Junctional Hemorrhage & Tourniquet Controls Care Overview
Junctional hemorrhage in trauma patients presents a critical challenge because proper casualty care must be administered within minutes. Junctional hemorrhage is characterized by severe bleeding where the torso meets a limb, making the traditional style of tourniquets impractical.
Junctional hemorrhage can result from combat zone injuries or civilian accidents. Because of the potential for rapid and extreme blood loss, these injuries can quickly result in hemorrhagic shock and death if the correct tactical combat casualty care procedures are not applied immediately. Learning to effectively treat these life-threatening hemorrhages before reaching the emergency department could save a life.
Junctional Hemorrhage Overview
A junctional hemorrhage is a compressible external hemorrhage that happens when the large blood vessels that move through the junction are injured. This bleeding can include injuries to the groin, pelvis, armpits, shoulders, or the base of the neck. An injury that occurs too close to the torso for a limb tourniquet to be applied is also considered a junctional hemorrhage.
There are three main approaches to dealing with junctional bleeding both on the battlefield and in civilian trauma patients:
- Direct pressure: Direct pressure with bleeding control supplies such as sterile gauze or pieces of folded material is the first line of defense. Use gauze made with hemostatic agents (hemostatic gauze) if available and press it all the way into the wound.Â
- Wound packing: Wound packing is a great option for junctional injuries where direct pressure is insufficient or becomes difficult to manage. If the bleeding continues after a minute or two, junctional tourniquets are the next step.
- Junctional tourniquet: Because of the unique position of these types of injuries, a conventional tourniquet cannot be used. The SAM® junctional tourniquet is made especially for junctional hemorrhage control and for stabilizing pelvic fractures.
Junctional Hemorrhage Causes
Junctional injuries have many serious and often devastating causes. Tactical combat casualty care procedures can be used to treat junctional hemorrhages due to causes including the following:
- Combat injuries such as those caused by blasts of explosive devices
- Motor vehicle injuries such as those caused by high-speed collisions
- Industrial injuries such as equipment-crushing accidents
- Sports injuries such as high-contact accidents
Junctional hemorrhage from any cause is extremely serious and it is critical to respond promptly and appropriately to prevent the patient from bleeding out.
Challenges in Junctional Hemorrhage Control
There are several key challenges to note when dealing with a massive hemorrhage in a junctional area.Â
Limited Accessibility to Control Bleeding
The groin, pelvis, and armpits are all junctional areas that are difficult to access. The anatomy of these areas may make correct blood vessel compression difficult. This makes it harder for first responders to stop the bleeding effectively.Â
Ineffectiveness of Extremity Tourniquets
Traditional tourniquets cut off the blood supply to extremity wounds. However, when hemorrhage control is needed at a junctional area, a standard tourniquet will not work. For example, an extremity tourniquet would not be effective for an axillary hemorrhage (a hemorrhage in the armpit area) because it cannot fit around the injury or provide pressure around the entire junction of the trunk and the arm.
Risk of Further Injury or Major Hemorrhage
Tactical combat casualty care protocols recommend using junctional tourniquets, wound packing, and direct pressure to control bleeding in junctional areas. However, excessive force or pressure to these types of injuries can further exacerbate the problem and cause additional damage to the surrounding nerves, organs, and blood vessels.
Junctional Tourniquets
Knowing what type of tourniquet to use in an emergency situation can be the difference between life and death. Extremity tourniquets have been used for centuries, and have been used regularly in combat at least back to WW1, if not before. However, as extremity tourniquets do not work for junctional hemorrhage control, junctional hemorrhage deaths have risen to be the main cause of death from hemorrhage in military personnel.
Trauma resulting in hemorrhage is the leading cause of preventable death in the military arena and the second leading cause of death in civilian emergencies. Increased awareness and use of junctional tourniquets could significantly reduce these deaths.
The SAM Junctional Tourniquet
The SAM® Junctional Tourniquet (SJT) is a great option for junctional injuries. The SJT is a CoTCCC-recommended junctional tourniquet. It has four main components:
- A belt
- Two target compression devices (TCDs)
- A buckle
- A pump
Follow these steps to control bleeding with the SAM junctional tourniquet:
- Position the belt around the patient's torso between the injury and the heart.
- Attach the TCD to the belt over the area to be compressed.
- Hold the TCD in place and secure the belt using the buckle.
- Pump up the TCD using the hand pump until the bleeding stops.
To control dangerous bleeding, the patented buckle safeguards the tightening force, ensuring the right amount of force is used. The TCDs on this junctional emergency treatment tool slow arterial bleeding using proximal compression.
The SAM junctional tourniquet can be applied in as little as 25 seconds to provide quick and effective prehospital hemorrhage control. You can buy a SAM junctional tourniquet online or in medical stores.
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Abdominal Aortic and Junctional Tourniquet
Another way to control junctional hemorrhage is with an Abdominal Aortic and Junctional Tourniquet (AAJT™) (formerly Abdominal Aortic Tourniquet or AAT). This junctional emergency treatment tool is a prehospital device designed to stop axillary, pelvic, and lower limb hemorrhage via exterior compression of major vascular structures. It also provides stability for pelvis injuries. The more up-to-date model—the Abdominal Aortic and Junctional Tourniquet-Stabilized (AAJT-S™)—is quicker and easier to apply than its predecessor.
A study published in the Journal of Surgical Research, Volume 226, June 2018 showed that the AAJT is equivalent to Zone 3 resuscitative endovascular balloon occlusion of the aorta (REBOA). REBOA (which was previously only available in the hospital setting) stops massive bleeding and confines blood volume to the heart, brain, and kidneys—depending on the placement of the balloon.Â
Important: The AAJT is contraindicated for pregnant patients, patients with known abdominal aortic aneurysms, and somewhat contraindicated for patients with penetrating abdominal trauma.
Combat Ready Clamp
The CRoC® Combat Ready Clamp is designed to control bleeding in the axilla, inguinal, and neck areas. These clamps are lightweight, durable, and collapsible, making them easy to use anywhere. The clamp can be applied to all seven truncal junctions and the website claims the device can stop bleeding in less than one minute.
Prepare Now to Control Junctional Bleeding
Standard tourniquets are advisable for extremity hemorrhage control, but junctional tourniquets are precisely made to address junctional hemorrhages by focusing on blood vessel compression in hard-to-reach areas.Â
Junctional tourniquets are well suited to their specific locations and function well to stabilize hemorrhage and save lives in emergency situations. Prepare now for junctional hemorrhage control and be empowered to save a wounded person’s life.
