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Managing junctional haemorrhage in the combat environment
  1. Shane A Smith1,2,
  2. V C McAlister1,
  3. L Dubois1,
  4. A Beckett2,3 and
  5. R Hilsden1,2
  1. 1 Surgery, Western University, London, Ontario, Canada
  2. 2 Surgery, Royal Canadian Medical Service, Ottawa, Ontario, Canada
  3. 3 Surgery, McGill Universiy, Montreal, Quebec, Canada
  1. Correspondence to Maj Shane A Smith, Surgery, Western University, London, ON N6A 3K7, Canada; shane.smith{at}


Tactical combat casualty care and the application of extremity tourniquets have saved lives in combat. In the modern combat environment junctional injuries are common and difficult to treat. Recently, junctional tourniquets have emerged as a potential solution to this problem. Junctional tourniquets can be used as an adjunct to persistent haemorrhage despite application of conventional tourniquets or in the persistently hypotensive casualty. Surgeons must have an approach to receiving patients with junctional tourniquets in place in the operating room. The algorithms presented allow for an evidence-based and command-driven implantation of junctional tourniquets as part of tactical combat casualty care.

  • vascular surgery
  • accident & emergency medicine
  • trauma management
  • surgery

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  • Contributors All authors contributed to the creation of the algorithms. SAS prepared the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors

  • Disclaimer The views expressed in this paper are those of the authors and do not constitute the views or policies of the Canadian Armed Forces.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Since this is a commentary and review no IRB/ERB approval was required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Author note SS, AB and RH are members of the Canadian Armed Forces.

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