Digital Supplement, Special Topics

December 2013 Supplement, Putting the Clamp on Hemorrhage


Every Red Blood Cell Counts

Uncontrolled bleeding is one of the leading causes of death in civilian and military environments, second only to central nervous system injury. Every red blood cell counts; effective hemorrhage control at the earliest moment is critical to patient survival. Early control of hemorrhage reduces the negative downstream consequences associated with substantial blood loss, including shock, late mortality and multiple organ failure.

Stop the Bleeding

The problem of major bleeding continues to stymie prehospital providers. Massive hemorrhage is second only to neurologic injuries as a cause of death due to trauma.

Point-of-Care Hemorrhage Control

Direct pressure, used in conjunction with limb elevation in extremity bleeding whenever feasible, will control the vast majority of external bleeding. However, controlling bleeding sometimes requires prehospital providers to take aditionals steps.

From Battlefields to City Streets

The decade of war in Iraq and Afghanistan has been unique from prior American conflicts because of a new partnership between military medicine and civilian trauma experts, combined with an innovative data collection system, the Joint Theater Trauma Registry (JTTR), which has tracked soldiers’ injuries throughout the war. This has allowed researchers to monitor the usefulness and safety of trauma treatments used by the military.

A New Tool in the Box

First U.S. field use of the iTClamp proves its value in treating hypoxia from a hemorrhagic standpoint.

How the iTClamp Works

Essentially all mechanical hemorrhage-control techniques work by applying pressure, either directly or indirectly to the bleeding vessels (or proximal to the bleeding vessels in the case of tourniquets). The iTClamp also relies on pressure to control hemorrhage, but does so in a novel manner. It essentially converts an open bleeding wound into a closed wound, which then allows a stable clot to form in the contained space, ultimately tamponading the bleeding vessel.

Training & Speed Are Crucial

Exsanguination accounted for more than half of the preventable deaths in Vietnam; almost 50% of combat fatalities before evacuation from Iraq were attributed to uncontrolled hemorrhage.1,2 Uncontrolled hemorrhage also results in the death of a large number of civilian trauma fatalities each year.