kragh - advancements in tourniquets 2014 -...
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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
Slide 16 of
AirWrapTM (Revmedx, Wilsonville, OR)
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Questions & comments
Manikins