Advancements in Tourniquets 2014

John F. Kragh, Jr., MD; COL (Ret), MC, USA Hemorrhage Control Devices

SECURITY CLASSIFICATION: UNCLASSIFIED

Summer 2014

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Portions of this presentation include studies that were conducted under a protocol reviewed and approved by the US Army Medical Research and Materiel Command

Institutional Review Board and in accordance with the approved protocol.”

The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or

the Department of Defense.

Portions of this presentation include studies that were conducted in compliance with the Animal Welfare Act, the implementing Animal Welfare Regulations, and the principles of

the Guide for the Care and Use of Laboratory Animals.

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4 Devices Compared in US Manikin

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Junctional Tourniquet Test: Scandinavia

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Junctional Tourniquet Test: US

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Junctional Tourniquet Test: US Continued

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Junctional Tourniquet Test: Israel

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Junctional Tourniquet Research: US

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Name Combat Ready Clamp Abdominal Aortic and Junctional Tourniquet

Junctional Emergency Treatment Tool

SAM Junctional Tourniquet

Nickname CRoC AAJT JETT SJT Maker Combat Medical Systems Compression Works North American Rescue

Products SAM Medical Products

City, State Fayetteville, NC Hoover, AL Greer, SC Wilsonville, OR 510(k) Date(s) 8/11/10; 4/29/13 10/18/11; 12/6/2013 1/3/13 3/18/13, 7/24/13

FDA Number(s) K102025; K130482

K112384, K133029 K123194 K123694; K131561

NSN 6515-01-589-9135 6515-01-616-4999 6515-01-616-5841 6515-01-618-7475

Cost ($ USD, est. USG)

654 515 220 292.50

Weight (gm) 799 485 651 499 Cube (liters) 0.8 1.4 1.6 1.5 Indication(s) Battlefield, difficult inguinal

or axilla bleeds Battlefield, difficult inguinal,

pelvis, or axilla bleeds Difficult inguinal bleeds Difficult inguinal or axilla

bleeds, or pelvic fracture immobilization

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SAM Junctional Tourniquet

 Pelvic fracture clearance existed

–  SAM pelvic binder  Inguinal application

–  Cleared –  Cadaver data

 Axilla application –  Cleared –  Cadaver data

Trial  

Time  to  Hemostasis  

(sec)  

#  of  Hand  Pumps  

45  Seconds  Hemostasis?  

Blood  Loss  (ml)  

Interior  Bulb  

Pressure  (mmHg)  

1   5.7   5   y   25   376  

2   6.9   4   y   21   306  

3   4.9   4   y   30   304  

4   5.3   3   y   30   261  

5   5.3   3   y   80   269  

6   8.9   5   y   25   321  

Average   6.2   4.0       35.2   306.2  

Std  Dev   1.5   0.9   22.2   41.1  

Manikin Data

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SJT Features

 Multiple Indications –  Junctional Hemorrhage Inguinal Area (bi-lateral) –  Axilla Hemorrhage –  Pelvic Fracture Immobilization

 Typical groin application in about 30 seconds  Easy to use (4-step application)  Lightweight (1 lb 1 ounce [488g])

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Key Components

Removable Hand Pump rapidly inflates TCDs

Large, repositionable Target Compression

Devices (TCD)

Illustrated instructions

printed on the product

Large, easily attached buckle

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Four Steps - Inguinal

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Axilla Application

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Future Directions

 Medic testing: axilla   Altitude testing  Manikin testing: axilla   Honest broker testing   Care assessment: case reports   Training assessment: data   Logistic management   Neck (not just its base)   Epidemiology: registry data  More cheap, light, small, rugged   Joint assessments

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Perfused Pig Carcass Model: Neck

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AirWrapTM (Revmedx, Wilsonville, OR)

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Questions & comments

  john.f.kragh.civ@mail.mil

Manikins