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Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) can be applied both successfully and rapidly by Combat Medical Technicians (CMTs)
  1. Thomas Nicholas Smith1,
  2. A Beaven2,
  3. C Handford2,
  4. E Sellon3 and
  5. P J Parker2
  1. 1Foundation Year Medical Officers, Queen Elizabeth Hospital, Birmingham, West Midlands, UK
  2. 2Orthopaedics, Queen Elizabeth Hospital, Birmingham, UK
  3. 3Radiology, John Radcliffe Hospital, Oxford, Oxfordshire, UK
  1. Correspondence to Thomas Nicholas Smith, Foundation Year Medical Officers, RCDM, Birmingham, B15 2WB, UK; smith_tom1{at}


Background ‘Non-compressible’ haemorrhage is the leading cause of preventable battlefield death, often requiring surgical or radiological intervention, which is precluded in the pre-hospital environment. One-fifth of such bleeds are junctional and therefore potentially survivable. We examine the use of the Abdominal Aortic Junctional Tourniquet - Stabilized (AAJTS) among UK Combat Medical Technicians (CMTs) as a device to control junctional haemorrhage with external compression of the abdominal aorta—compression of junctional haemorrhage previously considered ‘non-compressible.’ This follows animal studies showing that the AAJTS achieves control of haemorrhage and improves physiological parameters.

Methods CMTs were selected and applied the AAJTS to each other following a 1-hour training package. A consultant radiologist-operated hand-held ultrasound monitored flow changes in the subjects’ common femoral artery. CMTs were then surveyed for their opinions as to utility and function.

Results 21 CMTs were screened and 17 CMTs participated with 34 total applications (16 day and 18 low-light). 27/34 (79%) achieved a successful application. The median application time was 75 s in daylight and 57 s in low-light conditions. There was no significant difference in Body Mass Index (p=0.23), median systolic blood pressure (p=0.19), nor class of CMT (p=0.10) between successful and unsuccessful applications. Higher systolic blood pressure was associated with longer application times (p=0.03). Users deemed the device easy to use (median score 4.4 on a 5-point Likert scale).

Conclusion CMTs can use AAJTS successfully after a 1-hour training session in the majority of applications. Application was successful in both daylight and low-light conditions. Self-reported usability ratings were high.

  • trauma management
  • orthopaedic & trauma surgery
  • trauma management

Data availability statement

Data are available on reasonable request. Data available on reasonable request from T Smith ORCID - 0000-0001-8510-7832

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Data availability statement

Data are available on reasonable request. Data available on reasonable request from T Smith ORCID - 0000-0001-8510-7832

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  • Contributors CH, AB and PJP conceived the original concept and designed the study. TNS and ES performed data collection, which was overseen by PJP. TNS prepared the manuscript, with AB providing guidance and editorialisation. All authors approved the final draft. TS acts as guarantor.

  • 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.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.