Ep 273 - Surg Cap Ed Barnard on the Abdominal Aortic & Junctional Tourniquet (AAJT) for Exsanguinating, Non-Compressible Haemorrhage at BASICs 2025

Oct 9, 2025

Dr. Ed Barnard, UK's Defence Professor of Emergency Medicine, dives into the innovative abdominal aortic and junctional tourniquet (AAJT), a tool designed for non-compressible haemorrhage. He explains its development, how it works to occlude major vessels, and why it’s considered a last-resort device. Ed discusses the challenges of using AAJT, including pain tolerance and practical application in emergency settings. He highlights the need for thorough training and governance to ensure its effective and safe use during critical trauma cases.

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INSIGHT

Non-Compressible Bleeding Is Time-Critical

Hemorrhage is the leading cause of potentially survivable trauma death and often occurs in non-compressible regions.
The critical window for intervention is roughly 10–30 minutes after wounding, so very early control matters.

INSIGHT

AAJT Mechanism: Rapid External Aortic Occlusion

The AAJT is an inflatable belt placed around the umbilicus that can stop aortic flow within 30–40 seconds.
It inflates to high pressure (~250 mmHg) to compress the aorta against the spine and rapidly reduce distal flow.

ANECDOTE

Device Born From A Tragic Case

The AAJT evolved after a US special forces death from pelvic gunshot in 2005 and was developed from that case.
It began as the AAT, became the AAJT and now exists as the AAJTS with improvements to the bladder.

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Recorded at the BASICS Pre-Hospital Care Conference at Sketchley Grange, this episode explores one of the most experimental tools in civilian trauma care — the abdominal aortic and junctional tourniquet. Dr Ed Barnard joins us to discuss why this device was developed, how it works, and where it might — just might — save lives when all other options have failed.

The conversation traces the problem of non-compressible haemorrhage, the leading cause of potentially survivable trauma death. Conventional limb tourniquets, pelvic binders and packing can’t reach these deep bleeding sites. The AAJT offers a radical alternative: external aortic compression to buy a few crucial minutes until surgical control or REBOA is possible.

Ed explains the mechanism — an inflatable, ratcheted belt that can occlude the aorta or major junctional vessels — and the evidence so far. Laboratory and volunteer data show that it can stop flow, but pain and tissue ischaemia make it difficult to tolerate for long. Clinical experience remains limited to small case series, mostly in military or research settings, and no human trials yet demonstrate a survival benefit.

The discussion is candid about risk and realism. The AAJT is a last-resort device, to be used only within strict governance, with clear time limits and immediate plans for definitive haemorrhage control. It’s not something you reach for on a normal shift — it’s something you might need once in a career, and only if every other option has failed.

Ed shares insights from ongoing research, including its potential role as a bridge to REBOA, and the governance frameworks that should surround any trial use. The episode ends with a look to the future: how civilian and military collaboration might refine indications, training, and data collection for this rare but potentially life-saving intervention.

Surgeon Captain Ed Barnard

Surgeon Captain Ed Barnard is a Consultant in Emergency Medicine at Addenbrooke’s Hospital, Cambridge, and a Professor of Emergency Medicine with the Defence Medical Services. He also serves with East Anglian Air Ambulance as a HEMS doctor (having had many years as a BASICS responder). His academic work focuses on prehospital and military trauma care, with a portfolio spanning clinical trials, blood product innovation, and trauma system development.

Ed’s academic work focuses on improving survival from catastrophic bleeding, particularly non-compressible and junctional haemorrhage. He has published and presented widely on trauma resuscitation, traumatic cardiac arrest, and the evolving role of devices such as the abdominal aortic and junctional tourniquet (AAJT) and REBOA. He is a co-author of the 2025 BMJ Military Health systematic review examining the utility of the AAJT-S in military practice.

He is also an experienced educator, contributing to trauma training for BASICS, HEMS, and Defence Medical Services, and continues to combine clinical work with research aimed at translating lessons from military to civilian trauma care.

About BASICS:
The British Association for Immediate Care (BASICS) is a UK charity uniting clinicians dedicated to pre-hospital emergency medicine. Founded in 1977, it supports regional immediate-care schemes, delivers national training, and hosts the annual BASICS Pre-Hospital Care Conference, bringing together experts in trauma, retrieval, and critical care — like this conversation with Dr Ed Barnard.