Junctional tourniquet. A review.

The recent joint position statement of the US medical societies related to trauma patients (ACS, ACEP and NAEMSP) on prehospital hemorrhage management and treatment includes the use of junctional tourniquets to apply pressure in regions (shoulder/axilla and groin) that are too proximal for extremity tourniquet application. Nevertheless, the document also points that there is still inadequate clinical experience and data in civilian trauma to routinely recommend them.

As these are devices with very limited knowledge among civilian EMS providers (at least in Spain) we have gathered some information to give our readers a perspective on them. First of all, a StatPearls review, updated on November 2023, on EMS junctional hemorrhage control: https://bit.ly/3Lz9WxG . The article describes the four different devices that, evaluated on healthy volunteers in a systematic review published in 2019, https://bit.ly/3Yf8CHP , proved to be effective to achieve vascular occlusion. Its use in the combat environment is less controversial than in the civilian one, and this article, published in 2020, proposes an algorhytm for an implantation of junctional tourniquets as par of tactical combat casualty care. https://bit.ly/4cX0mkf

One of these devices is the SJT (SAM Junctional Tourniquet), that consists on a modified SAM pelvic sling in which we put a target compression device, inflatable with a removable hand pump. You can download here, https://bit.ly/4cMwEhM , a document that shows what the SJT is and how it works, and that includes a link to this video:

A similar device, belt-base, is the AAJT-S (Abdominal Aortic Junctional Tourniquet-Stabilized), a belt that uses a windlass to tighten and stabilize its position on the abdomen, groin or axilla. Once in place, a pneumatic bladder is inflated to occlude the aorta, iliac artery, or axillary artery. https://bit.ly/3LAqllv . This video shows you how to use it:

The CRoC^®Combat uses a different approach. It’s not inflatable; it has a vice-like compression disk that creates, according to the spefications sheet of the product, https://bit.ly/3SlA1Ed , bi-directional pressure exactly where it is needed, stopping collateral flow and controlling hemorrhage. 

Finally, The Junctional Emergency Treatment Tool™ (JETT^®) is a belt that includes two pressure devices in a single tool, allowing for simultaneous occlusion of blood flow to both lower limbs (bilateral) with an easy to apply, pre-assembled, ready-to-use belt solution. You can take a look at it in this brochure, https://bit.ly/3A3P5jp, and learn how to apply it in this video: