Trauma care: binder, tourniquet, POCUS
Recent threads and media roundups reinforce the ABCDE rapid-assessment approach, immediate pelvic stabilization with binders or sheets before imaging, advanced tourniquet/hemostatic dressing techniques for junctional bleeding, and growing EMS use of video laryngoscopy and point-of-care ultrasound for tamponade or pneumothorax outlined and discussed. The emphasis is on rapid control of hemorrhage and airway-first strategies in multi-system trauma.
A March 4, 2024 cadaver study found the T‑POD achieved significantly greater intrapelvic volume reduction than the SAM Pelvic Sling II when both were applied at the recommended greater‑trochanter level (p=0.031). link.springer.com A BMJ Military Health simulated‑evacuation trial published April 15, 2025 reported the SAM Pelvic Sling II was the fastest device to apply and that proprietary and improvised binders (FEPS) remained within 45 mm of displacement during 100 m casualty evacuation trials. militaryhealth.bmj.com XSTAT received FDA de novo clearance in April 2014 as a temporary, expandable hemostatic sponge for junctional groin/axilla wounds usable up to four hours. accessdata.fda.gov A pilot randomized clinical trial (PhoXSTAT, NCT04663087) led by the University of Alabama at Birmingham is actively evaluating prehospital XSTAT versus standard care for junctional hemorrhage in the field. cdn.clinicaltrials.gov Multicenter civilian data and systematic reviews show prehospital extremity tourniquet use is associated with improved survival (one large series reported an average tourniquet time of 77 minutes and a survival association), prompting wider civilian adoption. medauth2.mdedge.com FDA‑cleared junctional devices now include the SAM Junctional Tourniquet and AAJT, and recent perfused‑cadaver and large‑animal safety/effectiveness studies have provided supporting data for SJT and AAJT use in inguinal/axillary hemorrhage control. jsomonline.org ACEP’s May 2025 overview documents expanding prehospital POCUS programs that use eFAST to screen for pericardial effusion, pneumothorax, and intraperitoneal fluid in the field. acep.org Focused EMS training trials (the PEEPS protocol) demonstrated that a one‑hour didactic plus hands‑on practice improved paramedic interpretation of pericardial effusion, pneumothorax, and cardiac standstill versus baseline testing. cambridgecg.net A 2023 systematic review and meta‑analysis found video laryngoscopy preferred over direct laryngoscopy for first‑attempt success and fewer complications in emergency intubations, and a NEAR registry trauma analysis (2016–2018) across 23 EDs reported higher first‑pass success with video devices. link.springer.com Recent reviews in 2025 still call for randomized trials on pelvic binder mortality benefit and higher‑quality comparative research on junctional adjuncts, even as live‑stream and tele‑POCUS pilots have demonstrated feasibility for guiding out‑of‑hospital ultrasound interpretation in cardiac arrest. sciencedirect.com
