Author/Authors :
Mckee, Jessica L Department of Surgery - Foothills Medical Center - University of Calgary - Calgary, Canada , Mckee, Ian A Department of Fire - City of Edmonton - Edmonton - Alberta, Canada , Ball, Chad G Departments of Surgery - and Critical Care Medicine - University of Calgary - Calgary - Alberta, Canada , Tan, Edward Radboud University Medical Center, The Netherlands , Moloff, Alan Rocky Vista University - Parker - CO, USA , McBeth, Paul Departments of Surgery - and Critical Care Medicine - University of Calgary - Calgary - Alberta, Canada , LaPorta, Anthony Rocky Vista University - Parker - CO, USA , Bennett, Brad Department of Military & Emergency Medicine - Edward Hebert School of Medicine, USA , Filips, Dennis Innovative Trauma Care - Edmonton, Canada , Teicher, Carrie Medecins Sans Frontiers / Doctors Without Borders - New York, USA , Kirkpatrick, Andrew W Departments of Surgery - and Critical Care Medicine - University of Calgary - Calgary - Alberta, Canada
Abstract :
Background: Craniomaxillofacial (CMF) injuries are very common in both civilian and military
settings. Nearly half of all civilian trauma incidents include a scalp laceration and historical
rates of CMF battle injuries increased from 16%-21% to 42.2%. The scalp is highly vascular
tissue and uncontrolled bleeding can lead to hypotension, shock and death. Therefore, enabling
on-scene providers, both military and civilian, to immediately manage scalp and face
lacerations, in a manner that allows them to still function in a tactical way, offers operational
advantages. This case series examines how effectively a wound-clamp (iTClamp) controlled
bleeding from CMF injuries pre-hospital environment.
Methods: The use of the iTClamp for CMF (scalp and face laceration) was extracted from
iTrauma Care’s post market surveillance database. Data was reviewed and a descriptive
analysis was applied.
Results: 216 civilian cases of iTClamp use were reported to iTrauma Care. Of the 216 cases,
37% (n=80) were for control of CMF hemorrhage (94% scalp and 6% face). Falls (n=24) and
MVC (n=25) accounted for 61% of the mechanism of injury. Blunt accounted for 66% (n=53),
penetrating 16% (n=13) and unknown 18% (n=14). Adequate hemorrhage control was
reported in 87.5% (n=70) of cases, three respondents reported inadequate hemorrhage
control and in seven cases hemorrhage control was not reported. Direct pressure and packing
was abandoned in favor of the iTClamp in 27.5% (n=22) of cases.
Conclusions: CMF injuries are common in both civilian and military settings. Current options like
direct manual pressure (DMP) often do not work well, are formidable to maintain on long
transports and Raney clips are a historical suggestion. The iTClamp offers a new option for
control of external hemorrhage from open wounds within compressible zones.
