title: Assessment of Groin Application of Junctional Tourniquets in a Manikin Model.
abstract: Introduction To aid in preparation of military medic trainers for a possible new curriculum in teaching junctional tourniquet use, the investigators studied the time to control hemorrhage and blood volume lost in order to provide evidence for ease of use. Hypothesis Models of junctional tourniquet could perform differentially by blood loss, time to hemostasis, and user preference.
  
  
  METHODS
  In a laboratory experiment, 30 users controlled simulated hemorrhage from a manikin (Combat Ready Clamp [CRoC] Trainer) with three iterations each of three junctional tourniquets. There were 270 tests which included hemorrhage control (yes/no), time to hemostasis, and blood volume lost. Users also subjectively ranked tourniquet performance. Models included CRoC, Junctional Emergency Treatment Tool (JETT), and SAM Junctional Tourniquet (SJT). Time to hemostasis and total blood loss were log-transformed and analyzed using a mixed model analysis of variance (ANOVA) with the users represented as random effects and the tourniquet model used as the treatment effect. Preference scores were analyzed with ANOVA, and Tukey's honest significant difference test was used for all post-hoc pairwise comparisons.
  
  
  RESULTS
  All tourniquet uses were 100% effective for hemorrhage control. For blood loss, CRoC and SJT performed best with least blood loss and were significantly better than JETT; in pairwise comparison, CRoC-JETT (P .5, all models).
  
  
  CONCLUSIONS
  The CRoC and SJT performed best in having least blood loss, CRoC performed best in having least time to hemostasis, and users did not differ in preference of model. Models of junctional tourniquet performed differentially by blood loss and time to hemostasis. Kragh JF Jr , Lunati MP , Kharod CU , Cunningham CW , Bailey JA , Stockinger ZT , Cap AP , Chen J , Aden JK 3d , Cancio LC . Assessment of groin application of junctional tourniquets in a manikin model. Prehosp Disaster Med. 2016;31(4):358-363.
authors.affiliation: 1US Army Institute of Surgical Research - Damage Control Resuscitation,JBSA Fort Sam Houston,TexasUSA.
authors.forename: John F
authors.initials: JF
authors.lastname: Kragh
authors.affiliation: 2University of Texas Health Science Center at San Antonio - School of Medicine,San Antonio,TexasUSA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Lunati
authors.affiliation: 3San Antonio Military Medical Center - Emergency Medical Services,JBSA Fort Sam Houston,TexasUSA.
authors.forename: Chetan U
authors.initials: CU
authors.lastname: Kharod
authors.affiliation: 3San Antonio Military Medical Center - Emergency Medical Services,JBSA Fort Sam Houston,TexasUSA.
authors.forename: Cord W
authors.initials: CW
authors.lastname: Cunningham
authors.affiliation: 1US Army Institute of Surgical Research - Damage Control Resuscitation,JBSA Fort Sam Houston,TexasUSA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bailey
authors.affiliation: 1US Army Institute of Surgical Research - Damage Control Resuscitation,JBSA Fort Sam Houston,TexasUSA.
authors.forename: Zsolt T
authors.initials: ZT
authors.lastname: Stockinger
authors.affiliation: 1US Army Institute of Surgical Research - Damage Control Resuscitation,JBSA Fort Sam Houston,TexasUSA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
authors.affiliation: 1US Army Institute of Surgical Research - Damage Control Resuscitation,JBSA Fort Sam Houston,TexasUSA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Chen
authors.affiliation: 1US Army Institute of Surgical Research - Damage Control Resuscitation,JBSA Fort Sam Houston,TexasUSA.
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.affiliation: 1US Army Institute of Surgical Research - Damage Control Resuscitation,JBSA Fort Sam Houston,TexasUSA.
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
mesh_terms: D004638:Emergency Treatment / Q000379:methods / Q000592:standards*; D006119:Groin / Q000293:injuries*; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008348:Manikins; D008887:Military Medicine / Q000193:education* / Q000379:methods / Q000592:standards; D000066908:Simulation Training / Q000379:methods / Q000592:standards*; D014111:Tourniquets; D014481:United States
keywords: CRoC Combat Ready Clamp; Emergency Medical Services; FDA US Food and Drug Administration; JETT Junctional Emergency Treatment Tool; SJT SAM Junctional Tourniquet; USAISR US Army Institute of Surgical Research; hemorrhage; tourniquet