Life-saving Battlefield Tourniquet Approved for Use by Alabama First-Responders

The Abdominal Aortic Junctional Tourniquet™ (AAJT) that treats both pelvic hemorrhage and severe bilateral lower junctional hemorrhage has been approved for use by paramedics and other first-responders in Alabama.The AAJT, approved for military use in 2012 by the Federal Drug Administration (FDA), has saved many lives on the battlefield. Studies now show it also has applications for civilian populations and can assist emergency responders with patients who have massive, uncontrollable bleeding.

New research has shown that the AAJT capabilities are equivalent to Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Zone 3 of the aorta which extends from the lowest renal artery to the aortic bifurcation. “REBOA can be life-saving in trauma patients, and now we have data that shows the AAJT is equivalent to this intervention,” says John Croushorn, MD, an emergency medicine physician and one of the inventors of the tourniquet. His company, Compression Works LLC, (compressionworks.com) is the developer and manufacturer of the device.

“The significance is remarkable,” he says. “The cost of the most popular REBOA kits is just less than $2,000, requires a physician to perform the procedure using ultrasound, and has similar risks to a cardiac catheterization. The AAJT costs about $500 and can be placed by anyone. No knowledge of anatomy is required and it does not involve the invasive risks of the REBOA procedure.”

This alternative use of the AAJT device was observed in 2013 by a British military physician who was using the tourniquet on a severely wounded soldier. As he monitored the patient’s end-tidal carbon dioxide (CO2) levels, the patient’s CO2 dropped to a morbidly low 16 percent. “When they put the AAJT device on the soldier, his CO2 increased to the normal level of 60 percent in 60 seconds,” Croushorn says. “That is one of REBOA’s effects, and we saw it before we even knew about REBOA.”

Jason Rall, PhD, Senior Research Scientist at CFD Research Corporation in San Antonio, TX, and his colleagues studied the REBOA and AAJT techniques for pelvic and high junctional injuries in the field. Their findings concluded that both the AAJT and Zone 3 REBOA were equivalent in the effects on cardiac output, systemic vascular resistance, and mean arterial pressure.

“They found no differences in peripheral capillary oxygen saturation (SpO2) and the partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio,” Croushorn says. “If the two interventions show the same survival, hemostatic, hemodynamic and metabolic profiles in multiple studies, why wouldn’t you use the alternative that is less invasive, less expensive, safer and quicker?”

Croushorn points out that the device, being equivalent to REBOA, enables paramedics to perform the same life-saving intervention at an accident scene that physicians would provide at a hospital. “The AAJT procedure provides a bridge mechanism to help get the patient to the hospital alive,” he says.

Another exciting study related to the AAJT was presented at the Military Health System Research Symposium recently. Researchers from the 59 Medical Wing of the Air Force in San Antonio examined the use of the AAJT in cardiopulmonary resuscitation (CPR) following cardiac arrest. “Traumatic cardiac arrest is a difficult problem, because standard CPR is ineffective,” Croushorn says.

The research showed the AAJT improved outcomes in a traumatic cardiac arrest model precipitated by Class IV hemorrhage and remained in arrest for three minutes before resuscitation was started. “It wasn’t just a subtle improvement,” Croushorn says. “A Kaplan-Meier survival analysis showed a survival rate of 83 percent with the AAJT application. Hemodynamically, carotid blood flow and carotid blood pressure increased with the tourniquet.”

Croushorn says he and other long-practicing physicians in his field don’t completely understand how this type of resuscitation can occur. “As a doctor who has done this for 20 years, I still don’t understand the physiologic capability of stopping all the blood flow through the aorta,” he says. “It is dramatic in the potential life-saving that can occur, and for a paramedic to have that resource inhand is amazing.”

Croushorn and his colleagues continue to study the capabilities of the AAJT and currently are working with the military to determine if a small revision in the tourniquet can treat non-compressible torso hemorrhage. They are also working with physicians in third world countries to ascertain the potential impact of the AAJT on post-partum hemorrhaging, a major cause of death in that part of the world.

Complications of the Abdominal Aortic and Junctional Tourniquet: What the research says

Tactical medics worldwide use the Abdominal Aortic and Junctional Tourniquet™ (AAJT) to
control hemorrhage from armpit, groin and pelvic injuries. Research over the last Zve years has
proven that the AAJT can effectively halt massive bleeding, and battleZeld experience shows that the device can save lives. But what about complications?

When applied to the abdomen, the AAJT compresses
the descending aorta to occlude blood ]ow to the pelvis
and extremities. Some medical professionals have
expressed concern that extended compression of the
abdomen can lead to bowel ischemia and other
problems. What do animal and human studies indicate?

According to Richard Schwartz, MD, co-inventor of the AAJT, research consistently shows that abdominal application is safe when used within the FDA-cleared application time of 60 minutes. In addition, at the inguinal or axillary application sites, the AAJT has the same 4-hour recommended application time as other junctional tourniquets.

“While recent papers identify potential complications after extended application of the device, these
studies actually reinforce the Znding that the AAJT is safe when used as indicated,” Dr. Schwartz said.
“Beyond that, the research also sheds light on how to think about the AAJT when making real-life ‘risk This article was developed by Trauma System News in cooperation with our advertiser,
Compression Works.“ AAJT abdominal placement (click to enlarge) versus beneZt’ decisions.”

Swedish military study

Recently, researchers funded by Swedish Defense examined the effects of prolonged abdominal
placement of the AAJT. Their Zndings were published online in the Journal of Trauma and Acute Care Surgery in July 2018.

In the study, 15 pigs were subjected to a class II hemorrhage. Five received the AAJT for 60 minutes and Zve received the device for 240 minutes (there was also a ]uid-only control group). Here are the key results:

  • The AAJT was hemodynamically and respiratorily tolerable for all animals in the study.
  • Animals in the 240-minute group showed signs of small intestine and liver ischemia, hyperkalemia, metabolic acidosis and other complications.
  • Animals in the 60-minute group displayed only minimal complications, and all consequences of reperfusion were reversible.

“In this study, there were really no substantial complications
associated with abdominal application of the AAJT up to one hour,”
Dr. Schwartz said. “After four hours of application, predictably, there
were complications. However, with any tourniquet, if you leave it on
long enough you will develop ischemia.”

These Zndings align with early tests of the AAJT. “In our preliminary
data, we began to see a rise in potassium after about 90 minutes of
application,” Dr. Schwartz said. “That’s why when we submitted our
premarket notiZcation to the FDA, we speciZed a 60-minute
application time when used on the abdomen for aortic occlusion.”

Although extended application led to signiZcant complications in this study, Dr. Schwartz noted that the survival rate was 100% in an intensive care setting. “They were actually able to resuscitate all the animals, even after 240 minutes of application.”

U.S. Army study

In a similar investigation, researchers from the U.S. Army Institute of Surgical Research studied
abdominal application of the AAJT for 60, 90 and 120 minutes. Their results were published online in the Journal of Surgical Research in June 2018. Here are the main Zndings:

  • All animals in the 1-hour group recovered full mobility within 1 week. Damage to muscle, nerve and
    intestinal tissue was insigniZcant or undetectable.
  • Half of the animals in the 1.5-hour group developed persistent hind leg paraplegia.
  • All animals in the 2-hour group developed persistent paraplegia and other complications.

“These results suggest that the timeframe where problems start to
develop is between 1.5 and 2 hours,” Dr. Schwartz said. “But this paper
essentially shows the same Znding as the Swedish study — at 60 minutes
of abdominal application the AAJT is safe.”

Dr. Schwartz believes the complications data should be viewed in relation to other interventions for massive bleeding. For example, a recent military study demonstrated that in terms of physiology, abdominal application of the AAJT is essentially equivalent to Zone 3 REBOA. “The complications associated with the AAJT after extended application are very similar to what we see with REBOA within these timeframes,” he said.

He also believes the data sheds light on the question of risks versus beneZts. “The AAJT is indicated for individuals with devastating injuries in situations where there really is no other means of controlling the hemorrhage,” Dr. Schwartz said. “In these situations, the choice may be between a dead casualty and a casualty with ischemic gut if application goes over 60 minutes.”

Future directions

“Every study shows that abdominal application of the AAJT is safe for 1 hour — in my opinion that question is answered,” Dr. Schwartz said. New research will examine just how far the window of safety extends. “We need to do more work to identify the ‘in]ection point’ where you begin to see irreversible ischemic change.”

Dr. Schwartz is Chairman of Emergency Medicine and Hospitalist Services at the Medical College of Georgia at Augusta University. He and his colleagues are now designing a study that will look at AAJT complications that emerge between 1 and 2 hours of abdominal placement.

Future studies may also investigate the AAJT as an intervention for unstable pelvis. “The AAJT is the only FDA-cleared solution for the prevention of shock in pelvic bleeding,” said John Croushorn, MD, co-inventor of the device. “So pelvic fracture is an area we have a lot of interest in.”

Other investigations could focus on the AAJT as an adjunct to resuscitation. A recent U.S. Air Force study suggests that abdominal application of the AAJT could dramatically increase survival for victims of traumatic cardiac arrest.

“The AAJT has the ability to improve cerebral perfusion during CPR, so we think it holds substantial potential for use in cardiac arrest and other resuscitation scenarios,” Dr. Schwartz said. “Overall, we think we are just beginning to scrape the surface on the potential applications of this device.”

Increasing number of Alabama law enforcement agencies deploying new veteran developed life- saving technology

Birmingham, November 8, 2016 — In 2016, the number of Alabama Law Enforcement Agencies (LEAs) with access to the AAJT has more than doubled due to threats and officer assassination attempts around the country. In the event of life-threatening injury with massive, difficult to control bleeding, responding officers can render first aid in unsecured areas before paramedics arrive. Police, sheriff’s departments and SWAT units in from Mobile to Birmingham are now equipped to save lives in high risk operations or officer targeted shootings. “The AAJT has been used in overseas battlefields to save lives since 2012. Over a dozen militaries around the world have it as well as select EMS, trauma centers, federal, county and municipal law enforcement agencies,” said Chris Richards, U.S. civilian sector business developer for Compression Works. “We are proud to partner with our home-state LEAs as we deliver lessons learned on the battlefield to U.S. LE, hospitals and prehospital departments.” Co-inventor Dr. John Croushorn, Birmingham ER physician and former U.S. Army Task Force flight surgeon, began development of the AAJTTM after deployments in Iraq where extremity and junctional bleeding was once the leading cause of preventable death. The device was first sent to Afghanistan in 2012 with U.S. Special Operations Forces. The first first military save was in April 2013. Later that year, Dr. Croushorn used it at Princeton Baptist Medical Center in Birmingham to save the first two civilian lives, which involved severe bleeding from gunshot wounds to the shoulder and legs. “I would have been the doctor to tell his mom, ‘I’m sorry, your son has passed away,” said Croushorn of one particular event. “That weekend, I went to check on the guy at the hospital, and I got to meet his mom and dad. His mom just walked over and gave me a big hug and thanked me for saving her son’s life.” The AAJT is FDA indicated for difficult to control bleeding in the pelvis as well as upper and lower extremities. When placed in the abdomen, it compresses a major artery that supplies all blood flow to the pelvis, groin and legs. In essence, it “turns off the faucet” in cases of severe bleeding in the pelvis or both legs. When placed in the groin, it stops blood flow to a single leg. This type of injury was shown in a femoral artery wound scene in the popular 2001 movie, “Blackhawk Down.” The AAJT can also be placed in the shoulder to stop blood flow in penetrating wounds or amputations. The AAJT continues to be the only junctional and true truncal tourniquet to have saved life in upper and lower junctional hemorrhage. It is the only device that is indicated to stop pelvic bleeding. It is the most studied device for junctional hemorrhage and it remains the only junctional device to have human studies demonstrating safety and effectiveness at each of its application sites. Homewood, AL police officer Greg Brundage commented, “Our team carries the AAJT on every op and it’s an essential part of our kit. It gives us extra confidence so we can perform better. If one of us is injured by gunfire, we know we have the best bleeding control equipment. That’s real peace of mind.” About Trauma Care in U.S. Law Enforcement “Line of Duty Deaths strike at the heart of us as peace officers and represents the ultimate sacrifice as public servants,” Texas Sheriff Ron Hickman told Breitbart Texas in an exclusive interview. Line of duty deaths are up by 5 percent in 2016 over the same time period in 2015 according to the ODMP. 2015’s total of 130 was down from 2014’s reported deaths of 146 officers. “Clearly the past couple of years have been traumatic ones for law enforcement,” Sheriff Hickman stated. “These two years represent a change in the historic trends in line of duty deaths. Direct and unprovoked shootings of officers are a divergence from deaths from confrontations. Fortunately, the improvements in tactical gear and ballistic vests coupled with improvements in trauma care have combined to help reduce the number of fatalities.” – Bob Price, Breitbart, http://www.breitbart.com/texas/2016/11/07/report- nearly-1800-cops-killed-past-10-years/. About The Abdominal Aortic and Juntional Tourniquet (AAJT) The AAJT is a circumferential device that utilizes a belt, windlass, and pneumatic pressure to compress the indicated regions of the body. The belt and windlass together greatly increase the stability of the compression. The pneumatic wedge-shaped bladder provides focused pressure to squeeze the blood vessels passing through the region of application and preventing flow. In essence, the AAJT acts as a valve to figuratively “turn off the faucet” and prevent the further flow of blood out of wounds distal to its application site. About Compression Works Birmingham, Alabama-based Compression Works LLC specializes in the research, development of severe hemorrhage control devices. Compression Works’ novel AAJT device is used by militaries around the world, government agencies, select hospitals and law enforcement agencies. It is currently being launched to U.S. hospital and prehospital markets, such as trauma centers, rural hospitals, fire and rescue, EMS and various first responder units. For more information, visit https://compressionworks.com.

Stopping Hemorrhage by Aortic Compression

Limb exsanguination is no longer the most common cause of preventable death on the battlefield because of emergency tourniquets. Hemorrhage control for wounds in the junction between the trunk and the limbs and in the neck are an obvious care gap, most commonly in the pelvic area, including the buttocks and groin proximal to the inguinal ligament. (US Army Med Dep J 2011 Apr-Jun:38.) Managing hemorrhagic shock also requires support of central aortic pressure to maximize perfusion of the brain and heart and to control bleeding effectively.

Noncompressible torso hemorrhage is recognized as the leading cause of death in trauma, but definitive hemorrhage control has been challenging. A review of combat casualties from 2001 to 2011 showed that the most common sites of lethal hemorrhage were truncal (67.3%), junctional (19.2%), and peripheralextremity (13.5%). (J Trauma Acute Care Surg 2012;73[6 Suppl 5]:S431.)

The direct application of pressure over the distal aorta with an abdominal tourniquet and the insertion of a resuscitative endovascular balloon to occlude the aorta (REBOA) has recently come to the forefront as a potential life-saving option. The problem is bleeding from noncompressible vascular injuries. Traumatic or iatrogenic injuries to the common iliac, external iliac, internal iliac, profunda femoral, and superficial femoral can cause bleeding that is extremely difficult to control. (J Cardiovasc Surg (Torino) 2012;53[4]:495.) Exsanguination from one of these vessels can occur in minutes or even seconds.

Pulsed-wave Doppler measurements have documented that blood flow to the common femoral arterycan be stopped by applying direct pressure over the distal abdominal aorta or proximal iliac artery. (Prehosp Disaster Med 2006;21[6]:379.) A number of reports have now documented the ability to stop blood flow to these major vessels with the Abdominal Aortic and Junctional Tourniquet (AAJT) and the

REBOA. (Mil Med 2013;178[11]:1196; J Trauma Acute Care Surg 2013;75[1]:122; J Trauma Acute Care Surg 2013;75[3]:506.) Major trauma center experience with REBOA suggests that it is feasible and effective for proactive aortic control in patients with end-stage shock from blunt and penetrating mechanisms. (J Spec Oper Med 2013;13[3]:1.) Likewise, real-life experience with the AAJT also suggests that it can save lives. (J Spec Oper Med 2013;13[2]:1; Surgery 2011;150[3]:400.)

The AAJT and REBOA are relatively new concepts in emergency medicine, and their potential benefits and roles in managing life-threatening bleeding remain untapped to a significant degree. A respectable amount of research has been done for these tools and the FDA has approved several different applications of the AAJT, so it’s time to get broader clinical and research experience with them.

The AAJT has other applications besides inguinal and groin hemorrhage. The FDA approved it for lifethreatening axillary hemorrhage, and it has been used off-label for life-threatening neck hemorrhage.

But what about using the AAJT or REBOA instead of cross-clamping the aorta when an open
thoracotomy is performed? One animal study specifically looked at the use of REBOA for that purpose. (Can Med Assoc J 1964;91:128.) The AAJT would obviously occlude the aorta lower than the thoracic diaphragm cross-clamping location typically used during open thoracotomy, but cross-clamping the aorta during an open thoracotomy has been fraught with difficulty and plagued by operator inexperience. Many an esophagus has been inadvertently cross-clamped, and the traumatic injury to the aorta and its branching vessels from dissection and cross-clamping can be significant. The lower-placed AAJT would not occlude blood flow to the kidneys and the superior mesenteric artery, but maybe it’s not a bad idea to preserve blood flow to the kidneys and mesentery in addition to the brain and heart.

The biggest drawbacks to the REBOA are the technical skills required for insertion and the actual time it takes to insert the balloon. I want something fast when my patient is hemorrhaging uncontrollably, and that is where the AAJT fills the bill: it can be applied in less than 60 seconds. It’s possible these two tools can be used together effectively, with the AAJT being applied immediately to allow additional time for REBOA placement.

REBOA for stopping uncontrolled bleeding in pelvic fractures has been reported as quite effective. Posted by Larry Mellick, MD at 4:24 PM Be the first to comment REBOA for stopping uncontrolled bleeding in pelvic fractures has been reported as quite effective. Again, it would be great to see some experience with the application of the AAJT for that sameindication. Researchers reported in 1964 that compression of the aorta with the heel of the hand just
above the bifurcation of the common iliac arteries was an effective way of controlling catastrophic pelvic hemorrhage during laparotomy. (Ann Emerg Med 2013 Oct 23; doi:
10.1016/j.annemergmed.2013.09.026.) More recent reports describe external manual compression for abdominal bleeding associated with penetrating injuries and ruptured abdominal aortic aneurysms. (J Anesth 2002;16[2]:164; Obstet Gynecol 2014;123[4]:804.) Pelvic binding and the AAJT might slow blood loss significantly in pelvic fractures.

Postpartum hemorrhage is another life-threatening emergency that can occur after a Caesarean section or vaginal delivery. It is one of the most common obstetric maternal complications, and is responsible for approximately half of severe maternal morbidity. (Transfusion 2014 Mar 12; doi: 10.1111/trf.12550.) Worldwide, postpartum hemorrhage is a common etiology of maternal death, and uterine atony is the major associated cause. (WHO Guidelines; http://bit.ly/1nECNO7.) External manual compression of the

aorta is a common treatment for life-threatening post-partum hemorrhage. (Anaesth Intensive Care 1994;22[5]:571.) A commonly referenced case report describing successful management of a hemorrhaging patient with this technique was published in 1994. (Circulation 1993;88[4 Pt 1]:1916.) Again, here is another condition where it seems the AAJT could play a life-saving role in slowing uterine bleeding while other interventions are being started.

Applying the abdominal tourniquet during CPR has been discussed as one way to shunt blood flow selectively to the heart and brain, meeting CPR’s goal of maintaining blood flow to the vital organs until the heart can once again function independently. Aortic compression to augment cardiopulmonary resuscitation has been written about for decades. The results were variable, though, and a number of well-done papers demonstrated improved resuscitation parameters and outcomes when the aorta was occluded during CPR. (Am J Emerg Med 2002;20[5]:453; Resuscitation 2001;50[3]:319; Resuscitation 1999;40[3]:171; Resuscitation 2011;82[8]:1087; Resuscitation 2007;75[3]:515; Crit Care Med
1997;25[6]:1003.)

Applying the AAJT during CPR is a study that simply must be done. A significant step forward will have occurred in advanced cardiac life support if a distinctly positive outcome similar to the animal studies is found.

Both these tools can save lives for a wide spectrum of different life-threatening conditions. Unfortunately, the AAJT and the REBOA are currently relatively unknown and not being used. Emergency medicine and trauma programs need to include training in how to apply the AAJT and how to insert the REBOA. And, of course, we need increased research and assessment of various clinical applications.

 

Ingenious Tourniquet Invention Saves Lives

On June 7 in Birmingham, Ala., a blood-soaked, unconscious 41-year-old man arrived at a hospital in the passenger seat of a car. The man had lost 75 percent of his blood through
two bullet holes in his armpit, and when nurses pulled him from the car at 4:50 p.m., he was less than 5 minutes away from dying.

At 4:53 p.m, a former Army surgeon and inventor named John Croushorn strapped an inflatable tourniquet around the limp man’s chest. “We were all covered in blood. The nurse was
applying pressure, and I told her to remove her hands,” Croushorn tells Popular Science. “She said ‘No, blood’s just going to go everywhere again.’ And I said ‘It’s okay, you can take
your hands away.’ So she did, and she was shocked. There wasn’t a drop of blood coming out once the tourniquet was on.” They rushed the man to the operating room, where a
surgeon was able to repair the damage to his arteries.

“I would have been the doctor to tell his mom, ‘I’m sorry, your son has passed away,’ ” says Croushorn, who has spent the past six years perfecting his wedge-shaped tourniquet
invention. “That weekend, I went to check on the guy at the hospital, and I got to meet his mom and dad. His mom just walked over and gave me a big hug and thanked me for saving
her son’s life.”

Croushorn’s fanny pack-like tourniquet (which won a 2012 Popular Science invention award) received FDA approval in 2011 and saved its first two lives this summer. The invention
solves a problem that has long haunted combat medics and emergency room doctors. When a patient suffers a junctional hemorrhage—severe bleeding from the groin, pelvis,
shoulder, or base of the neck—he or she often dies because it is impossible to tie a conventional tourniquet tight enough around the torso to cut off blood flow.

Croushorn and co-inventors Richard Schwartz, the chairman of the emergency-medicine department at Georgia Regents University and a former combat medic, and Ted Westmoreland, a former medic with

U.S. Army Special Operations, became all too familiar with junctional hemorrhages during their
deployments overseas. Enemies would often target the pelvis and upper legs because body armor doesn’t always cover that area, and the U.S. Army cites junctional hemorrhage as one of the most common causes of death on the battlefield.

This new tourniquet stops heavy bleeding with a clever, yet incredibly simple, mechanical design: A medic buckles the device around a patient’s abdomen, over the belly button, and
then tightens it by twisting a windlass. A hand pump inflates a wedge-shaped bladder, which displaces the bowel and compresses the patient’s aorta against his spine, halting all blood
flow to the lower body. According to a recent Army report, a device like this tourniquet could have prevented an average of three military deaths every month between October 2001
and April 2010.

Two coincidences thwarted what would have been certain death for the Alabama man: He arrived at the hospital less than an hour before Croushorn’s shift ended—no one else on
staff would have known to grab the tourniquet from Croushorn’s office. What’s more, research at the Medical College of Georgia had just recently suggested the device could be used
to stop bleeding from the shoulder.

A few weeks before the shooting in Alabama, the Abdominal Aortic Tourniquet saved a man in Afghanistan who was moments away from dying after losing both his legs in a blast from
an improvised explosive device. The man is now recovering with his family.

Schwartz and Croushorn got the idea for an inflatable device at a medical conference in 2006. They soon began working with Westmoreland and testing early prototypes on
themselves. “At one point, Richard strapped a textbook to his stomach and put a regular blood pressure cuff underneath. His wife texted me a picture of him lying on the floor,” says
Croushorn, who politely describes wearing the device as “very uncomfortable.”

In October 2011, they applied for FDA approval, expecting the process to take three years. “Eight days later, the FDA told us they had accepted all our research,” Croushorn says. “We hadn’t even lined up a manufacturer yet.” (Read more about how they invented the tourniquet in the June 2012 issue of Popular Science.)

Soldier Saver:

The U.S. Army immediately ordered 60 tourniquets for combat medics in Afghanistan, with the first batch delivered to troops last summer. Since then, Croushorn’s company has sold
another 150 devices to U.S. and foreign militaries. European Union regulators certified the Abdominal Aortic Tourniquet in May 2012, and now special operations teams in the UK,
Netherlands, Austria, Germany, France, and Sweden all carry the device.

Schwartz, Croushorn, and Westmoreland have each lost patients and friends to bleeding that could have been stopped with their invention. “I remember an individual who was shot in
the groin,” Schwartz told Popular Science last year. “We were doing all kinds of things while getting the patient to the operating room, but even though we were in a level one trauma

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center, the patient bled to death because there wasn’t a way to get to the OR in time. This device gives us time.”

Soldier Saver

AN INFLATABLE TOURNIQUET THAT STOPS ABDOMINAL BLEEDING

While serving as an army medic during Operation Desert Storm, Richard Schwartz became all too familiar with gunshot wounds, particularly shots to the pelvis and upper legs. Enemies would target that region because body armor doesn’t always cover it. Conventional tourniquets don’t work around the abdomen— it’s impossible to tie them tight enough to cut off blood flow from the aorta. Soldiers with “junctional hemorrhages” may have only a few minutes before they bleed to death.

At a medical conference in 2006, Schwartz, now the chairman of the emergency-medicine department at Georgia Health Sciences University, struck up a conversation with John Croushorn, a former Army surgeon, about how to solve the problem. Soon after, the two began working on an abdominal tourniquet. Their first design was a bladder shaped like a wedge, attached to a strap that could be tightened around the abdomen at the navel. When medics inflate the bladder with a hand pump, the wedge displaces the bowel and, eventually, compresses the aorta against the spine and the posterior abdominal wall. The blood flow to the lower body stops.

Schwartz and Croushorn continued to modify the device, but they couldn’t make it stable enough to use during combat, because jostling the patient caused the tourniquet to shift out of position. Ultimately they fixed the problem by adding a base plate to hold the bladder in place and a windlass, a lever at the front that tightens the tourniquet and then locks.

The inventors tested the new version first on pigs and later on people. Last October, they applied for FDA approval, expecting the process to take about three years. “Eight days later, the FDA told us they had accepted all our research,” Croushorn says. “We hadn’t even lined up a manufacturer yet.”

The U.S. Army soon ordered 60 tourniquets for combat medics, with the first batch delivered to troops in May. The U.K. ministry of defense and French and German special forces have also expressed interest. The inventors next plan to market the tourniquet for nonmilitary use, and have already had inquiries from several emergency- medical-service and law-enforcement agencies.