Junctional Hemorrhage: When a Tourniquet Won't Work

The most challenging problems in trauma care: massive bleeding from "junctional" areas. These are the locations where the limbs meet the torso—the groin, the buttocks, the pelvis, the armpits (axilla), and the base of the neck. Standard extremity tourniquets are ineffective in these areas. This advanced topic demonstrates a higher level of expertise and introduces the specialized equipment designed to control these devastating injuries.

The SAM Junctional Tourniquet (SJT): Controlling the Uncontrollable

Junctional hemorrhage is exceptionally deadly because the major blood vessels in these areas, like the femoral and axillary arteries, are large and cannot be compressed by a standard tourniquet placed on an arm or leg. An injury in the groin or armpit requires a different tool and a different strategy.

The SAM Junctional Tourniquet (SJT) is a purpose-built device designed to address this exact problem. It consists of a belt that is secured around the pelvis or torso and one or more Target Compression Devices (TCDs). The TCD is a robust, pump-actuated bladder that can be precisely positioned over the source of the bleeding. Once the belt is secured, the user inflates the TCD with an integrated hand pump until it applies enough direct pressure to the artery to stop the blood flow.  

The SJT is a versatile device that can be used for bilateral inguinal (groin) injuries, pelvic fractures (by acting as a pelvic binder), and axillary (armpit) hemorrhage. Its application is an advanced skill requiring a thorough understanding of anatomy and the device's mechanics, but for these specific, highly lethal injuries, it is an indispensable life-saving tool.  

Pros and Cons of the SJT

• Pros:

  • Versatile Application: It is designed to control hemorrhage in both inguinal (groin) and axilla (armpit) areas where standard tourniquets are ineffective.  

  • Dual-Function: It is the only junctional device that is also FDA-cleared to stabilize pelvic fractures, making it a valuable two-in-one tool for blast or crush injuries.  

  • Rapid and Simple: The device is designed for quick application (typically under 25 seconds) with a simple four-step process and an AUTOSTOP buckle that "clicks" to confirm correct tightness.  

• Cons:

  • Respiratory Impact: When used for axillary hemorrhage, the device can restrict chest movement and affect breathing, which may require mitigation with mechanical ventilation.  

  • Difficult in Protective Gear: Application time and difficulty increase significantly when the user is wearing MOPP or CBRN protective gear.  

  • High Cost and Training Requirement: As a specialized device, it is expensive and requires a higher level of training to use correctly and safely.  

The JETT™: Another Tool for Junctional Bleeding

The Junctional Emergency Treatment Tool (JETT™) from North American Rescue is another specialized device designed primarily to control hemorrhage in the inguinal region (groin). It operates on a similar principle to the SJT but with a different mechanical design.  

The JETT™ consists of a belt that is applied around the casualty's pelvis and two compression pads that are positioned over the femoral arteries. The user then tightens the device using a windlass-like mechanical system, which drives the compression pads down into the groin, applying direct pressure to the source of the bleeding. It is designed for rapid application and can be used to control bleeding from one or both legs simultaneously.  

Like the SJT, the JETT™ is an advanced piece of equipment intended for use by trained medical providers. The existence of these specialized tools highlights a key evolution in tactical medicine: the recognition that junctional hemorrhage is a major cause of preventable death and the development of specific, engineered solutions to combat it.

Pros and Cons of the JETT™

• Pros:

  • Bilateral Capability: A single device can treat both unilateral and bilateral groin injuries simultaneously with its two pre-positioned, individually adjustable compression pads.  

  • Mechanical System: As a purely mechanical device, it is not affected by changes in altitude or temperature that can cause pneumatic devices to lose pressure during transport.  

  • Ready to Use: The device is pre-assembled and designed for easy application at or near the point of injury, saving critical time.  

• Cons:

  • Limited Application: It is indicated for inguinal (groin) use only and cannot be used for axillary (armpit) hemorrhage.  

  • Bulky and Heavy: The device is relatively heavy (over 1.5 lbs) and bulky, making it more difficult to carry in an individual kit compared to an extremity tourniquet.  

  • Limited Clinical Data: Compared to other junctional devices, there are fewer published reports of its clinical use in the field.  

Be prepared. Be Confident.