There are case reports and basic research into the use of commercial junctional tourniquets in axillary junctional hemorrhage, including another FDA-approved device, the Abdominal Aortic Tourniquet™, but many times they are not available or have been used on another casualty or at another site. As with neck wounds, junctional hemorrhage from a wound to the axillary region can be similarly challenging to treat. And, also like neck wounds, one approach is to perform wound packing with hemostatic dressings and apply pressure bandages using techniques that help maintain pressure without needing continuous direct manual pressure provided by another responder.

The wound should be exposed, packed with hemostatic dressing mounded to at least 1-2 inches above the skin, and direct pressure applied continuously for a minimum of 3 minutes. After bleeding has been controlled continue to maintain pressure on the wound. Apply a pressure bandage by wrapping an elastic bandage circumferentially around the shoulder and under the armpit twice on the affected side, diagonally across the body and under the opposite armpit and around the shoulder, and back across the body using a “figure 8” technique. Secure it with a nonslip knot or a securing device (depending on what type of bandage is used). Swath the upper arm on the injured side to the chest using a cravat or another bandage. The “figure 8” elastic bandage helps to maintain pressure on the wound when both arms are down at the casualty’s side. Continue to reassess for hemorrhage control, especially after casualty movement. Do not forget to ask other first responders to assist as needed.