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Therefore, causal inferences cannot be made regarding JTQ deterministic linkage rules. These limitations underscore
efficacy and survival. the need for better prospective data collection methods.
It is surprising to find so few cases of recorded JTQ use in the Conclusion
combat setting, especially given that JTQ models were first
31
FDA approved in 2010 and announced as standard issue for JTQ application in the combat setting is rare. When it is per-
32
Army combat medics in 2016. Furthermore, previous studies formed, it is frequently in the setting of polytrauma. Survival
have suggested that junctional hemorrhage has accounted for was high, but DoDTR enrollment survival biases were likely
6
up to 19% of potentially survivable combat injuries, and vari- confounded by this.
ous laboratory-based studies have suggested that JTQs may be
highly effective in treating these injuries. 10,14,17,33 Given the high Acknowledgments
rates of death from torso and junctional hemorrhage, it re- The authors acknowledge the Department of Defense Trauma
mains unclear why their use is so infrequent. Some possibilities Registry for providing the data for this study.
include JTQ cost, inadequate training or familiarization with
JTQ use and application, prolonged time to application, feared Author Contributions
dislodgement during transport, and lack of wide distribution HBR drafted the initial manuscript and performed revisions.
throughout the battlespace. Future studies may consider a BJL, JAR, ADF, and MDA provided critical subject matter
qualitative analysis of medics’ perspectives and concerns re- expertise. SGS, the overall principal investigator, conceptualized
garding JTQ use in combat to understand this discrepancy bet- the study, performed the data analysis, and made critical
ter. In short, while JTQ use may benefit the small percentage of revisions. All authors contributed substantially.
severely injured patients currently receiving them, their stan-
dard incorporation into medic field bags should be carefully Disclaimer
evaluated, considering both the monetary and practical costs The views expressed in this article are those of the authors and
of fielding them in such numbers. do not reflect the official policy or position of the U.S. Army
Medical Department, Department of the Army, Department of
If JTQ use is prioritized in the limited military equipment allo- Defense, or the U.S. Government.
cation and training time, further consideration should be given
to its implementation strategy. While limited data are available Disclosures
regarding the specific type of JTQ used, the high percentage of The authors have nothing to disclose.
abdominal injuries (second only to lower extremity injuries)
may suggest a larger future role for the AAJT model and its Funding
ability to perform external aortic compression. Prior studies No funding was received for this work.
have noted that such external aortic compression and its low
failure rates during transport may be the equivalent of the
“high and tight” maxim, emphasizing the importance of rapid, References
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