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Assessment of Groin Application of Junctional Tourniquets in a Manikin Model
- John F. Kragh, Jr., Matthew P. Lunati, Chetan U. Kharod, Cord W. Cunningham, Jeffrey A. Bailey, Zsolt T. Stockinger, Andrew P. Cap, Jacob Chen, James K. Aden, 3d, Leopoldo C. Cancio
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 4 / August 2016
- Published online by Cambridge University Press:
- 27 May 2016, pp. 358-363
- Print publication:
- August 2016
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- Article
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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.
HypothesisModels of junctional tourniquet could perform differentially by blood loss, time to hemostasis, and user preference.
MethodsIn 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.
ResultsAll 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 < .0001) and SJT-JETT (P = .0085) were statistically significant in their mean difference, while CRoC-SJT (P = .35) was not. For time to hemostasis in pairwise comparison, the CRoC had a significantly shorter time compared to JETT and SJT (P < .0001, both comparisons); SJT-JETT was also significant (P = .0087). In responding to the directive, “Rank the performance of the models from best to worst,” users did not prefer junctional tourniquet models differently (P > .5, all models).
ConclusionThe 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 .
Haitian Earthquake Relief: Disaster Response Aboard the USNS Comfort
- Ryan M. Walk, Timothy F. Donahue, Zsolt Stockinger, M. Margaret Knudson, Miguel Cubano, Richard P. Sharpe, Shawn D. Safford
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 6 / Issue 4 / December 2012
- Published online by Cambridge University Press:
- 08 April 2013, pp. 370-377
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Objective: The Haitian earthquake of January 12, 2010, was a disaster essentially unprecedented in the Western Hemisphere's recorded history. The USNS Comfort departed from Baltimore, Maryland, within 72 hours of the earthquake and arrived in Port-au-Prince harbor on January 19. During the subsequent 40 days, the ship provided one of the largest relief efforts in the US Navy's history.
Methods: The data analyzed included all patients evaluated and treated by the USNS Comfort between January 19 and February 27, 2010. A medical chart with a unique identifier was created for each patient on admission. A patient database was created from these records and used for this analysis.
Results: A total of 872 patients and 185 patient escorts were processed aboard the ship. Ages ranged from younger than 1 day to 89 years: 635 were adults and 237 were children. Of those admitted, 817 of the patients were admitted for longer than 24 hours; the average length of stay was 8.0 days. The need for surgery was substantial: 454 patients went to the operating room (OR) 843 times for 927 cumulative procedures. A total of 58 patients underwent amputations.
Conclusions: Haiti was almost completely reliant on foreign medical teams for trauma care. Analysis of the data illustrates the challenges of triage and treatment in a humanitarian mass-casualty response. The remarkable coordination and cooperation among the Haitian Ministry of Health, nongovernmental humanitarian aid organizations, and the US military highlighted the responders' respective capabilities and demonstrated the importance of collaboration in future disaster response efforts.
(Disaster Med Public Health Preparedness. 2012;6:370–377)