SAM® Junctional Tourniquet

Key Specifications

Why Junctional Hemorrhage Demands Specialized Devices

With the widespread adoption of CoTCCC-recommended limb tourniquets — the C-A-T Gen 7 and SAM XT — extremity hemorrhage mortality has dropped dramatically on the modern battlefield. Junctional hemorrhage, defined as compressible bleeding at the trunk–appendage junction (groin, pelvis, axilla), now accounts for approximately 19% of potentially survivable prehospital deaths. The common femoral artery exits the pelvis immediately below the inguinal ligament and cannot be compressed by a circumferential limb tourniquet — the artery is too proximal for the cuff to engage. The same anatomical constraint applies in the axilla.

Explosion-related injuries — IED blasts and high-energy fragmentation — frequently cause bilateral high-thigh wounds or proximal amputations precisely in this anatomical dead zone. A 2013 USCENTCOM and Joint Trauma System report found that junctional hemorrhage was the most common cause of death from compressible hemorrhage remaining after extremity tourniquet fielding — establishing the clinical imperative for CoTCCC's formal recommendation of junctional devices.

Product Overview

The SAM® Junctional Tourniquet was developed from the SAM® Pelvic Sling platform — a device with an established track record in pelvic fracture reduction — and adapted for hemorrhage control at junctional zones. Its core innovation is the Target Compression Device (TCD): a repositionable, removable pneumatic pad that is placed directly over the femoral or axillary artery, then inflated via hand pump until bleeding stops. The AUTOSTOP Buckle limits circumferential belt tension to 150N — the optimal force for arterial occlusion and pelvic fracture reduction while protecting against operator over-tightening.

A rigorous cadaveric effectiveness study published in the Journal of Special Operations Medicine (Johnson et al., 2014) at Wake Forest University demonstrated that the SJT required an average of only 107 mmHg to occlude the distal external iliac artery at the inguinal ligament in ≤7 seconds — significantly lower pressure than manual compression (139 mmHg average). For axillary control, the SJT required 739 mmHg versus 1,237 mmHg for manual compression. In all 12 trials, no tissue damage occurred and blood flow restored immediately upon device removal. A manikin comparison study (Kragh et al., Prehospital and Disaster Medicine, 2016) found the SJT produced the least blood loss of all four tested junctional devices in groin application scenarios.

The SJT is one of three CoTCCC-recommended junctional tourniquets and is the preferred device in studies tracking combat medic preferences. The U.S. Army Medical Materiel Agency fielded 460 SJTs to theater in October 2013 following FDA clearance, and the device carries NSN 6515-01-618-7475 for DoD procurement. Two TCDs can be deployed simultaneously for bilateral inguinal wounds — a critical capability in the bilateral below-knee or above-knee amputation patterns common in IED casualties.

How to Apply — Inguinal (Groin) Mode

1. Place the casualty supine; empty pockets and remove items from the hip area.
2. Pass the belt behind the casualty's thighs and slide it upward until the TCD is positioned over the femoral pulse — just below the midpoint of the inguinal ligament (approximately between the anterior superior iliac spine and pubic tubercle).
3. If wound has not been packed, apply Combat Gauze or hemostatic dressing before TCD placement over an open wound.
4. Hold the TCD in place and connect the belt by snapping the buckle. Pull the brown handles firmly apart until an audible click confirms the AUTOSTOP mechanism has engaged.
5. Use the hand pump to inflate the TCD until hemorrhage stops and no distal pulse is palpable. For bilateral injuries, position and inflate a second TCD on the opposite side.
6. Secure any excess belt using the hook-and-loop fastener. Document application time on the casualty's forehead and on DD Form 1380 TCCC Casualty Card.

See also: JETT Junctional Emergency Treatment Tool | AAJT-S | Complete tourniquets & pouches collection | Massive hemorrhage control kits

All products sourced from the actual brand manufacturer or authorized master distributors. CoTCCC recommendation status verified where applicable. Ships from MED-TAC International, Pembroke Pines, FL — clinician-founded, veteran-led, SDVOSB-certified.