Junctional Haemorrhage Control
The term “junctional haemorrhage” refers to injuries and bleeding occurring at the transition zones between the extremities and the torso. Although not an extremity, the neck is generally included in this category. Junctional haemorrhage injuries are difficult to manage as the vasculature is not amenable to circumferential compressions like limb bleeding and tourniquet placement.
Typical wounding mechanisms during that time in Lebanon were AK and M16 rifles, as well as rockets, and explosives. Sixty-three percent of his patients were military and 37% were civilian. During the time of that conflict, body armour would have been sparse at best. If armour was available, it would have been more traditional military “flak vests,” which have limited ballistic protection as they were designed to stop larger, high velocity, non-aerodynamic metal fragments, not bullets. Certainly, we can assume that 37% of his patients that were civilians were un-armoured.
Axila junctional haemorrhage wound because of the street fighting that often occurred throughout the country and near hospitals, 78% of the patients arrived in the Emergency Department within four minutes after being wounded. 97% of the wounds occurred from high-velocity missiles and fragments.
Of the Lebanese surgeon’s 1008 casualties with peripheral vascular injuries, 50% involved femoral and popliteal vasculature which we would assume could be managed with a tourniquet.
However, adding together injury to a “junctional” artery, vein, or both, 5% of patients had subclavian, 2% axillary, and 10% iliac vessel injuries. The carotid artery and Jugular vein injuries accounted for another 10% of injuries. Therefore 27% of his patients with what he felt were peripheral vascular injuries would not be expected to be manageable with a tourniquet. Although there are four “Junctional Tourniquets” commercially available, their penetrance in the civilian US market is minimal.
What does all this mean? You need to know how to pack junctional wounds if you are to save a casualty from bleeding to death from wounds in these locations. You can learn these skills in our online courses.
