title: Evaluation of Two Junctional Tourniquets Used on the Battlefield: Combat Ready Clamp® versus SAM® Junctional Tourniquet.
abstract: BACKGROUND
  Junctional hemorrhage (i.e., between the trunk and limbs) are too proximal for a tourniquet and difficult to compress. These hemorrhages are responsible for 20% of preventable deaths by bleeding on the battlefield. The majority of these involve the groin area. Devices allowing a proximal compression for arterial axes have been recently developed.
  
  
  OBJECTIVE
  The purpose of this study was to compare the use of two junctional- tourniquet models, the Combat Ready Clamp (CRoC®) and the SAM® Junctional Tourniquet (SJT), in simulated out-of-hospital trauma care when tourniquets were ineffective to stop the arterial flow.
  
  
  METHODS
  During our clinical study, 84 healthy volunteers wearing battle dress performed a physical exercise to come approximate the operational context. The volunteers were randomly divided into two groups according to the device (the CRoC or SJT) used as supplement to a tourniquet self-applied to the root of the thigh. The primary study end point was the complete interruption of popliteal arterial flow, measured with Doppler auscultation. Time to effectiveness and subjective questionnaire data to evaluate the devices' application were also collected.
  
  
  RESULTS
  Junctional device effectiveness was almost 90% for both the CRoC and the SJT, and did not differ between them, either used with a tourniquet (ρ = .36) or alone (ρ = .71). The time to effectiveness of the SJT was significantly shorter than that of the CRoC (ρ = .029).
  
  
  CONCLUSIONS
  The SJT and the CRoC were equally effective. The SJT was faster to apply and preferred by the users. Our study provides objective evidence to the French Tactical Casualty Care Committee for improving junctional hemorrhage treatment.
authors.forename: Jean-Guillaume
authors.initials: JG
authors.lastname: Meusnier
authors.forename: Charles
authors.initials: C
authors.lastname: Dewar
authors.forename: Erti
authors.initials: E
authors.lastname: Mavrovi
authors.forename: Frederic
authors.initials: F
authors.lastname: Caremil
authors.forename: Pierre-Francois
authors.initials: PF
authors.lastname: Wey
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Martinez
mesh_terms: D004867:Equipment Design; D006119:Groin; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008887:Military Medicine / Q000295:instrumentation; D008889:Military Personnel; D014111:Tourniquets / Q000592:standards*; D014857:Warfare