the JETT and the AAJT. In the vate views of the authors and are not to be considered as
current study, users assessed the SJT as more stable, and official or as reflecting the views of the French Military
easier and faster to apply. Subjects’ pain scores were Health Service.
comparable for both junctional devices and significantly
lower than the pain scores reported for SOFTT-NH.
Disclosures
Given its similar effectiveness, we think that the SJT has The authors declare no conflicts of interest.
more advantages than the CRoC. Its time to effective-
ness is significantly shorter, it makes a bilateral inguinal References
compression possible, and it is the only device indicated
for pelvic stabilization. Moreover, the SJT is less expen- 1. Kragh JF, Walters TJ, Baer DG, et al. Survival with emergency
sive and weighs less. All these factors are important in tourniquet use to stop bleeding in major limb trauma. Ann
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ing preventable death on the battlefield. Arch Surg. 2011;146:
by the patient. Second, the installation of the devices 1350–1358.
was performed by four different teams, which allowed 5. Kragh JF Jr, Murphy C, Dubick MA, et al. New tourniquet
a probable measurement bias. However, each team re- device concepts for battlefield hemorrhage control. US Army
ceived specific training and applied an equal number of Med Dep J. 2011;Apr–Jun:38–48.
CRoCs or SJTs. The multiplicity of teams allowed also 6. Tai NR, Dickson EJ. Military junctional trauma. J R Army
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terms of time to set up, stability, ease of use, and so field (2001–2011) : implications for the future of combat ca-
forth. Last, for better comparability, it would have been sualty care. J Trauma Acute Care Surg. 2012;73:S431–437.
preferable to use both junctional devices for each sub- 8. Eastridge BJ, Hardin M, Cantrell J, et al. Died of wounds
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More questions should be addressed in future studies. Spec Oper Med. 2013;13:76–84.
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Junctional Tourniquet Evaluations 45