The Department of Defense’s Committee on Tactical Combat Casualty Care (CoTCCC) recognizes there are situations where the typical devices used to stop bleeding may be less than optimal. One of these is bleeding injuries at the level of the neck or above. Tourniquets, as you can imagine, aren’t very helpful wrapped around a person’s neck.
In response to this issue, the CoTCCC has approved the iTClamp®, an item that has shown effectiveness in managing bleeding in this area. It’s the only non-tourniquet hemorrhage control device recommended for care under fire (which is different than tactical field care).
This is important: Statistics show that, although only comprising 12% of total body surface area, fully 38% of civilian bleeding injuries and 42% of battlefield wounds involve the head and neck. Penetrating neck injuries are particularly concerning, as the death rate can range from 10-50%.
Off the grid, survivors may experience similar damage from falls, extreme exertion, hostile encounters, and other issues. These wounds may be difficult or impossible to pack properly without compressing vital structures, such as the airway.
The iTClamp® works by closing the skin breach overlying a wound. This action forms a collection of blood (a “hematoma”) inside the wound cavity that generates pressure which reduces further blood loss from the injured vessel. The action of the device is similar to applying direct pressure, while leaving the medic’s hands free to perform other duties.
Studies have determined that the iTClamp® can be applied in 10 seconds or less. it works reliably without additional pressure in situations where tourniquet placement is problematic. Success rates exceed 90% in controlling bleeding on the first try, and an improper placement can be easily identified by blood leaking out the wound edges. Even if not successful, the item can be re-adjusted quickly.
The product can be used on body parts such as extremities, groin, and underarms, even by those with limited experience. It can also be applied as self-care by the casualty. The manufacturer claims it to be “virtually painless.”
There are limitations, however. iTClamp® is not for use in non-compressible areas like the chest or abdominal cavities. It’s also inappropriate to use near delicate structures, like the eye, and too small to apply to amputated limbs or large avulsions (like some shrapnel wounds). In large wounds, packing first with hemostatic gauze like ChitoSam, Quikclot or Celox and then closing the skin with the iTClamp® can be a reasonable strategy.
Shelf life is a big factor in a product’s usefulness as part of the survival medicine cabinet. The iTClamp®’s shelf life is about six years and it is currently unclear what happens beyond that. The iTClamp® is rated as a single-use device.
Given the limited storage capacity of the average household, size matters. According to the manufacturer, the iTClamp® is about one ounce in weight and 2.24 x 1.98 x 1.13 inches in dimension. As such, any laceration longer than, say, your thumb would require multiple iTClamps®. The item comes sterile and is latex-free. Like other items that are successful in stopping major bleeding fast, it’s pricey at $45-60 each.
Of course, the iTClamp® is not the end of the road when it comes to recovering from a bleeding wound. It must be removed and definitive surgical control of hemorrhage accomplished. The road to recovery will be long and difficult, and even more so in survival scenarios. This is one of the hard realities for the medic, and why obtaining training in hemorrhage control, wound care, and closure is so important off the grid.
Joe Alton MD
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