Junctional hemorrhage occurs in areas where a standard extremity tourniquet cannot be effectively applied. These injuries often involve major blood vessels and can result in rapid blood loss if not recognized and treated immediately.

Common locations for junctional hemorrhage include:

• Inguinal (groin) region
• Axillary (armpit/shoulder) region
• Base of the neck

These injuries are particularly dangerous because a tourniquet cannot be applied, leaving direct pressure and wound packing as the primary methods of hemorrhage control.

Management principles include:

• Rapid identification of severe bleeding
• Immediate direct pressure
• Aggressive wound packing when appropriate
• Application of a pressure dressing to maintain hemorrhage control
• Frequent reassessment for continued bleeding

Neck wounds require special consideration due to the presence of major blood vessels and the airway. Wounds above the clavicles are commonly managed with direct pressure and wound packing when appropriate. Care must be taken to avoid compromising the airway while controlling hemorrhage.

Providers should also be aware of commercially available junctional hemorrhage control devices designed for severe groin and axillary bleeding. Examples include:

• SAM Junctional Tourniquet (SAM JTQ)
• Combat Ready Clamp (CRoC)
• Junctional Emergency Treatment Tool (JETT)
• Abdominal Aortic and Junctional Tourniquet (AAJT)

While these devices may not be commonly available in all EMS systems, providers should understand their purpose and role in managing severe junctional hemorrhage.