Assessment of Trainer Skill to Control Groin-Wound Bleeding: Use of Junctional Tourniquet Models on a Manikin

Kragh, John F; Aden, James K; Shackelford, Stacy; Moore, Virgil K; Dubick, Michael A.

doi:10.55460/pcsm-zc4b

Cited by 4 publications

(1 citation statement)

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“…https://narescue.com ) consists of a fastening belt and two identical pressurized screws. Several studies have shown that JETT was less efficient than other tourniquets in unilateral hemostasis [ 83 , 92 , 93 ]. However, when focused on bilateral hemostasis, the advantage of JETT was demonstrated [ 94 ].…”

Section: Torso Hemorrhage and Its Noncompressibility: Nothing Is Impo...mentioning

confidence: 99%

Torso hemorrhage: noncompressible? never say never

Zhang,

Zhang

2024

Eur J Med Res

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Since limb bleeding has been well managed by extremity tourniquets, the management of exsanguinating torso hemorrhage (TH) has become a hot issue both in military and civilian medicine. Conventional hemostatic techniques are ineffective for managing traumatic bleeding of organs and vessels within the torso due to the anatomical features. The designation of noncompressible torso hemorrhage (NCTH) marks a significant step in investigating the injury mechanisms and developing effective methods for bleeding control. Special tourniquets such as abdominal aortic and junctional tourniquet and SAM junctional tourniquet designed for NCTH have been approved by FDA for clinical use. Combat ready clamp and junctional emergency treatment tool also exhibit potential for external NCTH control. In addition, resuscitative endovascular balloon occlusion of the aorta (REBOA) further provides an endovascular solution to alleviate the challenges of NCTH treatment. Notably, NCTH cognitive surveys have revealed that medical staff have deficiencies in understanding relevant concepts and treatment abilities. The stereotypical interpretation of NCTH naming, particularly the term noncompressible, is the root cause of this issue. This review discusses the dynamic relationship between TH and NCTH by tracing the development of external NCTH control techniques. The authors propose to further subdivide the existing NCTH into compressible torso hemorrhage and NCTH’ (noncompressible but REBOA controllable) based on whether hemostasis is available via external compression. Finally, due to the irreplaceability of special tourniquets during the prehospital stage, the authors emphasize the importance of a package program to improve the efficacy and safety of external NCTH control. This program includes the promotion of tourniquet redesign and hemostatic strategies, personnel reeducation, and complications prevention.

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Section: Torso Hemorrhage and Its Noncompressibility: Nothing Is Impo...mentioning

confidence: 99%

Torso hemorrhage: noncompressible? never say never

Zhang,

Zhang

2024

Eur J Med Res

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Combined effect of intermittent hemostasis and a modified external hemorrhage control device in a lethal swine model

Zhang,

Guo,

Zhao

et al. 2024

Heliyon

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Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) can be applied both successfully and rapidly by Combat Medical Technicians (CMTs)

Smith¹,

Beaven

Handford

et al. 2021

BMJ Mil Health

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Background‘Non-compressible’ haemorrhage is the leading cause of preventable battlefield death, often requiring surgical or radiological intervention, which is precluded in the pre-hospital environment. One-fifth of such bleeds are junctional and therefore potentially survivable. We examine the use of the Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) among UK Combat Medical Technicians (CMTs) as a device to control junctional haemorrhage with external compression of the abdominal aorta—compression of junctional haemorrhage previously considered ‘non-compressible.’ This follows animal studies showing that the AAJTS achieves control of haemorrhage and improves physiological parameters.MethodsCMTs were selected and applied the AAJTS to each other following a 1-hour training package. A consultant radiologist-operated hand-held ultrasound monitored flow changes in the subjects’ common femoral artery. CMTs were then surveyed for their opinions as to utility and function.Results21 CMTs were screened and 17 CMTs participated with 34 total applications (16 day and 18 low-light). 27/34 (79%) achieved a successful application. The median application time was 75 s in daylight and 57 s in low-light conditions. There was no significant difference in Body Mass Index (p=0.23), median systolic blood pressure (p=0.19), nor class of CMT (p=0.10) between successful and unsuccessful applications. Higher systolic blood pressure was associated with longer application times (p=0.03). Users deemed the device easy to use (median score 4.4 on a 5-point Likert scale).ConclusionCMTs can use AAJTS successfully after a 1-hour training session in the majority of applications. Application was successful in both daylight and low-light conditions. Self-reported usability ratings were high.

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Assessment of Trainer Skill to Control Groin-Wound Bleeding: Use of Junctional Tourniquet Models on a Manikin

Cited by 4 publications

References 0 publications

Torso hemorrhage: noncompressible? never say never

Torso hemorrhage: noncompressible? never say never

Combined effect of intermittent hemostasis and a modified external hemorrhage control device in a lethal swine model

Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) can be applied both successfully and rapidly by Combat Medical Technicians (CMTs)

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