Dysfunction At The Junction

💢 Stop the Bleed Where It Counts: A Street-Level Look at Junctional Tourniquets

Let’s be honest: bleeding control is one of those skills we all know has to be flawless. It’s one of the few things we can do that literally buys time for our patients — and sometimes, it’s the only thing that will.

We’ve gotten good at extremity tourniquets. Most of us can slap one on in seconds. But what happens when the bleed isn’tin an arm or a leg? What if it’s pouring out from the groin, axilla, or pelvis? You know — those spots where our go-to CAT tourniquets just won’t cut it?

That’s where junctional tourniquets (JTQs) come into play. They’re not new to military medics, but more and more civilian EMS agencies are recognizing their value. And if you’re not yet carrying one on your truck, it might be time to ask why.

🩸 Why Junctional Bleeding Matters

Junctional hemorrhage — bleeding from the pelvic, inguinal, or axillary regions — is a leading cause of preventable death in trauma. The problem is, these bleeds are in locations that are tough to compress, pack, or clamp in the field. You can’t tourniquet a pelvis with a CAT, and direct pressure only gets you so far — especially when you're trying to drag someone out of a wrecked vehicle or you're working solo on scene.

Studies in the past few years show that junctional tourniquets can reliably occlude major vessels in the groin or axilla. The newer devices are faster, easier to apply, and don’t require a second set of hands. If you've trained with one, you know what a game-changer it is.

🧠 Pro tip: A 2020 study found success rates for vascular occlusion in volunteers at 83–95% depending on the device used (CRoC, SJT, JETT).
— Kalin et al., Journal of Trauma and Acute Care Surgery, 2020.

🚑 What Devices Are Out There?

If your agency’s shopping for a JTQ, here are the main FDA-cleared options:

  • SAM Junctional Tourniquet (SJT) – Very intuitive. Good for axilla and groin.

  • JETT (Junctional Emergency Treatment Tool) – Simple and compact.

  • CRoC (Combat Ready Clamp) – A bit bulkier, but strong vascular control.

  • AAJT (Abdominal Aortic and Junctional Tourniquet) – Unique in that it can compress the abdominal aorta; great for pelvic bleeds and crush injuries.

We used the SJT on a training day last fall, and the difference between “theoretical” control and actual pressure on a femoral artery was eye-opening. The whole crew felt more confident just having it in the kit.

🛠️ When to Reach for One

Here’s the reality: If you’ve got a massive hemorrhage at a site where your CAT doesn’t reach and pressure isn’t doing the job, you need a junctional device. Think:

  • Pelvic trauma with uncontrolled groin bleeding

  • Axillary gunshot wounds

  • Blast injuries with junctional involvement

  • MCI or hostile scenes where you’re moving patients fast

Bonus: Devices like the AAJT have even been used for temporary aortic occlusion in patients bleeding from intra-abdominal trauma. (We’re talking advanced practice here, but it’s worth knowing.)

💡 Real-World Lessons

Let me share something real. A medic friend in Texas told me about a 2024 MVC where a motorcyclist had a groin impalement. Bleeding everywhere. CAT was useless. Thankfully, they had a junctional device on board. Two minutes later — pressure, no distal pulse, and bleeding slowed dramatically. He survived to OR.

That same department now includes JTQ deployment in all trauma training scenarios. And the cool part? They’re seeing faster recognition and more confident decisions across the board.

🧪 What the Research Tells Us (and Doesn’t)

While studies in volunteers and simulated settings have been promising, real-world civilian data is still growing. Most research comes from military use or healthy participants in labs. But so far:

  • Providers can deploy JTQs in <2 minutes with proper training.

  • Most effective when paired with wound packing, hemostatic gauze, TXA, and early transport.

  • Minimal complications when properly placed and monitored.

The Committee on Tactical Combat Casualty Care (CoTCCC) recommends JTQs as first-line for junctional bleeds — and we should take that seriously.

🚨 “EMS agencies must train and equip for these injuries before they happen — not after.”
— American College of Surgeons, 2021 TCCC Guidelines

📝 What You Can Do Right Now

✅ Check your protocols – Are JTQs authorized? If not, advocate.
✅ Practice – Train on real people, mannequins, and under pressure.
✅ Stock smart – Choose a device that fits your team and environment.
✅ Team up – Incorporate JTQs into MCI, active shooter, and high-risk trauma drills.
✅ Debrief and share – Every field application teaches all of us.

🎯 Final Thoughts

Look — no one hopes to use a junctional tourniquet. But when you're kneeling in gravel next to a mangled car and someone's life is literally bleeding out in front of you, hope isn’t a plan.

The gear exists. The training exists. The evidence is mounting. Now it’s on us — the people showing up first — to be ready when the bleed doesn’t play by the rules.


#bloggingfromthebay

— CrashCart Kelly

📚 References

  1. Kalin, L., et al. (2020). Comparison of four junctional tourniquets in human volunteers. Journal of Trauma and Acute Care Surgery.

  2. Arana, A. A., et al. (2021). Junctional hemorrhage and control strategies in trauma. American College of Surgeons.

  3. StatPearls Publishing. (2024). Junctional Tourniquet Use.

  4. JTS/CoTCCC Guidelines. (2021–2023). Hemorrhage Control Recommendations.

  5. Rockwall EMS Protocol Manual (2025). Junctional Tourniquet and Field Blood Protocols.

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