Page 44 - JSOM Fall 2019

control bleeding, it may be removed and a fresh Disclaimers
dressing of the same type or a different type applied. The opinions or assertions contained herein are the private
(Note: XStat is not to be removed in the field, but ad- views of the authors and are not to be construed as official
ditional XStat, other hemostatic adjuncts, or trauma or as reflecting the views of the Defense Health Agency, the
dressings may be applied over it.) Department of Defense, nor the US Government. This recom-
• If the bleeding site is amenable to use of a junc- mendation is intended to be a guideline only and is not a sub-
tional tourniquet, immediately apply a CoTCCC- stitute for clinical judgment.
recommended junctional tourniquet. Do not delay in
the application of the junctional tourniquet once it is Disclosures
ready for use. Apply hemostatic dressings with direct Ms Mckee has been employed as a contractor for Innovative
pressure if a junctional tourniquet is not available or Trauma Care, the company that manufactures and distributes
while the junctional tourniquet is being readied for the iTClamp. She has had her travel covered by Innovative
use. Trauma Care as part of her position with the company and
c. For external hemorrhage of the head and neck where is entitled to stock options. The other authors have no disclo-
the wound edges can be easily re-approximated, the sures to report.
iTClamp may be used as a primary option for hemor-
rhage control. Wounds should be packed with a hemo- References
static dressing or XStat, if appropriate, prior to iTClamp 1. Eastridge BJ, RL Mabry, P Seguin, J Cantrell, T Tops, P Uribe,
application. et al. Death on the battlefield (2001-2011): implications for
• The iTClamp does not require additional direct pres- the future of combat casualty care. J Trauma Acute Care Surg.
2012;73(6 suppl 5):S431–S437.
sure, either when used alone or in combination with 2. Phrampus PE, L Walker. Danger zone. The prehospital assess-
other hemostatic adjuncts. ment & treatment of blunt & penetrating neck trauma. JEMS.
• If the iTClamp is applied to the neck, perform 2002;27(11):26–38; quiz 40–41.
frequent airway monitoring and evaluate for an 3. Shaw GLT. A service evaluation of the iTClamp50 in pre-hospital
expanding hematoma that may compromise the air- external haemorrhage control. Br Paramedic J. 2016;1(2):30–34.
™
way. Consider placing a definitive airway if there is 4. Hudson A, W Glazebrook. First UK use of the iTClamp haemor-
rhage control system: Case report. Trauma. 2014;16(3):214–216.
evidence of an expanding hematoma. 5. Chovanes DJS, Mckee JL, Wang JL. Bridging the Gap: A novel
• DO NOT APPLY on or near the eye or eyelid (within method for hemorrhage control. J Health Educ Res Dev. 2017;
1cm of the orbit). 5(1).
6. Thompson L. Application of the iTClamp in the clinical manage-
ment of haemorrhage: a case study. J Paramedic Pract. 2014;6(5):
Levels of Evidence for the Above Recommendations 228–230.
The levels of evidence used by the American College of Car- 7. Tan EC, JH Peters, JL McKee, MJ Edwards. The iTClamp in the
diology and the American Heart Association were outlined by management of prehospital haemorrhage. Injury. 2016;47(5):
Tricoci in 2009 : 1012–1015.
64
8. McKee JL, AW Kirkpatrick, BL Bennett, DA Jenkins, S Logsetty,
Level A: Evidence from multiple randomized trials or JB Holcomb. Worldwide case reports using the iTClamp for ex-
ternal hemorrhage control. J Spec Oper Med. 2018;18(3):39–44.
meta-analyses. 9. McKee JL, IA McKee, CG Ball, E Tan, A Moloff, P McBeth,
Level B: Evidence from a single randomized trial or et al. The iTClamp in the treatment of prehospital craniomaxillo-
nonrandomized studies. facial injury: a case series study. J Inj Violence Res. 2019;11(1):
29–34.
Level C: Expert opinion, case studies, or standards 10. Butler FK Jr, J Hagmann, EG Butler. Tactical Combat Casualty
of care. Care in special operations. Mil Med. 1996;161 suppl:3–16.
11. Butler FK. Tactical Combat Casualty Care: update 2009. J
Trauma. 2010;69 suppl 1:S10–S13.
Using the taxonomy above, the levels of evidence for the rec- 12. Bennett BL, LF Littlejohn, BS Kheirabadi, FK Butler, RS Kot-
ommendations in this change are shown below. wal, MA Dubick, et al. Management of external hemorrhage in
Tactical Combat Casualty Care: chitosan-based hemostatic gauze
1. The iTClamp is effective at controlling external hemor- dressings–TCCC guidelines change 13-05. J Spec Oper Med.
rhage in selected cases of external hemorrhage. Level C 2014;14(3):40–57.
2. The iTclamp is safe to use for the control external hemor- 13. Sims K, HR Montgomery, P Dituro, BS Kheirabadi, FK Butler.
rhage. Level C Management of external hemorrhage in Tactical Combat Casu-
alty Care: the adjunctive use of XStat compressed hemostatic
sponges: TCCC guidelines change 15-03. J Spec Oper Med. 2016;
16(1):19–28.
Recommendations for Further Research 14. Kotwal RS, FK Butler, HR Montgomery, TJ Brunstetter, GY
1. The Joint Trauma System performance improvement pro- Diaz, JW Kirkpatrick, et al. The Tactical Combat Casualty Care
cess should be used to identify all future casualties on whom Casualty Card TCCC guidelines–proposed change 1301. J Spec
the iTClamp are used and how the device performed. Con- Oper Med. 2013;13(2):82–87.
sider casualties with CMFI and PNI as well as other injuries 15. Meghoo CA, JW Dennis, C Tuman, R Fang. Diagnosis and
for which the iTClamp was used. management of evacuated casualties with cervical vascular inju-
2. Clinical study to evaluate outcomes of prehospital iTClamp ries resulting from combat-related explosive blasts. J Vasc Surg.
2012;55(5):1329–1336; discussion 1336–1337.
use, in both military and civilian trauma settings. 16. Beekley AC, JA Sebesta, LH Blackbourne, GS Herbert, DS Kau-
3. Evaluate the use of the iTClamp as a hemostatic adjunct var, DG Baer, et al. Prehospital tourniquet use in Operation Iraqi
for tourniquet conversion in casualties with extremity Freedom: effect on hemorrhage control and outcomes. J Trauma.
hemorrhage. 2008;64(2 suppl):S28–S37; discussion S37.

42 | JSOM Volume 19, Edition 3 / Fall 2019