Managing junctional haemorrhage in the combat environment

Abstract

Tactical combat casualty care and the application of extremity tourniquets have saved lives in combat. In the modern combat environment junctional injuries are common and difficult to treat. Recently, junctional tourniquets have emerged as a potential solution to this problem. Junctional tourniquets can be used as an adjunct to persistent haemorrhage despite application of conventional tourniquets or in the persistently hypotensive casualty. Surgeons must have an approach to receiving patients with junctional tourniquets in place in the operating room. The algorithms presented allow for an evidence-based and command-driven implantation of junctional tourniquets as part of tactical combat casualty care.

Results of combat medic junctional tourniquet training: a prospective, single-blind, randomized, cross-over study

“…[2,10,11] Efforts to stop junctional bleeding-related prehospital deaths have led to the development of FDA-approved junctional tourniquets. [6,[12][13][14] Although there are several other tourniquets designed to control junctional bleeding, the SAM ® Junctional Tourniquet (SJT ® , USA) and the Tactical Abdominal Junctional Tourniquet (T-AJT ® Fora Group Defense Ltd., Türkiye) have been actively used by Turkish security forces. [14] The T-AJT ® , which is similar in design to the AAJT, has been designed for application to the umbilicus, the axilla, and the groin.…”

“…[ 2 , 10 , 11 ] Efforts to stop junctional bleeding-related prehospital deaths have led to the development of FDA-approved junctional tourniquets. [ 6 , 12 - 14 ]…”

“…Stopping junctional bleeding is particularly challenging and requires the use of specifically designed junctional tourniquets. [4][5][6][7] Junctional tourniquet application times (AT) are generally longer than conventional tourniquets…”