Lt. Gen. Nadja Y. West, the new Army Surgeon General, posed the battlefield medicine question Thursday that had no answer until recently: “How do you put a tourniquet around the chest?”
It couldn’t be done with the standard issue Combat Application Tourniquet for torso or high leg and arm wounds, West said, but the Army has now developed “junctional tourniquets” to stop the bleeding for most body areas.
The Army’s Medical Materiel Agency (USAMMA), a subordinate command of the U.S. Army Medical Research and Materiel Command (USAMRMC) at Fort Detrick, Maryland, has already begun fielding the new tourniquets to improve battlefield survivability rates.
The junctional tourniquets weigh about one pound, strap on like a belt, and include two inflatable air bladders – much like those on the arm cuff for taking blood pressure -- that medics can inflate individually or together to apply pressure to a wound.
“The device is designed so that a person can position it in under a minute -- a crucial factor for combat medics who only have mere minutes to save a fellow warfighter's life if he or she is hemorrhaging,” according to USAMMA.
Each device comes with a training DVD and step-by-step instructions printed on the actual tourniquet as well as on an instructional card. The U.S. Army Medical Department Center and School staff is also training new combat medics on how to use junctional tourniquets.
“One of the unique elements about this device is that it is easy to carry and use, yet incredibly effective when used properly," said Megan McGhee, a biomedical engineer and product manager assigned to the Project Management Office for Medical Devices at USAMMA, according to an Army report.
At a breakfast with defense reporters, West said the new tourniquets were part of a kind of renaissance for the use of tourniquets in general in the military and in civilian life to meet the first challenge of any traumatic injury – stop the bleeding.
“We actually got away from tourniquets” over concerns that their application might lead to the loss of a limb, West said, “so we actually got away from tourniquets for a while.”
But the Army found that getting a tourniquet in place quickly and “not necessarily by a medical person but by the infantryman, the soldier that was right there on the ground when the injury occurred – getting that tourniquet on saved a lot of lives,” West said.
The correct use of tourniquets contributed to survivability rates from battlefield wounds that averaged 89.8 percent in Iraq and 91.4 percent in Afghanistan, compared to 76 percent in Vietnam, 78.2 percent in Korea, and 70.7 percent in World War II, according to Army statistics.
“Tourniquets throughout history have kind of been in vogue and out of vogue,” West said. “More recently, the concern has been that those who didn’t know how to apply them would put them on too tightly or leave them on too long,” with the result being the loss of a limb.
“So people were starting to get adverse to using tourniquets. But then we found that this adversion to using tourniquets” could lead to a soldier exsanguinating – or bleeding to death – “because folks were more concerned about salvaging the limb,” West said.
Law enforcement has followed the Army’s lead on tourniquets as lifesavers. In June the American Medical Association recommended that all law enforcement, firefighters and the general public be trained in the use of tourniquets to stop traumatic bleeding.
According to the Centers for Disease Control, post-traumatic bleeding is the leading cause of potentially preventable death among trauma patients. In response, the Department of Homeland Security began a new program called "Stop the Bleed."
With the backing of the White House, national programs have also begun to place tourniquets in schools, stadiums, airports, malls and other places to reduce casualties from terrorist attacks and bombings.