As mentioned briefly in the introduction to wound packing, the junctional areas are located at the junctions of the extremities and neck with the torso. Junctional hemorrhage occurs with injury to the large blood vessels that pass through the junctional areas or to the extremities themselves if the injury is too close to the torso to allow for a limb tourniquet to be applied. Junctional hemorrhage is compressible external hemorrhage and must be treated without delay. Although blood vessels at the junctional areas are larger than in the limbs, they can still be compressed and a hemostatic dressing and direct pressure should be applied immediately, and application of a commercial or improvised junctional tourniquet should be considered.

The major areas of concern are the axillae, the groin, and the base of the neck, and we will review some techniques unique to each anatomic location, as each of them presents their own challenges. Control of bleeding from junctional areas and noncompressible torso bleeding remains the greatest challenge in prehospital trauma care. (van Oostendorp, 2016)

The TCCC Guidelines state:

“If the bleeding site is amenable to use of a junctional tourniquet, immediately apply a CoTCCC-recommended junctional tourniquet. Do not delay in the application of the junctional tourniquet once it is ready for use. Apply hemostatic dressings with direct pressure if a junctional tourniquet is not available or while the junctional tourniquet is being readied for use.”