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Assessment of Groin Application of Junctional Tourniquets in a Manikin Model

Published online by Cambridge University Press:  27 May 2016

John F. Kragh Jr. ,
Matthew P. Lunati ,
Chetan U. Kharod ,
Cord W. Cunningham ,
Jeffrey A. Bailey ,
Zsolt T. Stockinger ,
Andrew P. Cap ,
Jacob Chen ,
James K. Aden 3d  and
Leopoldo C. Cancio
John F. Kragh Jr.*
Affiliation:
US Army Institute of Surgical Research - Damage Control Resuscitation, JBSA Fort Sam Houston, Texas USA
Matthew P. Lunati
Affiliation:
University of Texas Health Science Center at San Antonio - School of Medicine, San Antonio, Texas USA
Chetan U. Kharod
Affiliation:
San Antonio Military Medical Center - Emergency Medical Services, JBSA Fort Sam Houston, Texas USA
Cord W. Cunningham
Affiliation:
San Antonio Military Medical Center - Emergency Medical Services, JBSA Fort Sam Houston, Texas USA
Jeffrey A. Bailey
Affiliation:
US Army Institute of Surgical Research - Damage Control Resuscitation, JBSA Fort Sam Houston, Texas USA
Zsolt T. Stockinger
Affiliation:
US Army Institute of Surgical Research - Damage Control Resuscitation, JBSA Fort Sam Houston, Texas USA
Andrew P. Cap
Affiliation:
US Army Institute of Surgical Research - Damage Control Resuscitation, JBSA Fort Sam Houston, Texas USA
Jacob Chen
Affiliation:
US Army Institute of Surgical Research - Damage Control Resuscitation, JBSA Fort Sam Houston, Texas USA
James K. Aden 3d
Affiliation:
US Army Institute of Surgical Research - Damage Control Resuscitation, JBSA Fort Sam Houston, Texas USA
Leopoldo C. Cancio
Affiliation:
US Army Institute of Surgical Research - Damage Control Resuscitation, JBSA Fort Sam Houston, Texas USA
*
Correspondence: John F. Kragh, Jr, MD US Army Institute of Surgical Research 3698 Chambers Pass Bldg. 3611 Rm 222-4 JBSA Fort Sam Houston Texas 78234-7767 USA E-mail: John.f.kragh.civ@mail.mil
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Abstract

Introduction

To aid in preparation of military medic trainers for a possible new curriculum in teaching junctional tourniquet use, the investigators studied the time to control hemorrhage and blood volume lost in order to provide evidence for ease of use.

Hypothesis

Models of junctional tourniquet could perform differentially by blood loss, time to hemostasis, and user preference.

Methods

In a laboratory experiment, 30 users controlled simulated hemorrhage from a manikin (Combat Ready Clamp [CRoC] Trainer) with three iterations each of three junctional tourniquets. There were 270 tests which included hemorrhage control (yes/no), time to hemostasis, and blood volume lost. Users also subjectively ranked tourniquet performance. Models included CRoC, Junctional Emergency Treatment Tool (JETT), and SAM Junctional Tourniquet (SJT). Time to hemostasis and total blood loss were log-transformed and analyzed using a mixed model analysis of variance (ANOVA) with the users represented as random effects and the tourniquet model used as the treatment effect. Preference scores were analyzed with ANOVA, and Tukey’s honest significant difference test was used for all post-hoc pairwise comparisons.

Results

All tourniquet uses were 100% effective for hemorrhage control. For blood loss, CRoC and SJT performed best with least blood loss and were significantly better than JETT; in pairwise comparison, CRoC-JETT (P < .0001) and SJT-JETT (P = .0085) were statistically significant in their mean difference, while CRoC-SJT (P = .35) was not. For time to hemostasis in pairwise comparison, the CRoC had a significantly shorter time compared to JETT and SJT (P < .0001, both comparisons); SJT-JETT was also significant (P = .0087). In responding to the directive, “Rank the performance of the models from best to worst,” users did not prefer junctional tourniquet models differently (P > .5, all models).

Conclusion

The CRoC and SJT performed best in having least blood loss, CRoC performed best in having least time to hemostasis, and users did not differ in preference of model. Models of junctional tourniquet performed differentially by blood loss and time to hemostasis.

KraghJFJr , LunatiMP , KharodCU , CunninghamCW , BaileyJA , StockingerZT , CapAP , ChenJ , AdenJK3d , CancioLC . Assessment of Groin Application of Junctional Tourniquets in a Manikin Model. Prehosp Disaster Med. 2016;31(4):358–363.

Keywords

Emergency Medical Serviceshemorrhagetourniquet
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 4 , August 2016 , pp. 358 - 363
Copyright
© World Association for Disaster and Emergency Medicine 2016 

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References

1. Bowden, M. Black Hawk Down: A Story of Modern War. New York USA: Grove Press; 1999.Google Scholar
2. Blackbourne, LH, Mabry, R, Sebesta, J, Holcomb, JB. Joseph Lister, non-compressible arterial hemorrhage, and the next generation of “tourniquets?” US Army Med Dep J. 2008;Jan-Mar: 56-59.Google Scholar
3. Andersen, RC, Shawen, SB, Kragh, JF Jr., et al. Special topics. J Am Acad Orthop Surg. 2012;20(Suppl 1):S94-S98.Google Scholar
4. Eastridge, BJ, Hardin, M, Cantrell, J, et al. Died of wounds on the battlefield: causation and implications for improving combat casualty care. J Trauma. 2011;7(1):S4-S8.Google Scholar
5. Kragh, JF Jr., Dubick, MA, Aden, JK 3rd, et al. US Military experience with junctional wounds in war from 2001 to 2010. J Spec Oper Med. 2013;13(4):76-84.CrossRefGoogle ScholarPubMed
6. Eastridge, BJ, Mabry, RL, Seguin, P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431-S437.Google Scholar
7. Anonymous. Abdominal aortic tourniquet? Use in Afghanistan. J Spec Oper Med. 2013;13(2):1-2.Google Scholar
8. Tovmassian, RV, Kragh, JF Jr., Dubick, MA, Baer, DG, Blackbourne, LH. Combat ready clamp medic technique. J Spec Oper Med. 2012;12(4):72-78.CrossRefGoogle ScholarPubMed
9. Taylor, DM, Coleman, M, Parker, PJ. The evaluation of an abdominal aortic tourniquet for the control of pelvic and lower limb hemorrhage. Mil Med. 2013;178(11):1196-1201.CrossRefGoogle ScholarPubMed
10. Croushorn, J, Thomas, G, McCord, SR. Abdominal aortic tourniquet controls junctional hemorrhage from a gunshot wound of the axilla. J Spec Oper Med. 2013;13(3):1-4.CrossRefGoogle ScholarPubMed
11. Kragh, JF Jr., Murphy, C, Steinbaugh, J, et al. Prehospital emergency inguinal clamp controls hemorrhage in cadaver model. Mil Med. 2013;178(7):799-805.Google Scholar
12. Kragh, JF Jr., Mann-Salinas, EA, Kotwal, RS, et al. Laboratory assessment of out-of-hospital interventions to control junctional bleeding from the groin in a manikin model. Am J Emerg Med. 2013;31(8):1276-1278.CrossRefGoogle Scholar
13. Committee on Tactical Combat Casualty Care. Guideline 140602. https://www.naemt.org/education/TCCC/guidelines_curriculum. Accessed April 6, 2015.Google Scholar
14. Committee on Tactical Combat Casualty Care. Supplementary Modules (CRoC Module, JETT Module, SJT Module). https://www.naemt.org/education/TCCC/guidelines_curriculum. Accessed April 6, 2015.Google Scholar
15. Kotwal, RS, Butler, FK, Gross, KR, et al. Management of junctional hemorrhage in tactical combat casualty care: TCCC guidelines proposed change 13-03. J Spec Oper Med. 2013;13(4):85-93.CrossRefGoogle ScholarPubMed
16. Klotz, JK, Leo, M, Anderson, BL, et al. First case report of SAM? Junctional tourniquet use in Afghanistan to control inguinal hemorrhage on the battlefield. J Spec Oper Med. 2014;14(2):1-5.Google Scholar
17. Ruterbusch, VL, Swiergosz, MJ, Montgomery, LD, Hopper, KW, Gerth, WA. ONR/MARCORSYSCOM. Evaluation of Self-Applied Tourniquets for Combat Applications. 2005.Google Scholar