A casualty can die from massive hemorrhage quickly due to bleeding from junctional hemorrhage. If a junctional tourniquet is not available, apply a hemostatic dressing and direct pressure immediately.
An improvised junctional pressure delivery device (PDD) may be needed to apply additional, targeted, and sustained pressure to control junctional bleeding. An improvised PDD can be made using materials that are readily available on the battlefield, including limb tourniquets, water bottles, canteens, boots, shoes, etc.
The PDD is placed in the inguinal gutter while continuously maintaining pressure on the gauze-packed wound. The PDD is then secured using two limb tourniquets joined together around the casualty’s body and around the PDD. When the TQ windlass is tightened, additional pressure is applied to the PDD over the wound until the bleeding is stopped and the distal pulse is absent.