Patent Publication Number: US-9427238-B2

Title: Device for control of hemorrhage including stabilized point pressure device

Description:
BACKGROUND OF THE INVENTION 
     The present invention relates to emergency treatment and control of hemorrhage in places where compression is needed but a tourniquet is not desired, and where control by compression is difficult. 
     Serious injuries, as in military conflict or automobile collisions, for example, often result in hemorrhage. Two types of hemorrhage that are not addressed well by currently available products are non-tourniquetable compressible hemorrhage and noncompressible hemorrhage. 
     Internal bleeding due to a fractured pelvis can easily result in death. Rapidly reducing a fracture of a pelvis decreases mortality substantially, and devices are known for reducing a fracture and stabilizing the fractured pelvis in emergency situations, so that a patient can be transported to a hospital or other treatment facility. Stabilization of the pelvis within the first hour after a fracture occurs is critical and may often determine whether the patient lives or dies. 
     Bleeding can often be stopped if direct pressure is applied on a hemorrhaging wound, but a tourniquet often cannot be used when the wound is either not on an extremity or is too close to the torso for effective tourniquet use. For a non-compressible hemorrhaging wound, direct pressure is not possible or not effective, so one must occlude the vasculature proximal to the injury site. It is common that wounds in the junctional or torso area occur in polytrauma patients, where the bleeding wound is not the only injury. In cases where pelvic fracture is also present, the pelvis should be reduced to a controlled compression level in order to prevent internal exsanguination. 
     Krieg, et al, U.S. Pat. Nos. 6,554,784 and 7,008,389 disclose devices which can be used to encircle the hips of an injured person and provide a proper amount of hoop tension to urge the parts of a person&#39;s fractured pelvic ring toward a normal relationship and thus reduce internal bleeding at the site or sites of fracture. 
     Ward, U.S. Patent Application Publication Document No. US 2010/0179586, discloses a belt system with inflatable bags attached and adjustable in position, for use in control of hemorrhage in regions of the body where it is difficult to apply conventional compression, but different operators may adjust the belt to different levels of tightness. If stabilization of a pelvic fracture is desired at the same time as arterial hemorrhage control through the bladder, the reduction force to the pelvis may be excessive or the force applied to achieve hemostasis may be inadequate. 
     SUMMARY OF THE INVENTION 
     The present invention, as defined by the claims which form a part of the disclosure herein, provides an answer to the aforementioned need for a way to provide pressure to occlude blood vessels or compress a wound, and one embodiment may include a device for applying pressure to an axillary artery. 
     A device that is one embodiment of the device disclosed herein will control junctional hemorrhage (groin and axilla) in a combat environment by applying pressure proximal to or directly over a major arterial bleed. 
     The present disclosure describes a combination of a binder such as a belt-like device which controls the circumferential compression force to a predefined level, and a harness or similar support system useful in other places on a person, combined with one, two or more point pressure devices which when activated may either occlude vessels or compress a wound. In one embodiment the device is secured using a spring controlled buckle mechanism, which guides the user to a controlled baseline circumferential force. This controlled baseline force ensures that inflation of the point pressure devices will achieve a consistent and desired tissue compression depth for occlusion of the artery. In one embodiment the belt incorporates a flat non-repositionable inflatable backing bladder to provide an additional and customizable force level. 
     In one embodiment of the device disclosed herein, fastening material such as Velcro™ hook-bearing fastener material is provided on an outer end portion of the strap, and material such as Velcro™ loop-bearing fastener material is provided along an intermediate portion of the strap. 
     In one embodiment of the device, a surface of the main body of the device, at the end from which the strap extends, is securely and matingly receptive to hook-bearing fastener material such as Velcro™ hook-bearing fastener material located on the outer end portion of the strap. 
     One embodiment of the device described herein includes point pressure devices and a carrier that can be used to press such a point pressure device against a person, either directly over a wound or proximal to the wound to occlude the proximal vessels and stop or control bleeding. 
     One embodiment of the device is compact and light in weight so as to minimize effort needed to carry it in readiness for use in a military environment. 
     An inflatable bladder, in one embodiment, may in use provide pressure at several points along the length of a blood vessel. 
     The foregoing and other features of the invention will be more readily understood upon consideration of the following detailed description of the invention taken in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE SEVERAL DRAWINGS 
         FIG. 1  is an isometric view of a pelvis-stabilizing device that is an exemplary embodiment of an aspect of the present invention. 
         FIG. 2  is a front elevational partially cutaway view of the pelvis-stabilizing device shown in  FIG. 1 , showing the device extending around the pelvic area of a person and showing a portion of the skeleton of the person to illustrate the proper location of the device during use. 
         FIG. 3  is a top plan view of the pelvis-stabilizing device shown in  FIGS. 1 and 2 , under tension and with the strap shown secured so as to maintain tension to keep the buckle engaged while the device is fastened around a person of a minimum size for use of the device. 
         FIG. 4  is an isometric front view of end portions of the main body of the pelvis-stabilizing device shown in  FIGS. 1-3 , illustrating the device secured and under tension at a small circumference, as if to fit a slender person. 
         FIG. 5  is an isometric view of a buckle useful as a part of the pelvis-stabilizing device shown in  FIGS. 1-4 . 
         FIG. 6  is a sectional view of the buckle shown in  FIG. 5 , taken along line  6 - 6  of  FIG. 5 , with the buckle in a relaxed condition. 
         FIG. 7  is a view similar to  FIG. 6 , but showing the condition of the buckle when subjected to a predetermined tension to cause the buckle to engage a strap that is a part of the pelvis-stabilizing device shown in  FIGS. 1-4 . 
         FIG. 8  is a view similar to  FIG. 4  showing the pelvis-stabilizing and supporting device under tension so that the buckle engages the strap, at a larger circumference than that shown in  FIG. 4 , as if properly in place on a larger person. 
         FIG. 9  is a view similar to  FIG. 8 , showing the pelvis-stabilizing and supporting device with the strap under tension and engaged by the belt at yet a larger circumference than that shown in  FIG. 8 , as if properly secured in place on a yet larger person. 
         FIG. 10  is a view similar to  FIG. 9 , showing the pelvis-stabilizing and supporting device with the strap under tension and engaged by the buckle as if properly secured in place around a person of yet larger circumference, near the maximum for the size of the device. 
         FIG. 11  is an isometric view of an alternative embodiment of the pelvis-stabilizing device shown in  FIGS. 1-10 , which may also be used as a cervical collar for the protection of a person&#39;s neck. 
         FIG. 11A  is a sectional view taken along line A-A in  FIG. 11 . 
         FIG. 12  is an isometric view of the main body portion of a pelvis-stabilizing device which is another alternative embodiment of the device shown in  FIGS. 1-10 . 
         FIG. 13  is an isometric view of the main body portion of a pelvis-stabilizing device which is yet a further alternative embodiment of the device shown in  FIGS. 1-10 . 
         FIG. 14  is a perspective view showing the pelvis-stabilizing device shown in  FIGS. 11 and 11A  in use as a cervical collar to support a person&#39;s neck. 
         FIG. 15  is a perspective view of a pelvis-stabilizing device which is yet another alternative embodiment of the device shown in  FIGS. 1-10 , which may also be used as a cervical collar to support a person&#39;s neck. 
         FIG. 16  is a perspective view of the pelvis-stabilizing device shown in  FIG. 15  in use as a cervical collar to support a person&#39;s neck. 
         FIG. 17  is a view of an end portion of the main body of a pelvis-stabilizing and neck-supporting device similar to that shown in  FIG. 15  and incorporating a chin rest, shown in a non-deployed position with respect to the body portion of the pelvis-stabilizing and neck supporting device. 
         FIG. 18  is a view similar to  FIG. 17 , showing the chin rest in a deployed position. 
         FIG. 19  is a perspective view of the pelvis-stabilizing and neck supporting device shown in  FIGS. 17 and 18  in use as a cervical collar to support a person&#39;s neck. 
         FIG. 20  is an isometric view of a junctional and truncal point tourniquet and pelvis-stabilizing device that is an exemplary embodiment of one aspect of the present invention. 
         FIG. 21  is an isometric view of another junctional and truncal point tourniquet and pelvis-stabilizing device that is an exemplary embodiment of one aspect of the present invention, in which a main body is of a minimal width. 
         FIG. 22  is an isometric view of the main body portion of a device such as that shown in  FIG. 21 , together with an inflatable bladder attached to the main body portion of the device. 
         FIG. 23  is a front elevational view of the junctional and truncal point tourniquet and pelvis-stabilizing device shown in  FIG. 21 , together with an inflatable bladder attached to the main body portion of the device, in use on a pelvic area of a person. 
         FIG. 24  is a side elevational view showing how a junctional and truncal point tourniquet and pelvis-stabilizing device shown in  FIG. 20  might be used on a person in a selected one of three different possible positions to stabilize a fractured pelvis. 
         FIG. 25  is a front view of the junctional and truncal point tourniquet and pelvis-stabilizing device shown in  FIG. 20  in use, with a pair of inflatable point pressure exerting members located so as to occlude a person&#39;s femoral arteries. 
         FIG. 26  is a front view of the junctional and truncal and point tourniquet and pelvis-stabilizing device shown in  FIG. 21  in use, with a pair of inflatable point pressure exerting members located so as to occlude a person&#39;s femoral arteries. 
         FIG. 27  is a front elevational view showing the device shown in  FIG. 21  applied around a patient&#39;s upper torso, so as to occlude an axillary artery. 
         FIG. 28  is an isometric view of the device shown in  FIGS. 21, 22, and 26 , rolled into a compact configuration for packaging. 
         FIG. 29  is an isometric view of an inflatable pressure application device such as the ones shown in  FIGS. 20, 21, 24, 25, and 26  in a deflated condition. 
         FIG. 30  is an isometric view of the device shown in  FIG. 29  in an inflated condition and inverted. 
         FIG. 31  is a sectional view taken along line  31 - 31  in  FIG. 29 . 
         FIG. 32  is a sectional view taken along line  31 - 31  of  FIG. 29 , but showing the flexible bladder in an inflated condition. 
         FIG. 33  is an isometric view of another junctional and truncal point tourniquet and pelvis-stabilizing device that is an exemplary embodiment of an aspect of the present invention. 
         FIG. 34  is an isometric view of an inner face of the main body portion of the device shown in  FIG. 33 , together with a point pressure device in place thereon, at an enlarged scale. 
         FIG. 35  is a view of the outer side of a portion of the device shown in  FIG. 33 , at an enlarged scale, showing an auxiliary strap extended and available for use. 
         FIG. 36  is a view similar to that of  FIG. 25 , showing the use of the junctional and truncal point tourniquet and pelvis-stabilizing device shown in  FIGS. 33-35 . 
         FIG. 37  is a view of the back of the patient shown in  FIG. 36 , with the device shown in  FIGS. 33-35  in use. 
         FIG. 38  is a front elevational view of the device shown in  FIGS. 33-35  in use as applied to a patient&#39;s upper torso and used to occlude an axillary artery. 
         FIG. 39  is a rear elevational view of a patient&#39;s torso with the device in use as shown in  FIG. 38 . 
         FIG. 40  is an isometric view of yet another junctional and truncal point tourniquet and pelvis-stabilizing device that is another embodiment of an aspect of the present invention. 
         FIG. 41  is an isometric view of an inner face of the main body portion of the device shown in  FIG. 40 , at an enlarged scale. 
         FIG. 42  is an isometric view of an outer face of a mid-length portion of the main body part of the device shown in  FIG. 40 , showing an auxiliary strap extended from within a pocket in the main body portion of the device. 
         FIG. 43  is a front elevational view of a patient&#39;s torso with the device shown in  FIGS. 40-42  in place and retaining an inflatable point pressure device so as to occlude an axillary artery. 
         FIG. 44  is a rear elevational view of the patient&#39;s torso with the device shown in  FIGS. 40-42  in place as shown in  FIG. 43 . 
         FIG. 45  is a somewhat schematic view showing an inflatable point pressure device such as the one shown in  FIGS. 29-32  in section view and in contact with a patient&#39;s body, showing the locations where pressure is applied to the patient&#39;s body with the inflatable point pressure device in an uninflated condition. 
         FIG. 46  is a view similar to  FIG. 45  but showing the inflatable point pressure device partially inflated, with one of the ridges surrounding the central pressure member in contact with the patient. 
         FIG. 47  is a view similar to  FIGS. 45 and 46 , but showing the inflatable point pressure device fully inflated so that only the central pressure member is in direct contact against the patient&#39;s body. 
         FIG. 48  is a view similar to  FIG. 46 , showing a pressure concentrating member in place on the central pressure member. 
         FIG. 49  is a perspective view from above and at one side of the pressure-concentrating member shown together with an inflatable point pressure device in  FIG. 48 . 
         FIG. 50  is a perspective view from the bottom of the pressure concentrating member shown in  FIG. 49 . 
         FIG. 51  is a perspective view from above and at one side of the pressure-concentrating member shown in  FIGS. 49 and 50  in place on an inflatable point pressure device. 
         FIG. 52  is an isometric view of the pelvis supporting and stabilizing device and truncal and junctional tourniquet shown in  FIGS. 33-39  in a compact package. 
         FIG. 53  is a perspective view of a junctional and truncal point tourniquet and pelvis-stabilizing device including a stabilizing support device for a point pressure application device, in use on a patient to apply pressure to an axillary artery. 
         FIG. 54  is a perspective view from the rear of a patient, showing the junctional and truncal point tourniquet and pelvis-stabilizing device shown in  FIG. 53  in use as shown in  FIG. 53 . 
         FIG. 55  is a perspective view of the junctional and truncal point tourniquet and pelvis-stabilizing device shown in  FIG. 53 , without the stabilizing support device or the point pressure application device. 
         FIG. 56  is a perspective view of one end portion of the main body portion of the junctional and truncal point tourniquet and pelvis-stabilizing device shown in  FIG. 55 . 
         FIG. 57  is an isometric view of the stabilizing support device and point pressure application device shown in  FIG. 53 , as well as a receptacle for the stabilizing support device, taken from a point of view similar to that of  FIG. 53 . 
         FIG. 58  is an isometric view of the stabilizing support device and point pressure application device shown in  FIG. 57 , taken from the side facing toward the patient in  FIG. 53 . 
         FIG. 59  is an isometric view of a stabilizing support device for a point pressure application device which is an alternative embodiment of the stabilizing support device shown in  FIG. 58 . 
         FIG. 60  is a perspective view from the front of the junctional and truncal point tourniquet and pelvis-stabilizing device shown in  FIG. 53 , shown in the configuration in which it is shown in use on a patient in  FIG. 53 . 
         FIG. 61  is a perspective view from the rear of the junctional and truncal point tourniquet and pelvis-stabilizing device shown in  FIG. 53 , shown in the configuration in which it is shown in use on a patient in  FIG. 53 . 
     
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
     Referring first to  FIGS. 1-4  of the drawings which form a part of the disclosure herein, a pelvis supporting and stabilizing device  12  for stabilizing a fractured pelvis, hereinafter often called a pelvic sling, is shown in  FIG. 1  ready for application to a person to provide stabilization and support for a fractured pelvic ring by encircling the hip region of a person. A main body portion  14  is of strong flexible material and has the general shape of a wide belt. A buckle  16  is attached to a first end portion  18  of the main body  14  by a small loop of a strap  20  of strong fabric such as woven webbing, permanently attached to the first end portion  18 , as by being sewn securely to it. As used herein the term “permanently attached” means that removal and reattachment are not easily accomplished by a user and cannot be accomplished readily without use of equipment such as that needed for initial manufacture. The fabric of the strap  20  also defines a large loop  22 , attached to the first end portion  18  so that it can be used as a handle by a person applying the pelvic sling  12  to an injured person, as will be explained more fully presently. 
     A central portion of the main body  14  may be covered on an exterior face by a sheet  24  of low friction flexible plastic material which will be exposed on the posterior side of a person on whom the pelvic sling  12  is in use, facilitating movement of such person on a backboard or other support. 
     At a second end portion  26 , opposite the first end portion  18 , an inner end  28  of an elongate flexible strap  30  is permanently attached to the main body  14 , as by being sewn, riveted, or thermally or sonically welded securely to the second end portion  26  of the main body  14 . The strap  30  extends longitudinally away from the second end portion  26 , generally aligned with the longitudinal axis  32  of the main body  14 . An outer end portion  34  of the strap  30  may include a loop  36  of strong fabric such as Nylon webbing attached to an intermediate portion  38  of the strap  30 , which may be of heavier and consequently slightly stiffer, yet still flexible, webbing. The loop  36  may be securely sewn or otherwise permanently attached to the intermediate portion  38  of the strap  30 . The loop  36  is thus available for use as a handle to pull the strap  30  away from the buckle  16 , as will be explained more fully presently. 
     Pairs of holes  40  may be defined in the intermediate portion  38  of the strap  30 . The holes  40  of each pair are aligned with each other transversely across the width  42  of the strap  30  and loop  36 , which may be about two inches, for example. Adjacent pairs of holes  40  may be evenly spaced apart longitudinally of the strap  30  at a pitch  44  of, for example, 0.625 inch, so as to permit the effective circumference of the pelvic sling  12  to be adjusted in increments small enough to provide a desirable amount of tension in the pelvic sling  12  encircling a person&#39;s hips to stabilize a fractured pelvis. 
     The main body portion  14  may be of laminated fabric, and may include a central layer of padding material (not shown), between an inner layer  46  of a comfortably soft yet strong fabric such as a Nylon tricot material, on the side of the main body  14  intended to be placed against a person, and an exterior layer  48  of a strong fabric such as a tricot material of Nylon or another synthetic material brushed to produce a nap of fiber loops that can act as a fastener material of a first kind, such as a loop-bearing fastener material capable of being engaged matingly by a fastener material of a second kind, such as a hook-bearing flexible fastener material such as that well known under the trademark Velcro. As used herein, the terms “loop-bearing fastener material” and “hook-bearing fastener material” will refer to fastener material that functions similarly to the Velcro™ combination of loop-pile fabric and “thistle-cloth” to stick removably together. Thus, for example, such loop-bearing fastener material is a first kind of flexible fastener material and such hook-bearing material is a second kind of flexible fastener material that can matingly engage the first kind of flexible fastener material. 
     A binding  49  may be provided around the exterior margin of the main body  14 , and an adhesive may also be used to keep the inner and exterior layers  46  and  48  together with the central layer. 
     An exterior side  50  of the intermediate portion  38  of the strap  30  may be covered by a layer of a flexible loop-bearing fastener material  52 , securely attached to the strap  30 , as by being sewn to the webbing. Such loop-bearing fastener material  52  ideally may be present along the entire exterior side or face  50  of the strap  30 , the side that is exposed in the same general direction as the exposed face of the exterior layer  48 , from a point abutting the outer end portion  34  to the second end portion  26  of the main body  14 , and may be present on the inner end  28  of the strap  30 . 
     A piece of hook-bearing fastener material  54  may be securely attached to the exterior side  50  of the outer end portion  34  of the strap  30 , as by being sewn to the webbing material forming the loop  36 . Thus the area hook-bearing fastener material  54  may abut against the loop-bearing fastener material  52  on the exterior side  50  of the intermediate portion  38  of the strap  30 . 
     At least one area  58  of hook-bearing fastener material is located on the second end portion of the main body  14 . Advantageously, each area  58  may be a narrow, elongate piece of hook-bearing fastener material with a width  60  less than the width  42  of the strap  30 , and a length  62 , extending generally parallel with the longitudinal axis  32  of the main body portion  14 . Such elongate areas  58  may be separated laterally from one another by a distance  64 . For example, where the width  42  of the strap  30  is two inches, the width  60  of each area  58  may be about 0.75 inch, and the distance  64  between areas  58  may be about one inch. The length  62  may be as great as can be accommodated in the second end portion  26  and thus may be, for example, in the range of about 5 inches to about 7.3 inches, depending on the size of the pelvic sling  12 . As will be understood in light of subsequent explanation, the foregoing dimensions are not critical, but the relationships of the width  60  and the distance  64  with the width  42  of the strap  30  can provide significant functional advantages. 
     As may be seen in  FIG. 2 , when the pelvic sling  12  is properly in place on an injured person, it encircles the person&#39;s hips and buttocks at the level of the greater trochanters  66  and the symphysis pubis, with the main body portion  14  extending around the posterior of the person. The first and second ends  18  and  26  extend forward around the person&#39;s body and toward each other at the anterior side of the abdomen, with the strap  30  extending through the buckle  16  and doubled back toward the second end portion  26  of the main body portion  14 , along the exterior of the pelvic sling  12 . Although the pelvic sling  12  is shown consistently in one orientation herein, it is to be understood that it may be symmetrical in shape, about the central longitudinal axis  32 , and thus can just as well be placed on a person with the buckle  16  and strap  30  oriented oppositely with respect to the person. 
     When the pelvic sling  12  is properly in place there is a prescribed amount of tension maintained in the main body portion  14  as it encircles the injured person, so that a fracture  70  in the pelvic ring is reduced. That is, the portions of the fractured bone are held together and stabilized by the tension in the pelvic sling  12 . This tension is maintained by engagement of the buckle  16  with the strap  30 . The desired amount of tension exerted on the buckle  16  by the strap  30  causes a portion of the buckle  16  to move, exposing pins  72  which extend through the ones of a pair of holes  40 . As shown in  FIGS. 2, 3, and 4 , the outer, or pulled end, part  80  of the intermediate portion  38  of the strap  30  extends along the second end portion  26  of the main body  14 , parallel with the outer surface of the exterior layer  48  when the device  12  is adjusted to a nearly minimum circumference. The loop-bearing fastener material  52  on the exterior side  50  of the strap  30  is aligned with and in mating contact with one of the areas  58  of hook-bearing fastener material, as shown in  FIG. 2 , so that the hook-bearing material  58  is matingly engaged with the loop-bearing fastener material  52  on the strap  30 . Mating engagement of the fastener materials  58  and  52  is sufficient to maintain the tension in a portion  74  of the strap  30  between the inner end  28  and the buckle  16  to keep the pins  72  engaged in the holes  40  and thus keep the strap  30  engaged with the buckle  16 . 
     The buckle  16  may be substantially similar to the buckle described in U.S. Pat. No. 7,008,389. Thus, as shown in  FIGS. 5, 6, and 7 , the buckle  16  includes two main parts, a rigid frame  82  and a sliding block  84 . One side of the frame  82  is secured to the first end portion  18  of the main body portion  14  by a small loop of the fabric of the strap  20 . The sliding block  84  is moveable relative to the buckle frame  82  in the directions indicated by the arrow  86 . The strap  30  may extend through the opening defined by the frame  82 , sliding along the contact surface of the curved face  87  of the sliding block  84  when the strap  30  is pulled to tighten the pelvic sling  12  about a person&#39;s pelvis. A pair of holes  88  are defined in the sliding block  84 , and the pins  72  extend into the holes  88 , with their ends preferably flush with the face  87  when the buckle  16  is not in tension. When a pair of holes  40  in the strap  30  then move into alignment with the holes  88  in the sliding block  84  the sliding block  84  is moved leftward toward the position shown in  FIG. 6 , so that the pins  72  protrude from the holes  88  and can extend through the holes  40 , thus engaging the strap  30  and preventing it from moving relative to the buckle  16 , apart from any differences in size between the pins  72  and the holes  40 . 
       FIGS. 6 and 7  show a spring  90  positioned around one of the pins  72 . An identical spring  90  may be used on the other pin  72 . The springs  90  are compressed significantly when the sliding block  84  is in its fully extended position, as shown in  FIG. 5 , so that substantial force must be applied to the buckle  16  by tension in the straps  20  and  30  before the sliding block  84  begins to move relative to the buckle frame  82 . Internal springs  90  are compressed further as the sliding block  84  moves leftward toward the position shown in  FIG. 6  when there is sufficient tension in the strap  30 . Flanges  92  on the buckle frame  82  are engaged by lips  94  on the sliding block  84  when the sliding block  84  is in the fully extended position as shown in  FIGS. 5 and 6 , thus withstanding the compressive force in the springs  90 . 
     As the sliding block  84  moves leftward toward the position shown in  FIG. 2  from the position shown in  FIG. 6 , the lips  94  ride up and over the tops of the ramps  96  beneath the flanges  92 , so that movement of the sliding block  84  may create an audible click as the sliding block  84  moves along the pins  72  and the pins extend into the holes  40 , indicating to the user that the buckle  16  is engaged with the strap  30 . Thereafter the inwardly directed elastic force in the sides of the sliding block  84  presses the lips  94  against the ramps  96  and helps to keep the pins  72  engaged in the holes  40 , so that a slightly lower amount of tension in the portion  80  of the strap between the pins  72  and the loop  36  is sufficient to keep the sliding block in the leftwardly depressed position, once the pins  72  have become engaged in the holes  40  as shown in  FIGS. 2 and 4 . 
     As the strap  30 , when the outer end  34  is pulled away from the buckle  16 , passes over the curved face  87  of the sliding block, when the predetermined tension is applied to the buckle  16  by the strap  30 , the sliding block  84  moves, further compressing the springs  90  and allowing the pins  72  to extend from the holes  88  and proceed through the holes  40 , preventing further movement of the strap  30  around the sliding block  84 . The holes  40  in the strap  30  may have a slightly larger diameter than the largest transverse dimension of the pins  72 , so that engagement of the pins  72  in the holes  40  occurs easily and smoothly at the desired tension in the strap  30 . Thus, as described in previously mentioned U.S. Pat. No. 7,008,389, when the proper amount of tension has been reached in the portion of the pelvic sling  12  wrapped around an injured person, the buckle  16  will engage the strap  30 , and so long as tension in the pulled portion  80  of the strap  30  extending beyond the buckle  16  is not greatly reduced, the pins  72  will remain engaged in the holes  40 . It will be understood that the buckle  16  could be constructed to include only one pin  72  or more than two pins  72  and that the strap  30  could be provided with compatibly located holes  40 . 
     Once the pins  72  have engaged the holes  40 , tension should be substantially maintained in the outer or pulled portion  80  of the strap  30 , and the pulled portion  80  should be moved toward the person on whom the pelvic sling is being used and should be pressed against the outer end portion  26  of the main body  14  to engage the two mating kinds of fastener material with one another to retain the strap  30  at the desired location. 
     It would be possible to use other buckles (not shown), instead of the buckle  16 , so long as such buckles can sense a predetermined amount of tension and engage the strap  30  in response. 
     As a result of the locations and sizes of the areas of hook-bearing fastener material  54  and  58  and the loop-bearing fastener material  52  on the exterior face  50  of the strap  30 , the portion  80  of the strap  30  extending outside the buckle  16  and being pulled by a person applying the pelvic sling  12  to an injured person is able to be securely held by the combination of hook-bearing fastener material and loop-bearing fastener material at any effective circumference of the pelvis stabilizing pelvic sling device  12  at which the pins  72  of the buckle  16  may be engaged in a pair of holes  40  along the strap  30 . Thus, as shown in  FIGS. 2, 3 , and  4 , with the effective circumference of the pelvic sling  12  at or near a minimum, the area of hook-bearing fastener material  58  aligned centrally along the second end portion  26  of the main body is engaged with a confronting portion of the loop-bearing fastener material  52  on the exterior side  50  of the strap  30 . An available area of hook-and-loop fastener engagement is thus equal to the area of the hook-bearing fastener material  58  of one of the  3  strips shown in  FIG. 1 , and the mated fastener materials can hold the outer, or pulled end, portion  80  of the strap  30  securely enough to maintain enough tension in that portion  80  of the strap  30  so that the pins  72  of the buckle remain exposed beyond the sliding block  84  and engaged in the holes  40  of the strap  30 . 
     In  FIG. 8 , the pelvis-stabilizing pelvic sling  12  is shown in tension as when in place on a person having a larger girth, and the loop-bearing fastener material  52  of the intermediate portion  38  of the strap  30  is not aligned with the area of hook-bearing fastener material  58 . Instead, as shown in  FIG. 8  the hook-bearing fastener material  54  mounted on the loop  36  of the outer end portion  34  is engaged with the loop-bearing fabric of the exterior layer  48  of the outer end portion  26  of the main body  14  on each side of the centrally located area of hook-bearing fastener material  58 . As previously mentioned the fabric of the exterior layer  48  functions as loop-bearing fastener material. Accordingly, engagement of the area of hook-bearing fastener material  54  with the fabric  48  maintains sufficient tension in the outer, or pulled, portion  80  of the strap  30  to keep the pins  72  of the buckle  16  engaged in a pair of holes  40  in the strap  30 , to maintain the proper amount of tension in the pelvic sling  12  to support and stabilize a person&#39;s fractured pelvis. It will be apparent that the loop  36  could be located slightly differently with the same position of the strap  30  with respect to the buckle, as shown in broken line. Thus the hook-bearing fastener material  54  could engage the fabric of the exterior layer  48  largely between two of the areas  58  of hook-bearing fastener material, overlapping somewhat on each of the areas  58 , rather than by straddling a single area  58 . 
     As shown in  FIG. 9 , with the pelvis-stabilizing pelvic sling  12  in place under proper tension on a somewhat larger person than in  FIG. 8 , the hook-bearing fastener material  54  on the loop  36  at the outer end  34  of the strap  30  may be engaged with loop-bearing fastener material  52  at the inner end  28  of the strap  30  where it is attached to the second end portion  26  of the main body  14  and may also be engaged with the fiber loops of the fabric of the exterior layer  48  of the outer end portion  26 , to the extent that the area of hook-bearing fastener material  54  extends beyond the inner end portion  28  of the strap  30 . 
     As may be seen in  FIG. 10 , with the pelvis-stabilizing pelvic sling  12  under the proper amount of tension to stabilize and support a fractured pelvis in an even larger person, the hook-bearing fastener material  54  on the loop  36  at the outer end of the strap  30  can mate securely with the loop-bearing fastener material  52  on the portion  74  of the strap  30  between the second end portion  26  of the main body  14  and the buckle  16 . The mated hook-bearing fastener material  54  and loop-bearing fastener material  52  securely maintain sufficient tension in the strap  30  as it is engaged with the buckle  16  to keep the pins  72  engaged in a pair of holes  40  in the strap  30 . 
     Thus by referring to  FIGS. 4, 8, 9, and 10 , it may be seen that, regardless of the circumference of the person on whom the device  12  is being used, within a relatively wide range of different circumferences, application of the device  12  is very straightforward. As a result of the availability and locations of the areas of flexible fastener material of two mating kinds, located on the second end portion  26  of the main body  14 , on the strap  30 , and on the loop  36 , the outer, or pulled end, portion  80  of the strap  30  that extends beyond the buckle  16  can be fastened securely enough to maintain tension in the strap  30  to act against the sliding block  84  and thus maintain engagement of the buckle  16  with the pins  72  in any of the pairs of holes  40  along the part of the strap  30  extending beyond the second end portion  26  of the main body  14 . 
     As the inner end portion  28  of the strap  30  is permanently attached to the second end portion  26  of the main body  14 , adjustment of the pelvic sling  12  to provide the required amount of compression of the pelvis of an injured person is accomplished by pulling the strap  30  through the buckle  16 , without first having to assemble any parts of the device. The pelvic sling  12  is placed around the hips of an injured person suspected of having a broken pelvis by sliding the main body portion  14  beneath the hips of the injured person. With the person lying in a supine position, the exterior side of the main body  14 , the side shown in  FIG. 1 , should be downward. This permits the low friction plastic sheet  24  to slide easily along a surface of a backboard or other surface on which the person is resting, and exposes the necessary portions of the pelvic sling  12  so that it can be fastened. 
     Proper application of the pelvic sling  12  to an injured person thus can be accomplished simply and rapidly. First the sling should be placed at the level of the greater trochanters  66  and symphysis pubis, and the loop  36  and strap  30  must be passed through the opening in the frame  82  of the buckle  16  and around the curved face  87  of the sliding block  84 . The pelvic sling can be tightened around a person by pulling the strap  30  and the buckle  16  in opposite directions, using the large loop  22  as a handle to pull toward the patient&#39;s left, as shown by the arrow  76 , and, by using the large loop  36  as a handle, pulling the outer end  34  of the strap  30  in the opposite direction when the strap  30  extends through the buckle  16  and is doubled back toward the injured person&#39;s right side, as indicated by the arrow  78  in  FIG. 2 . The strap  30  is thus pulled through the buckle  16  until sufficient tension is achieved to move the sliding block  84  and allow the pins  72  to become engaged in a pair of holes  40  in the strap  30 . While maintaining tension in the outer portion  80  of the strap  30  against the buckle  16 , the flexible fastener materials can be engaged in one of the several alignments as described above to retain the tension in the strap  30  relative to the buckle  16  and thus to keep the pins  72  engaged in the holes  40  of the strap  30  at any effective circumference of the pelvic sling  12  at which the pins  72  are able to become engaged in a pair of holes  40 . 
     Thus, engagement of the loop-bearing fastener material  52  of the strap  30  with the hook-bearing material in the areas  58  on the second end portion gives a first range of smallest available effective circumferences of the pelvic sling  12 . Engagement of the fabric of the outer layer  48  of the second end portion of the main body  14  gives a second range of available, somewhat larger effective circumferences of the pelvic sling  12 . Finally, engagement of the area  54  of hook-bearing fastener material of the outer end  34  of the strap with the loop-bearing fastener material  52  on the intermediate portion  38  of the strap  30  gives a third range of available effective circumferences, and the adjacent parts of the ranges overlap each other. 
     The pelvic sling  12  is made from a minimal number of components, and preferably of materials which are, except for the springs  90 , radiolucent, and is ready for application as manufactured. 
     The pelvic sling  12  may be provided in various sizes. A normal size pelvic sling  12  may have a length  98  of its main body of, for example, 24 inches, and larger and smaller sizes may be provided for use with very slender or very large persons. For a normal size pelvic sling  12  the length of the strap  30  combined with the extent of the loop  36  may be similar to or slightly shorter than the main body length  98 . 
     While the description above has described the use of hook-bearing fastener material and loop-bearing fastener material, other two-component flexible fastener systems could also be used by similar placement of areas of the two matable fastener kinds on the strap  30  and a second end portion of a main body  14 . 
     Referring next to  FIGS. 11 and 11A , a pelvic sling  112  may also be used as a cervical support, hereinafter simply called a cervical collar, that can be wrapped around a patient&#39;s neck, as will be explained presently. The pelvic sling  112  is in many ways similar to the pelvic sling  12 , and so like reference numbers will be used with like components of the pelvic sling  112 . The pelvic sling  112  includes an inflatable bladder  114  in a central portion of the main body  14 , where it may be located between two fabric layers  48  and  46 . A fill tube  120  communicating with the bladder  114  may be provided on the outer side of the pelvic sling  112  at the first end portion  18  of the main body portion  14 . A suitable fill fitting  122  may be provided on the fill tube  120  to permit temporary attachment of a squeeze bulb (not shown) or connection to another source of air to inflate the bladder  114 . The fill fitting  122  may include a check-valve or other closure to maintain inflation of the bladder as required. 
     A piece of loop-bearing fastener material  123  may be provided on the second end portion  26  of the main body  14  as shown in  FIG. 11 , to supplement the loop-bearing nature of the fabric layer  48  if desired, to provide for secure engagement with the hook-bearing material  54  on the loop  36  at the outer end portion  34  of the strap  30 . 
     A pair of elongate stays  124  and  126  are attached to the main body portion  14 , as by strips  128  and  130  of strong fabric such as nylon webbing material sewn to the outer layer  48  of fabric of the main body portion  14 . The strips  128  and  130  of fabric might also be attached by other means such as thermal welding or adhesives, if more practical. The stays  124  and  126  are spaced apart from each other along the length of the main body  14  and may reside near or even overlapping the respective opposite ends of the bladder  114 , as may be seen in  FIG. 11A . The stays  124  and  126  may be narrow and elongate, and are held where they extend transversely across the length of the main body  14 , parallel with each other, where they can provide support along the opposite sides of a patient&#39;s neck when the pelvic sling  112  is utilized as a cervical collar, as will be explained in greater detail presently. 
     Each of the fabric strips  128  and  130  may thus have a length equal to the width of the main body portion  14  of the pelvic sling  112  and a width, parallel with the length of the main body  14  of, for example, about two inches. Each stay  124  and  126  may each have a length enough less than the width of the main body portion  14  to permit the opposite ends of the pieces of fabric  128  and  130  to be fastened securely to the main body  14  to capture the stays  124  and  126 . 
     Each stay  124  or  126  may have a width of, for example, about 0.5 inch (1.25 mm), although the specific dimensions are not critical. Each of the stays  124 ,  126  may be made of a suitable metal with sufficient thickness to provide firm support for the main body  14 . For example the stays  124 ,  126  may be of sheet steel or sheet aluminum, or a suitable composite material such as a fiber-reinforced resin of ample strength, with some amount of flexibility and resiliency. 
     It should be understood also that there might be only one, or more than two stays  124  and  126 . Also, the stays might extend diagonally and might not be parallel with one another, in different embodiments of the pelvic sling, and might be wider and less elongate, or in the nature of small plates of metal. In one version such stays or plates might be malleable enough to be bent to a desired configuration to help support a patient&#39;s neck or pelvis. 
     An area  132  of flexible fastener material of the second kind, such as hook-bearing flexible fastener material, may be provided on the loop  36  at the outer end of the strap member  30 , facing in the same direction as the inner side of the strap member  30 , and thus opposite the hook-bearing material  54  on the outer end portion of the strap member  30 , to be used to fasten the outer end  34  of the strap member  30  to the intermediate portion  38  of the strap member  30 . The area  132  of fastener material may, as shown in broken line in  FIG. 11 , be an extension of the area of  54  of hook-bearing flexible fastener material with one part thereof located as described with respect to the separate piece  132  so as to be exposed on the inner side of the strap member  30  at its outer end  34 . 
     A flexible tension-bearing member of another sort, such as a flexible cord, or cable, might also be attached to the second end portion  26  and used with a suitable fastener of a different sort, such as a spool or hook, (not shown) in place of the buckle  16  on the first end portion  18  of the main body portion  14 , to hold the main body around a patient&#39;s fractured pelvis. Another sort of fastener (not shown) might then be used together with the flexible tension-bearing member to secure the elongate main body portion  14  wrapped around the neck of a patient P. 
     A pelvic sling  140  that can also be used as a cervical collar is shown in  FIG. 12 , but with only a short portion of the strap member  30 . The pelvic sling  140  is similar in most respects to the pelvic sling  112 , and so will be described in detail only with respect to the significant differences. The principal difference in the pelvic sling  140  is that it includes three separate bladders, each somewhat smaller than the bladder  114  as illustrated in  FIGS. 11 and 11A . A central bladder  142  is the largest of the three and is located in substantially the same position, centrally within the main body portion  14 , as the bladder  114  is in the previously described pelvic sling  112 . Two more, smaller, bladders  144  and  146  are located respectively in the first end portion  18  and the second end portion  26 . The bladders  142 ,  144 , and  146  may all be installed in the same general manner as is the bladder  114  shown in  FIGS. 11 and 11A , and respective fill tubes and fill fittings (not shown), may be utilized to inflate each of the bladders  142 ,  144 , and  146 , or the bladders may be interconnected with each other and inflated through a single fill tube. The stays  124  and  126  and their associated retaining fabric pieces  128  and  130  are, as shown in  FIG. 12 , located similarly to their locations as in the pelvic sling  112  shown in  FIGS. 11 and 11A  and are between the central bladder  142  and the respective one of the end bladders  144  and  146 . 
     A pelvic sling  150  is yet another embodiment of the pelvic sling, as shown in  FIG. 13 . The pelvic sling  150  is generally similar to the pelvic sling  140  shown in  FIG. 12 , except that it lacks the stays  124  and  126  and their associated fabric strips  128  and  130 , and, as a result, there is room for the central bladder  152  and respective end bladders  154  and  156  to be somewhat larger and extend toward each other slightly more closely than the similar locations of the bladders  142 ,  144 , and  146  of the sling  140 . The bladders  142 ,  144 , and  146  may be inflated when the pelvic sling  112  or  140  is used, taking care not to provide too much tension in the pelvic sling. 
     Referring next to  FIG. 14 , the pelvic sling  112  is shown as used as a cervical collar on a patient P. For use of the pelvic sling  112  as a cervical collar, the main body portion  14  is wrapped around the neck of the patient P. The device  112  is placed around the neck of the patient P with the buckle  116  extending beyond the first end  18  of the main body portion and toward the posterior of the patient on the patient&#39;s right hand side. The strap member  30  is extended around the main body portion and overlapped onto its own intermediate portion  38 , and the outer end  34  of the strap member  30  is fastened to the intermediate portion  38  by mating interaction between the two types of fastener material. Thus when using the Velcro™ type hook-and-loop fastening materials described above, the piece of hook-bearing fastener material  132  on the outer end  34  of the strap member  30  mates securely with the loop-bearing fastener material  52  on the exterior side  50  of the intermediate portion  38  of the strap member  30 . The second end portion  26  of the main body portion  14  of the pelvic sling  112  overlaps the first end portion  18  and can be positioned by the medical service provider applying the device  112  as a cervical collar to provide the needed support for the chin of the patient P. With the device ideally located the stays  124  and  126  extend vertically along the neck of the patient P, providing stiffness in a lateral direction with respect to the main body portion  14 , that is, generally vertically along the neck of the patient P as shown in  FIG. 14 . Medical personnel can, if necessary, bend one or both of the stays  124 ,  126  to conform as desired to the patient&#39;s shoulders, neck, and head, and the device  112  can be placed on the neck of the patient P in the location deemed most appropriate to place the stays  124  and  126  where required, which may ordinarily be in a generally symmetrical arrangement with the stay  124  near the patient&#39;s left ear or jaw and the stay  126  near the patient&#39;s right ear or jaw. With the device wrapped around the neck of the patient P and the outer end  34  of the strap member  30  secured to the intermediate portion  38  of the strap  30  as shown in  FIG. 14 , the bladder  114  may be inflated as desired to provide support and to cause the interior layer  46  of fabric of the main body portion  14  to conform to and press against the neck of the patient P with a desired amount of pressure, by adjusting the extent of inflation of the bladder  114 . Either the pelvic sling  140  or the pelvic sling  150  would also be applied to the support the neck of a patient P in the same manner shown in  FIG. 14 , with the exception of additionally having the optional use of the additional bladders  144 ,  146 ,  154 , and  156  to modify the amount of support provided to the neck of patient P, and that in application of the pelvic sling  150  as a cervical collar the stays  124  and  126  are not available to provide support for the neck of the patient P as with the pelvic slings  112 , and  140 . 
     Referring next to  FIGS. 15 and 16 , a pelvic sling  160  is yet another embodiment of the pelvic sling shown in  FIGS. 1-10  and is generally similar to the pelvic sling  12  except as will be described presently. The pelvic sling  160  is shown including a piece  123  of loop-bearing fastener material attached to the second end portion  126  of the main body portion  14 . As with the pelvic slings  112 ,  140 , and  150 , an area of hook-bearing flexible fastener material  132  is attached to the interior side of the strap member  30  at its outer end  34 . 
     On one side of the first end portion  18  a margin is shaped to define a concave-shaped chin receptacle part  162  spanning a distance  164  of several inches of the main body portion  14  of the pelvic sling  160  for use of the pelvic sling  160  as a cervical collar as shown in  FIG. 16 . The distance  164  may, for example, be in the range of 4-8 inches and more preferably in the range of about 5-7 inches when the pelvic sling  160  is straightened out into a flat condition as shown in  FIG. 15 . While an arcuate concave chin receptacle  162  is shown the shape may vary, so long as there is some concavity and opposite sides to receive and help to stabilize the chin of the patient P. 
     For the sake of simplicity, the pelvic sling  160  is shown in  FIGS. 15 and 16  with the simple construction of the main body portion  14  similar to that shown in  FIGS. 1-10 , without showing any bladders or stays. It will be understood that in another embodiment including the concave margin defining the chin receptacle  162 , one or more bladders might be included as shown in  FIGS. 11, 11A, 12, and 13 . Similarly, stays  124  and  126  might be included in the pelvic sling  160 . 
     When the pelvic sling  160  is used as a cervical collar, as shown in  FIG. 16 , it can be placed under the chin of a patient P as shown in  FIG. 16  to receive and assist in stabilizing the chin of the patient P as the body portion  14  is wrapped around the neck of the patient P and the outer end  34  of the strap member  30  is connected to the intermediate portion  38  of the strap member  30  by interaction of the hook-bearing fastener material in the area  132  with the loop-bearing fastener material  52  on the exterior side  50  of the intermediate portion  38  of the strap member  30 , as shown in  FIG. 16 . 
     A pelvic sling  170 , shown in  FIGS. 17-19 , is similar to the pelvic sling  160  shown in  FIGS. 15 and 16 , except with respect to its first end portion  18 , where there is a moveable chin support piece  172  attached to the margin of the outer end portion  18  and aligned with the concave chin receptacle portion  162  of the margin of the outer end portion  18 . As shown in  FIG. 17 , the outer end portion  18  is flat, as in  FIG. 15 , and the movable chin support piece  172  is in a retracted, or non-deployed, position lying closely alongside the interior face of the main body portion  14  of the pelvic sling  170 . The moveable chin support piece  172  is attached to the margin of the end portion  18  by a pair of hinges  174  and  176  located near the opposite ends  178  and  180  of the moveable chin support piece  172 . The hinges  174  and  176  have respective hinge axes  175  and  177  aligned with the locations on the concave chin rest margin portion  162  where each hinge is attached and interconnects the end portion  18  with the moveable chin support piece, and as a result the axes  175  and  177  of the hinges  174  and  176  are coplanar but not parallel, and diverge from each other by an obtuse angle, as seen in  FIG. 17 , when the end portion  18  lies flat. 
     The moveable chin support piece  172  may be of a somewhat stiff and self-supporting yet flexible material such as multiple layers of heavy laminated textile fabric, or a somewhat flexible yet fairly stiff synthetic plastics material, so that the moveable chin support piece is able to flex along with the end portion  18  and lie closely alongside it when the pelvic sling  170  incorporating such a moveable chin support piece  172  is applied as a pelvic sling with the moveable chin support piece  172  in the retracted, non-deployed position shown in  FIG. 17 . The hinges  174  and  176  may be, for example, short pieces of narrow strong textile fabric such as nylon webbing sewn to the concave portion  162  of the margin of the end portion  18  and to the concave inner margin of the moveable chin support piece  172 . Alternatively, particularly if the moveable chin support piece  172  is of molded plastics material, the hinges  174  and  176  may be “live” plastic hinges with connected ears that can be sewn or otherwise fastened in well-known ways to the material of the outer end portion  18  and the chin support piece  172 . Also instead of being permanently attached and moveable, the chin support piece  172  could be attached to the end portion  18  of the main body portion  14  by detachable fasteners, such as Velcro, snap fasteners, or buttons. 
     When it is desired to use the pelvic sling  170  as a cervical collar, the moveable chin support piece  172  can be deployed to the exterior side of the end portion  18 . With the end portion  18  bent as shown in  FIGS. 18 and 19  so as to fit around and conform to the neck of a patient P, the axes of rotation of the hinges  174  and  176  are no longer coplanar, but are oriented differently with respect to each other, so that the moveable chin support piece  172  is held in a nearly horizontal orientation extending outwardly from the outer end portion  18  with an upwardly concave curved shape, so that it can support and cradle the chin of the patient P as shown in  FIG. 19 . Thus when the pelvic sling  170  is used as a cervical collar as shown in  FIG. 19  the moveable chin support piece  172  is deployed, and the main body portion  14  is placed on the neck of the patient P so it can support and cradle the chin of the patient P. The second end portion  26  of the pelvic sling  170 , depending upon the size and circumference of the neck of the patient P, may provide more or less additional support beneath the moveable chin support piece  172 , with the outer end  34  of the strap member  30  secured to the intermediate portion  38  of the strap member  30  by interaction between the area  132  of hook-bearing fastener material on the outer end  34  of the strap member with the loop-bearing fastener material  52  on the intermediate portion  38  of the strap member  30 . 
     It will be understood that the main body portion  14  of the pelvic sling  170  might be constructed in any desired one of the various configurations shown in  FIGS. 1-13 , to include or not to include one or more inflatable bladders and transversely-oriented stays while still incorporating the moveable chin support piece  172 . 
     Depending upon whether it is desired for the pelvic sling  170  to be able to be used only once or for more or fewer patients P, it will be understood that the moveable chin support piece  172  may also be made of various materials such as plastics, impregnated cloth or laminated paper, for example. 
     Referring next to  FIGS. 20-32 , a pelvic sling and junctional or truncal point pressure tourniquet  190  shown in  FIG. 20  includes the ability to compress a blood vessel such as a femoral artery, iliac artery, brachial artery, axillary artery, carotid artery, abdominal aorta or subclavian artery, as well as being able to perform the functions of a pelvic sling as described above. 
     The pelvic sling and junctional or truncal point tourniquet  190  disclosed herein may also be used to provide perfusion support in low flow disease states such as hemorrhagic shock and cardiac arrest, as by applying pressure to limit blood flow to distal parts of a patient and thereby reducing the size of the portion of the body where artificially assisted circulation is in effect. 
     The pelvic sling and tourniquet  190  shown in  FIG. 20  includes a main body portion  192  similar to the main body portion  14  of the device  12  shown in  FIGS. 1-4 , with the general shape of a wide belt. The main body portion  192  may be constructed of, for example, a pair of flexible, substantially inelastic sheets of strong loop-bearing flexible fastener material defining a wide central portion  194  with a width  196  of about 7 inches, for example, and a pair of tapered opposite end portions  198  and  200 . Alternatively, the main body  192  may be of another strong cloth, such as a polyethylene fiber fabric, covered by the loop-bearing fastener material, and may include a padding layer of batting (not shown). A buckle  202 , which may be similar to the buckle  16  of the device  12  shown in  FIGS. 1-4 , and which is therefore not described in detail here, is attached to the first end portion  198  of the main body  192 , preferably by a pivoting connection. A loop  204  of strong webbing material may engage the buckle, and corresponding holes in that webbing material and in the first end  198  of the main body  192  may be interconnected by a fastener such as a short bolt  206 . The holes in the first end portion  148  and the webbing material  204  attached to the buckle  202  may be suitably reinforced, as by the use of metal grommets. 
     At the second end portion  200  of the main body an inner end of an elongate flexible strap  30  similar to the strap member  30  of the pelvic slings  112 ,  140 ,  160 , and  170  is permanently attached to the main body  192 , as by being sewn, riveted, or thermally or sonically welded securely to the second end  200  of the main body  192 . The strap  30  extends longitudinally away from the second end portion, generally aligned with the longitudinal axis of the main body portion  192 . An outer end portion  34  of the strap  30  may include a loop  208  of strong fabric such as nylon webbing material covered by hook-bearing fastener material  210  on at least the outer face of the part adjacent to the outer face of the strap  30 . The strap  30  may be of strong, inelastic flexible nylon webbing, and at least an intermediate portion  212  has a layer of loop-bearing flexible fastener material  213  securely attached to and extending along an outer face  214  of the strap. 
     The strap  30  is provided with pairs of holes  216  to interact with the buckle  202  as explained above in connection with the pelvic sling  12  and buckle  16 , so that the main body portion  192  and the strap member  30  form a loop under tension when the buckle  202  is engaged with the strap member  30 , to act as a support for application of pressure inward with respect to that loop. 
     In the central portion  194  of the main body  192 , between the two layers of loop-bearing fastener material, is an inflatable bladder  220  similar to the bladder  114  of the pelvic sling  112  described above. The bladder  220  may be generally rectangular and of flexible sheet plastic, and may be referred to as a backing bladder. An inflation or fill tube  222  is connected to the bladder  220 , and a valve  224 , such as a luer activated valve, may be connected with the outer end of the tube  222 . The bladder  220  may be inflated by the use of a small pump, such as a squeeze bulb  226  with an outlet tube  228  equipped with a corresponding connector such as a luer fitting  229  at its outer end. A valve  230  may be provided at the squeeze bulb or pump outlet, to provide for relieving pressure and exhausting fluid from within the bladder  220  when desired, and a pressure gauge  231  may also be connected with the squeeze bulb  228  or other pump to provide a medical caregiver a means of assessing force level. 
     A strip  232  of hook-bearing flexible fastener material, an inch in width, for example, extends along and is securely fastened to the main body portion on its outer face  234 , so that the loop-bearing fastener material  213  on the outer face  214  of the strap  30  can mate with and be held against the outer face  234  of the main body portion when the strap  30  extends through the buckle  202  and is bent back alongside the main body  192  as shown in  FIGS. 23 and 24 . 
     A loop  240  of material such as Nylon webbing fits snugly around the strap  30 . A face of the loop  240  on the inner side of the strap  30  is provided with an area  242  of loop-bearing fastener material, and a selectively inflatable point pressure application device  244  may be attached to the loop  240  on the inner side of the strap  30  by a corresponding area  246  of mating hook-bearing fastener material attached to the base of the point pressure device, as will be explained in greater detail below. The loop  240  may be slid along the strap  30  to a desired position between the end  200  of the main body  192  and the buckle  202  to attach the point pressure device  244  to the strap  30 . 
     One or more point pressure devices  244  may also be attached removably to the inner face  248  of the main body portion  192  at any desired position, by mating interaction of the hook-bearing fastener material  246  on the base of the point pressure device with the loop-bearing fastener material on the inner face  248  of the main body portion  192 . A point pressure device  244  could also be attached permanently, as by sewing or adhesive attachment, to a selected location on the inner face  248 , as in the end portion  198 . 
     The pelvic sling and truncal and junctional tourniquet  250  shown in  FIG. 21  is generally similar to the device  190  shown in  FIG. 20 , except that the main body portion  252  of the device is narrower than the main body  192 , and may have a uniform width  254  of about 3 inches, for example. With such a smaller width, the device  250  may lack an inflatable bladder within its main body  252 , although its structure may otherwise be similar to the main body  192 , thus including a pair of sheets of strong loop-bearing fastener material, fastened together, and having a strip  256  of hook-bearing fastener material attached to and extending along an outer face  258 . Optionally, the main body may be of a strong fabric with loop-bearing fastener material attached to both sides. The pelvic slings  190  and  250  shown in  FIGS. 20 and 21  have been demonstrated to effectively reduce pelvic fractures when applied at each of three different anatomical levels I, II, and III as shown in  FIG. 24 . 
     A selectively inflatable hemostatic point pressure application device  244  may also be removably attached to a loop  240  slidably disposed on the strap portion  30  of the pelvic sling and tourniquet  250 , as with the device  190 , and another such point pressure application device  244  may be attached removably in a selected location on to the inner face  256  of the main body portion  252  by mating interconnection of the fastener materials at a desired position along the length of the main body portion  252 , although the smaller width  254  of the main body portion provides less choice of position. 
     Instead of the inflatable bladder contained within the main body portion  192  of the pelvic sling and tourniquet  190 , the device  250  may be accompanied by a separate inflatable pressure device  260  having a length  262  of, for example, about 13 inches, and a width  264  of, for example, about 7 inches, and containing a bladder  266  similar to the bladder  220  between a pair of layers of fabric each having an outer surface of loop-bearing flexible fastener material similar, for example, to that of the outside of the main body of the pelvic sling and tourniquet  190 . A strip of hook-bearing fastener material  268  an inch in width, for example, extends longitudinally along a central axis on each side of the separate inflatable pressure device  260 . A fill tube  270  is provided and may extend from one end of the inflatable bladder  266  and may be equipped with a connector and fill valve  224  such as the ones described above. 
     As may be seen in  FIG. 28 , the pelvic sling and truncal tourniquet  250  may be rolled tightly, together with a pair of point pressure devices  244 , into a compact package that can be carried in a minimum amount of space, ready for use for emergency treatment of injured personnel, as in military operations where size and weight of emergency medical supplies may be critical. 
     A point pressure device  244 , in one embodiment, as is shown in  FIGS. 29-32 , includes a baseplate portion  272 , which may be molded of a strong, rigid plastics material, and an inflatable flexible bladder portion  274  having a peripheral rim  276  of a shape and size corresponding to the shape of the baseplate  272 . The peripheral rim is fastened securely and hermetically sealed, as by an adhesive, or overmolding, or thermal welding, to a top surface of the baseplate  272 . An inlet fitting such as a barbed nipple or spigot  278  extending radially out in the plane of the baseplate  272  defines a bore leading inward beyond the outer rim portion  276  of the bladder  274  and extending upward, opening through the top surface of the baseplate  272  to be able to inflate the bladder. While the baseplate  272  as shown is generally flat, it could be shaped to correspond to the bladder  274  to be more compact in a package. The hook-bearing fastener material  246  on the bottom of the point pressure device  244  may be, as shown in  FIG. 20 , a simple square, or may, as shown in  FIG. 30 , be shaped to conform more closely to the shape of the baseplate  272 . A pressure limiting and relief valve  280  may be mounted in the base  272  as shown in  FIGS. 30 and 31 , to be sure that the bladder  274  doesn&#39;t fail because of overpressure, and to accommodate changes in ambient air pressure such as when a patient is airlifted, so that the bladder  274  does not become overextended or exert more than the desirable amount of pressure against a patient&#39;s body. 
     A suitable pressure relief valve  280 , for example, has a cracking pressure of 21.8 pounds per square inch (150 kPa)±15 percent. Such a pressure relief valve might be press fitted into a boss  282  defined in the baseplate  272 , or press fitted into a brass sleeve ultrasonically welded into the boss  282  in the baseplate, or ultrasonically welded directly into the boss in the baseplate, or the baseplate  272  could be over-molded onto the valve  280 . Alternatively, a relief valve could be connected to the point pressure device  244  through tubing connected to the fill tube spigot  278 . 
     The inflatable flexible bladder portion  274  of the point pressure device  244  is of a flexible material such as suitably strong and flexible plastics material molded in concentric pleats  286  arranged to unfold and allow a central part  288  to extend telescopically from the configuration shown in  FIG. 29  to a height  290  as shown in  FIG. 32  that is at least double and may be more than four times as great as the collapsed height  292  shown in  FIG. 29 , as a result of inflation and corresponding straightening of the concentric pleats  286 . The central part  288 , when the bladder  274  is extended, is the outer end of the bladder and is reinforced and thus stiffer than the expanded pleated portions  286  in order to be able to exert pressure firmly against a patient&#39;s body in a small area, such as a circular area with a diameter of about 2.2 inches, in a desired location, as to compress and hold a wound, or to exert pressure through a patient&#39;s tissue in order to compress and occlude a major blood vessel. In one embodiment of the inflatable point pressure device  244  the bladder portion  274  may have a collapsed height of about 0.6 inch and a diameter  294  of about 4 inches, with a wall thickness  296  of about 0.075 inch and a thickness of the central outer end parts  288  of about 0.25 inch. When extended, the height  290  may be about 3.0 inches. An inflation or fill tube mounted on the barbed spigot  278  may have a valve  224  of a luer activated type similar to that on the bladder  220 , compatible with the squeeze bulb pump  226  described previously. Alternatively, a valve (not shown) compatible with use of a CO 2  cartridge may be provided. 
     The inflatable point pressure device  244  or the separate inflatable pressure device  260  would be positioned between the belt  30  or the main body portion  192  or  252  and the patient, to apply pressure to a wound to be compressed or vasculature to be occluded. The bladders could be attached and positioned by various means such as being loosely sandwiched between the patient and belt, or being attached by hook-and-loop fasteners, clips, straps or the like. 
     Particularly where medical personnel need to limit blood flow to the legs, and regardless of whether a pelvic fracture exists or is suspected, to use the pelvic sling  190  or  250  the belt  30  would be tightened to a predetermined force dictated by a tension control mechanism such as the buckle  202  as described in greater detail above. This would provide a baseline force level. The operator would then activate one, two, or more separate inflatable pressure devices  260  or inflatable point pressure devices  244  to apply pressure to a wound or to press on the vasculature whose flow is to be limited or stopped. 
     One alternative to the inflatable bladder point pressure device  244  shown would be a screw system (not shown). The pelvic sling would have a series of threaded holes through the belt  30 . Once the belt was tightened to the controlled minimum tension, with a rigid end piece positioned between the patient and belt a screw would be inserted into one of the holes and connected to the rigid end piece. As the screw was tightened, force would be directed down towards the patient and the treatment/occlusion target. 
     Since patients have different circumferences, the junctional and truncal tourniquets  190  or  250  provides for a means of adjusting the distance between inflatable point pressure devices  244 . An inflatable point pressure device  244  on a pelvic sling and junctional and truncal tourniquet  190  or the like could be in a fixed position, possibly close to the buckle  202 . The emergency caregiver could adjust the position of the pelvic sling  190  or  250  on the patient so that the point pressure device is in the ideal fixed location for treatment or occlusion. Then, the second inflatable point pressure device  244  could be positioned according to the patient size and shape. Alternatively, both point pressure devices  244  could be fixed or both adjustable. 
     If the point pressure device  244  is to be pre-fixed to the main body  192  or  252 , this could be done with sewing, hook-and-loop, heat, adhesive, etc. 
     The separate pressure device  260  or the point pressure device  244  could be applied in the pelvic/groin/abdominal region as shown in  FIGS. 23, 24, 25, and 26  to close and compress open wounds or occlude femoral vessels, iliac vessels or the aorta, or in the shoulder area as shown in  FIG. 27  to treat or occlude carotid, axillary or subclavian vessels. If used in the shoulder area, the point pressure device may be fitted with a harness, a cup that cups the shoulder or a looping strap that goes around the shoulder which keeps the device from slipping away from the required location. With the device worn as shown in  FIG. 27  the strap member  30  may extend from the buckle  202  and over the patient&#39;s shoulder to be secured in the desired position and arranged by engaging the loop-bearing fastener material on the strap  30  with the strip of hook-bearing fastener material  232  on the main body  252 . 
     The bladder  220  and the inflatable pressure devices  244  and  260  may be inflated with the squeeze bulb  226  connected directly or via the tube  222  or  228 . The pressure devices could instead be inflated via a syringe-like pump, or by an electrically powered air pump, that could include an ambient air pressure sensor and could inflate the bladder and pressure devices to a predetermined pressure. Alternatively, the pressure devices  244  and  260  could be fitted with ports allowing connection to a pressurized gas chamber such as a disposable  12  gram CO 2  cartridge. If the pressure device  260  is fixed to the inside of the junctional or truncal point tourniquet  190  or  250  it may be desirable to have the inflation or fill tube extend through the junctional or truncal point tourniquet rather than around it, via a port through the belt (not shown) that connects the bladder to the source of inflation. The communication between a bladder and its inflation device could thus be via tubing or intimate interconnection. 
     The separate inflatable pressure device  260  could be of square, oval, circular, diamond or other shape to direct force directly inward from the main body  192  or  252 . The composition of the bladder or fabric covering the actual bladder, as shown in  FIGS. 22 and 23  could be a mostly non-elastic material such as loop-bearing fastener material, so that lateral stretch is reduced and force is directed controllably inward towards the patient. 
     The separate inflatable pressure device  260  could also have an attached rigid cup-like or otherwise protruding element (such as the pressure-concentrating member  408  described below) positioned between it and a patient to assist in focusing force. A rigid body at the bladder-patient interface results in maintaining a static surface area while force increases, thereby maximizing focused pressure. 
     To use the junctional and truncal point tourniquet and pelvis-stabilizing devices  190  and  250  in the pelvic or inguinal area, first insure the bladders  220  and  266  are deflated. If necessary, deflate them by attaching a squeeze bulb  226  and opening the valve  230 . Next, position the point pressure devices  244  on the junctional and truncal point tourniquet as required by the patient&#39;s size and the caregiver&#39;s personal preference, such as having the two point pressure devices  244  on the wider portion of the main body  192  or  252 , perhaps aligned with the backing bladder  220 . Wrap the junctional and truncal point tourniquet device around the patient, aligned on a plane with or proximal to the injury site. The buckle  202  could be in the back or in the front of the patient depending upon caregiver preference and the condition of the patient. 
     Next, thread the holed strap  30  through the buckle  202  and double it back toward the second end  200  of the main body  192 , so that the loop-bearing fastener material  213  on the portion of the strap member  30  that is doubled back faces toward the main body portion  192  or  252 . If one of the inflatable point pressure devices  244  is on the sliding loop  240 , slide the loop to the desired position along the strap member  30 . Then, holding the buckle or the main body portion, pull the strap member  30  through the buckle  202  with enough force to cause the buckle  202  to click and engage the holes  216  in the belt member. Then holding the strap in the same position to keep the buckle  202  engaged in the holes in the strap, press the strap  30  down to the main body  192  or  252  to secure the loop-bearing fastener material  213  to the strip of hook-bearing fastener material  232 . 
     Next ensure that the valve  230  in the squeeze bulb  226  is in the closed position and attach the pump connector fitting  229  to a luer connection  224  of one of the inflatable point pressure devices  244 , and then inflate the point pressure device  244  as much as possible. 
     If necessary, to compress a wound or gain tension to improve the effectiveness of an inflatable point pressure device  244  inflate the backing bladder  220  in the main body  192  or a separate pressure device  260 , as well. 
     For abdominal use of the junctional and truncal point tourniquet and pelvis-stabilizing devices  190  and  250 , first ensure the bladders  220  and  266  are deflated as explained above. Position an inflatable point pressure device  244  in the center of the central portion  194  of the main body  192 , over the backing bladder  220 . Wrap the junctional and truncal point tourniquet  190  or  250  around the patient with the inflatable point pressure device  244  centered over the patient&#39;s umbilicus. Thereafter proceed as explained above with respect to pelvic or inguinal area use to tension the device around the patient and inflate the point pressure device  244 , and, if necessary inflate the backing bladder  220  to obtain the desired result, such as occlusion of the abdominal aorta. 
     For use of the junctional and truncal point tourniquet and pelvis-stabilizing devices  190  and  250  to occlude the axillary artery or close a wound in the axilla prepare the device by ensuring the bladders  220  and  266  are deflated as explained previously and position one or more of the inflatable point pressure devices on the main body  192  or  252  or on the sliding loop  240  as explained above, and then wrap the junctional and truncal point tourniquet  190  or  250  around the patient, crossing under both shoulders. Align the inflatable point pressure device  244  on or proximal to an injury site and thread the end of the strap  30  through the buckle  202  and pull the outer end of the strap  30  until the buckle clicks and engages the holes  216  in the strap member  30 . Retaining tension in the strap to keep the buckle  202  engaged, pass the outer portion of the strap  30  over the top of a shoulder of the patient, depending on the desired configuration, and press the strap against the outer face of the main body of the device to mate the loop-bearing fastener material  213  with the strip of hook-bearing material  232  or  256  on the main body  192  or  252  to secure the strap member  30  and retain the desired tension in the tourniquet  190  or  250 . Depending upon the location of a wound or other factors that may be involved the device may be placed on the patient in various ways to accomplish the desired results. Once the tourniquet  190  or  250  is in the desired position the inflatable point pressure device or devices should be inflated, and if necessary, the backing bladder  220 , or a separate inflatable pressure device  260  should be inflated. 
     In some cases one of the inflatable point pressure devices  244  or a separate inflatable pressure device  260  may be useful separately, in which case the bladder  266  or  274  should initially be deflated as explained above. The pressure device  244  or  260  should be placed over the injury site or proximal to it and secured in place with a suitable bandage, ensuring that the fill tube and its connection fitting or valve  224  is accessible, after which the inflatable pressure device  244  or  260  should be inflated. 
     Referring now to  FIGS. 33-35 , a junctional and truncal point tourniquet and pelvis-stabilizing device  281 , at times called simply a tourniquet  281  below, has a main body  283  of strong flexible relatively inelastic and non-absorbent fabric such as a pair of layers of 500 Denier Cordura Nylon, and is generally similar in shape to the main body  192  of the pelvic sling and truncal and junctional tourniquet  190  except that it may have a smaller width  284  of about 4 inches, for example. 
     At a first end portion  287  of the main body  283  a receptacle or female part  289  of a the guide thing you do carry quick release fastener such as a side release buckle is attached to the main body  283 , as by a sewn loop of webbing material. Also attached to the first end portion  287 , as by another loop of webbing material, is a link  291  which may be a D-ring of molded plastic resin material. A handle  293  in the form of, for example, a loop of webbing material may also be attached to the first end  287  of the main body  283 . At an opposite second end portion  295  of the main body  283 , an inner end of a strap member  297  is attached to the main body  283 . The strap member  297  is similar to the strap member  30  of the previously described pelvic sling  12 , in general, and defines a series of pairs of holes  40  along its length arranged to interact with a force-controlling buckle  301 , generally similar to the previously described buckles  16  and  202 , which has pins  72  that can engage the holes  40  once a desired amount of force is applied. Instead of being attached to the first end  287  of the main body  283  by a loop of webbing material as in the sling  12 , however, the buckle  301  has, attached to its frame, the male portion  302  of a side release buckle that is releasably mateable with the buckle receptacle  289  mounted at the first end  287  of the main body  283 . Unless tension is applied in the strap member  297  the buckle  301  is free to slide along the strap member  297  between a soft stop  304 , which may be a short piece of fabric or plastic, attached to the strap member  297  and extending to each side far enough to impede movement of the buckle  301  without application of some amount of force, and a retainer  306  located near the outer end  308  of the strap member  297  to keep the buckle  300  on the strap member  296 . A handle  310 , in the form of a loop of webbing material such as that of which the strap member  297  is formed, may be provided at the outer end  308 . 
     At least one face of the strap member  297  may include a layer of loop-bearing fastener material  311 , and a patch of hook-bearing fastener material  54  may be provided on the loop  310 . 
     On the outer face  312  of the main body  283 , at a location between the first end portion  287  and the second end portion  295  of the main body, an auxiliary strap  314  is attached. As shown in  FIG. 33 , it may be folded and stowed within a pocket having an opening  316  defined on a margin of the main body  283 . The opening  316  permits the auxiliary strap  314  to be stowed easily and neatly, as when the device  281  has been used in training. A first end  318  of the auxiliary strap  314  is securely attached to the main body, as by being sewn to it within the pocket and extending through a slit, as may be seen best in  FIG. 35 . Ideally, the distance  319  between the location where the first end  318  is fastened and the attachment of the link  291  to the first end portion  287  is 50 percent of the 50 th  percentile of adult chest circumference, or about 20.2 inches (51 cm) from the fastening of the link  291  to the first end portion  287  of the main body  283 . A buckle  320  forms a loop spaced apart from the first end  318 , attaching a swivel attached to a fastener which may be a snap hook  322  and which is preferably of a size which can be inserted through and mated in the opening in the D-ring fitting  291  on the first end  286  of the main body  283  as will be explained presently. A keeper  324  such as a Velcro-retained strip of fabric may be utilized to retain the hook  322  when the strap member  314  is folded and stowed within the pocket  316 . The keeper  324  may be a narrow strip of material including loop-bearing fastener material, and a small area of hook-bearing fastener material may be provided on the outer face  312  to receive and retain the keeper  324  as shown in  FIG. 35 . 
     Areas of loop-pile bearing fastener material  328  and an area of hook-bearing material  330  may be located on the outer face  312  of the main body  283  at its second end  295  to mate with and secure the strap member  297  when it has been engaged with the buckle  301  when the tourniquet  281  is in use on a person. 
     As may be seen in  FIG. 34 , an area  332  of loop pile bearing fastener material may be attached to the inner face  334  of the main body  283  at the first end  286 . 
     An inflatable point pressure device  340  may include mating hook-bearing fastener material attached to its baseplate  272 , and may be is attached to the inner face  334  of the main body  283  by the loop pile bearing fastener material  332 , in a position which may be selected as required to place the point pressure device in an effective location for use of the tourniquet  281 . 
     In  FIG. 36 , which is generally similar to  FIG. 25 , the tourniquet  281  is shown in place on a patient, around the patient&#39;s pelvis, where it may be utilized to stabilize a fractured pelvis and to control hemorrhage in the lower extremities by occluding the flow of blood through the femoral arteries. 
     Since the force-controlling buckle  301  is slidable, and located and retained on the strap member  297  as shown in  FIG. 33 , the tourniquet  281  may be applied quickly. Preliminary to placement of the main body  283  around the patient&#39;s pelvis an inflatable point pressure device  340  is located on and attached to the fastener material  332  on the inner face  334 , at the first end  287  of the main body  283  in a position calculated to facilitate bringing pressure against the femoral artery to stop hemorrhaging from the leg. The tourniquet  281  is then applied by placing the main body  283  around the patient&#39;s pelvis and snapping the side release buckle male portion  302  into the female portion or receptacle  289  on the first end  287 . The strap member  297 , including the soft stop  304 , may then be pulled through the buckle  300  by the handle loop  310  while the handle  293  on the first end  287  of the main body  283  is pulled in the opposite direction until the force-controlling buckle  301  is operated by sufficient tension to engage the pins  72  in a pair of the openings  40  in the strap member  297  at the appropriate position to hold the strap member  297  and maintain the desired amount of tension in it and the main body  283 . 
     With the tension maintained by engagement of the buckle  301  the outer end of the strap member  297  is attached to the second end  295  by the engagement of the hook-bearing fastener material  330  in the loop pile material  311  on the inner face of the strap member  297  to keep the buckle  301  engaged. 
     If hemorrhaging is present in both legs a second point pressure device  340  may be attached to the strap member  297  before the tourniquet  281  is tightened. As may be seen in  FIG. 37 , with the tourniquet  281  in place as just described for the purpose of stabilizing a fractured pelvis and treating hemorrhaging in one or both legs, the auxiliary strap  314  remains stowed in its pocket within the main body  283 . 
     The tourniquet  281  may also be used in various other locations on a patient&#39;s abdomen in a manner similar to use of the truncal point tourniquets  190  and  250  as described above, or on the upper torso, as shown particularly in  FIGS. 38 and 39 , where the tourniquet  281  is shown used to control hemorrhaging by occluding the subclavian artery of a patient. With a point pressure device  340  attached to the first end portion  287  the main body  283  has been placed around the patient&#39;s chest just below the arms, and the tourniquet  281  has been placed in tension around the patient&#39;s chest, as may be seen by the projection of the pins  70  of the buckle  301  through a pair of holes  40  in the strap member  297  in  FIG. 38 , so that tension will hold the point pressure device  340  against the chest of the patient. The auxiliary, or shoulder, strap  314  has been extended, and the snap hook  322  has been engaged in the opening in the D-ring-like fitting  291 . The auxiliary strap  314  has been shortened sufficiently, using the buckle  320 , to pull upwardly on the first end  287  of the main body  283 , thus ensuring that the point pressure device  340  is held firmly against the patient in the required position to be able to exert pressure to occlude the subclavian artery to reduce hemorrhage. Because of the snug fit the tension in the auxiliary strap  314  will retain the point pressure device  314 , although loop-pile or Omni-tape fastener material could be mounted on the auxiliary strap  314  to provide added security. 
     As mentioned above, placement of the tourniquet  281  and point pressure device  340  could be adjusted in order to utilize the point pressure device  340  to occlude the carotid or axillary arteries. 
       FIG. 39  shows the auxiliary strap or shoulder strap  314  extending from the mid portion of the main body  283  over the shoulder of the patient toward the D-ring fitting  291 . Also seen in  FIG. 39  is the outer end of the strap member  296 . 
     In some cases placement of a point pressure device  340  appropriately and providing tension in the main body  283  may be sufficient to cause the point pressure device  340  to occlude an artery such as the subclavian artery and thus stop hemorrhaging. In many cases, however, it will be necessary to apply additional concentrated pressure to occlude a blood vessel by inflating the point pressure device  340 , as will be shown and explained in greater detail presently. 
     A junctional and truncal point tourniquet and pelvis-stabilizing device  350  shown in  FIGS. 40-44  is similar in many respects to the junctional and truncal point tourniquet and pelvis-stabilizing device  281 . A main body portion  352  is somewhat larger than the main body  283  of the device  281  but has a tension-bearing connecting or strap member  354  similar to the strap member  297  attached to and extending from a second end portion  356 . A handle  358  is attached to the first end portion  360  of the main body  352 . A buckle  301  is disposed on the strap member  354  and slidable along it between a hard stop  364 , which may be in the form of a plastic rod with bent-over ends sewn into a loop along the strap member  354  near its outer end  308  and handle loop  310 , and the second end portion  356  of the main body  352 . A loop  366  of fabric bulging apart from the strap member  354  may be provided a short distance toward the main body  352  from the hard stop  364  as a soft stop to keep the buckle  301  near the hard stop  364 , so that it is readily available when applying the device  350  to a patient. A movable loop  362  of loop-pile fastener material may be located on the strap member  354  to receive a hook-bearing fastener to support an inflatable point pressure device  340 . Having the buckle  301  close to the outer end  308  of the strap member allows the male part  302  of a strong quick-release fastener, such as a side release buckle extending from the frame of the buckle  301 , to be inserted easily into the female part or receptacle  289  of the side release buckle, attached to the main body  352  near its first end portion  360 . 
     Also as in the tourniquet  281 , the strap member  354  has fastener material  311  applied securely along one side, and mating fastener material  368  is located on the outer face  370  of the main body  352  adjacent the second end portion  356 . The specific loop-pile and hook-bearing fastener materials such as at  311 ,  328 ,  330 ,  332 ,  368 ,  378 ,  379 ,  382 , and  384  may be replaced by “Omni-Tape™”, a fastener material combining hooks and loops and able to connect with other pieces of the same material. 
     The main body  352  may be of two layers of suitably strong, flexible and generally inelastic fabric bound together about the periphery except at a pocket opening  372 , which may be provided with Velcro or other similar fastener material to keep the pocket closed normally. 
     An auxiliary strap  374  may have a handle in the form of a loop  376  normally kept attached to the outer face  370  and in a non-obstructing position, by fastener material  378  on the outer face  370  and mating hook-bearing fastener material  379  on the loop  376 . An end of the auxiliary strap  374  is fastened to the main body  352  within the pocket. The auxiliary strap  374  may be folded and kept within the main body portion  352 , extending out through a slit  380 . The auxiliary strap material  374  may be reached through the pocket opening  372  to fold it into a compact, neat configuration when the auxiliary strap is not to be used. 
     As shown in  FIG. 42  in particular, each side of the auxiliary strap  374  may be covered with fastener material  382  that can be engaged by hook-bearing fastener material  384  located on each side of the slit  380 . 
     As shown best in  FIG. 41 , a strip  388  of fastener material may be attached to and extend along a medial portion of the inner face  390 . Alternatively, the entire inner face  390  may be covered in loop pile fastener material. 
     Utilization of the junctional and truncal point tourniquet and pelvis-stabilizing device  350  in a pelvis-stabilizing application, or as a junctional tourniquet for occluding a femoral artery is essentially the same as utilization of the device  281  as described above and need not be described in detail. 
     As shown in  FIGS. 43 and 44 , however, utilization as a junctional point tourniquet, as to occlude a subclavian artery, is slightly different. The tourniquet  350  is placed around a patient&#39;s torso beneath the armpits and secured to provide a predetermined amount of tension around the patient&#39;s chest by action of the buckle  301  as described previously. Because of the somewhat greater width of the main body portion  352  of the device  350 , however, an inflatable point pressure application device  340  attached to the inner face  390  of the main body  352  by the fastening material  388  may not be appropriately located to apply occlusive pressure against the subclavian artery. The point pressure device  340  may, instead, be attached to the auxiliary strap  374  by fastening material on its baseplate  272 , as shown best in  FIG. 43 . The auxiliary strap  374  is extended from the pocket within the middle of the main body  352  along the patient&#39;s back and over the patient&#39;s shoulder, and is looped inside and back up around the outer side of the first end portion  360  of the main body  352 . The hook-bearing fastener material  379  on the loop  376  is used to engage the fastener material along the length of the auxiliary strap  374  to make the auxiliary strap  374  snug, and to maintain tension in the auxiliary strap  374  to hold the inflatable point pressure application device  340  tightly against the patient&#39;s body. The inflatable point pressure application device is then inflated, as necessary, to provide enough pressure against the patient to occlude the subclavian artery. 
     The inflatable point pressure device  340  is shown in  FIGS. 45, 46, 47, and 48  in sectional view in order to illustrate its function of occluding an artery or other vessel. The point pressure device  340  is similar in most respects to the point pressure device  244  described previously, and so it is not necessary to repeat that description here. Reference numerals used in the previous description of the point pressure device  244  will be used in connection with the point pressure device  340 . 
     In  FIG. 45 , the inflatable point pressure device  340  is not inflated but is in its normal relaxed condition. The central part  288  is a relatively rigid centrally located pressure member having a pressure face. A pair of concentric pleats  286  define, respectively, an inner ridge  402  surrounding the central part  288  and an outer ridge  404  surrounding both the central part  288  and the inner ridge  402 , with both the top of the central part  288  and the tops of the two ridges  402 ,  404  lying essentially within a single plane. As shown in  FIG. 45 , with a blood vessel  398  located beneath the surface  400  of the skin of a patient, when the point pressure device  340  is held against the patient&#39;s skin, as by the tension in the main body  283  and strap member  297  of the junctional tourniquet  281  or by tension in the auxiliary strap  314  extending over the shoulder of a patient, the inner and outer ridges  402 ,  404  and the central part  288  all exert some pressure against the blood vessel  398 , tending to squeeze it and thus reduce its patency and stop the flow through the blood vessel  398  to the location of a hemorrhage. 
     While each pressure point against the blood vessel should have some effect, the total effect may in some cases be insufficient, and, rather than increase the tension in the main body  283  and connecting strap member  297 , additional pressure to occlude the blood vessel  398  may be provided by increasing pressure within the inflatable part of the point pressure device  340 , raising the central part  288  and unfolding the outer pleat  286 , revising the shape of the point pressure device to  340  to the configuration shown in  FIG. 46 , where only the inner ridge  402  and the central part  288  continue to press against the patient, but with increased pressure over a smaller area, so that the more concentrated pressure can better squeeze the blood vessel  398  to occlude the flow of blood to the location of the hemorrhage. Thus, as shown in  FIG. 46  the inner ridge  402  presses on the blood vessel  398  on each side of the central part  288  with greater force and pressure than shown in  FIG. 45 . 
     If inflation to the form shown in  FIG. 46  is insufficient the inflatable flexible bladder portion  274  can be inflated to a higher pressure, unfolding the pleat  286  defining the inner ridge  402  and leaving only the central part  288  pressing against the skin surface  400  and tending to squeeze and occlude the blood vessel  298 . Depending on the totality of factors including the amount of tension in the tourniquet, the thickness of tissue between the skin surface  400  and the blood vessel  398 , the size of the blood vessel  398 , and the blood pressure within the blood vessel  398 , flow of blood through the blood vessel  398  may or may not be completely occluded. If the situation suggests it to the person treating the injured person, or if occlusion does not occur, possibly because of one of the factors mentioned above, a pressure-concentrating member  408  may be fitted onto the central part  288  of the point pressure device  340 , so that when the point pressure device  340  is inflated pressure on the blood vessel  398  can be concentrated and increased sufficiently to occlude the blood vessel  398  and stop hemorrhaging from occurring or from being fed by the blood vessel  398 . The pressure-concentrating member  408  may be made of a substantially rigid plastics material in a form such as that shown in  FIGS. 49, 50, and 51 , for example. A base portion  410  is designed to fit snugly onto the central part  288 , with a skirt  412  fitting around the periphery of the central part  288 . The base thus defines a shallow cavity  414  in which the central part  288  fits snugly to press against the underside of the base  410 . A pressing face  416  smaller than the pressing face of the central part  288  may be supported and spaced apart from the base  410  a distance of, for example, 0.8 inches by a suitable supporting structure  418 , and the entire pressure-concentrating member may be a monolithic molded plastic device. The pressing face  416  may, for example, be about 1 inch long and ⅝ inch wide. 
     The pressure-concentrating member  408  is ideally shaped to fit in where the central part  288  of the point pressure device  340  may be too large. For example, the best subclavian artery pressure point is between the clavicle and the upper rib and is fairly deep. The extra extension and small size of the pressing face  416  of the pressure-concentrating member  408  can reach the subclavian artery. 
     As shown in  FIG. 51 , the pressure-concentrating member ideally is placed upon the central part  288  so that when pressed against the blood vessel  398  it extends transversely across the blood vessel  398  so as to provide maximum pressure to flatten and squeeze the blood vessel  398  closed to stop hemorrhaging flow through the blood vessel  398 . 
     Preferably the truncal and junctional tourniquet and pelvis-stabilizing device  280  may be packaged in a tightly folded configuration and contained within a protective covering such as a shrink wrapped or vacuum-packed envelope  422  as shown in  FIG. 52 . This preferred compact package is desired to make it possible for military medical personnel or emergency medical personnel in ambulances, for example, to carry such a device so that it is readily available for use yet does not take up so much space that it prevents the caregiver from carrying other essential emergency care equipment in the available space. 
     Referring also to  FIGS. 53-56 , in another junctional and truncal point tourniquet and pelvis-stabilizing device  430  (at times hereinafter referred to as a tourniquet device), a hemostatic pressure application device  432 , which may include a selectively inflatable point pressure application device  244 , is carried on a stabilizing carrier assembly  435 . The junctional and truncal point tourniquet and pelvis-stabilizing device  430  is shown in  FIGS. 53 and 54  in place on a patient&#39;s torso so as to apply pressure to the patient&#39;s axilla to occlude an axillary or subclavian artery. 
     As shown in  FIGS. 53 , 54, and 55 , a main body portion  434  of the tourniquet device  430  extends around a patient&#39;s torso with opposite end portions  436  and  438  of the main body portion  434  connected with each other, forming a loop, and adjusted to provide a desired amount of hoop tension in the tourniquet device  430 . 
     The stabilizing carrier assembly  435  includes a stabilizer member  440  carrying a hemostatic pressure application device  432  and allowing the pressure application device  432  to be located in an appropriate position to provide required hemostatic pressure to areas in the upper torso of a patient, including the axilla. In particular, the stabilizing carrier assembly  435  can facilitate applying hemostatic pressure to the patient&#39;s axilla, including the area of the infraclavicular fossa medial to the coracoid process, over the axillary artery. An auxiliary strap  442 , that may be of suitably strong and flexible woven webbing, for example, has a first end  444  attached to an outer end  446  of the stabilizer member  440  and extends over the patient&#39;s shoulder and along the patient&#39;s back as shown in  FIGS. 53 and 54 . 
     A quick-acting connector, such as a self-mousing hook, a carabiner, or a snap hook  448  attached movably to the auxiliary strap  442 , as by a loop  450 , of wire or molded metal, disposed around the auxiliary strap, connects an intermediate part  452  of the auxiliary strap  442 , spaced apart from the first end  444  of the auxiliary strap, to the main body portion  434  of the junctional and truncal point tourniquet and pelvis-stabilizing device  430 , as may also be seen in  FIG. 61 . A loop  454  of strap material may be provided at an outer end of the auxiliary strap  442  for convenient use as a handle for pulling on the auxiliary strap  442  to establish tension between the outer end  446  of the stabilizer member  440  and the loop  450  carrying the snap hook  448 . When the tourniquet device  430  is packed ready for use the loop  450  carrying the snap hook  448  may be kept near the outer end of the auxiliary strap  442  by using a small piece  456  of a fastener material to form a loop in the end of the auxiliary strap  442  to hold the loop  450  where a user of the tourniquet device can easily find the snap hook  448  to attach it to the main body portion  434  before removing slack from the auxiliary strap  442 . 
     With the loop  450  carrying the snap hook  448  located at a desired position along the intermediate part  452  of the auxiliary strap  442 , the portion of the auxiliary strap  442  extending beyond the loop  450  may be doubled back and extended along the portion of the auxiliary strap  442  extending from the outer end  446  of the stabilizer member  440 . An area of hook-and-loop fastener material  457 , such as “Omni-tape”™ may be provided on the auxiliary strap  442  so as to fasten the parallel parts of the auxiliary strap to each other and thereby keep the loop  450  in the desired location along the length of the auxiliary strap  442 . 
     As may be seen in  FIG. 55 , the main body portion  434  of the junctional and truncal point tourniquet and pelvis-stabilizing device  430  is generally similar to the tourniquet  281  described above. A MOLLE-like attachment such as a length of strong, flexible, cord  458 , such as parachute cord, may be secured to the exterior face of the main body portion near its parallel margins  460  and extending to the end portions  436  and  438 , as by being securely sewn to the fabric of the main body portion  434  at several places  462 . Alternatively, a one-inch-wide length of strong webbing material might similarly be attached at several places, or small D-rings or reinforced holes in the fabric of the main body portion  434  may be provided at spaced locations. 
     At the first end portion  436  of the main body portion  434  a receptacle of a quick-release fastener, such as a female part  289  of a side release buckle, is attached to the main body portion  434 , as by a sewn loop of webbing material. A handle  464  in the form of, for example, a loop of webbing material, may also be attached to the first end portion  436  of the main body portion  434 . 
     Also attached to the first end portion  436 , is a connector such as a buckle receptacle  468  which may be a female part of a side release buckle of molded plastic resin material, and which may be attached to the first end portion  436  by another loop of webbing material. The buckle receptacle  468  is shown directed to the upper side of the main body portion as seen in  FIG. 55 , and in  FIG. 56  it may be seen that mating areas  470 ,  472  of hook-and-loop fastener material may be provided to keep the buckle receptacle  468  in the position shown in  FIG. 55  so that medical personnel familiar with the tourniquet device  430  will know where to find it. When desired, however, the buckle receptacle  468  can be released and moved to an opposite position, as when it is desired to apply the junctional and truncal point tourniquet device  430  to a patient in an orientation opposite from that shown in  FIG. 53 . 
     At the opposite , second, end portion  438  of the main body portion  434 , an inner end  474  of a strap member  476  is attached to the main body portion  434 . The strap member  476  is similar to the strap member  30  of the previously described pelvic sling  12 , in general, and may define a series of pairs of holes  40  along its length arranged to interact with a force-controlling buckle  301 , that is generally similar to the previously described buckles  16  and  202 , and has pins  72  that can engage the holes  40  once a desired amount of force is applied. As in the tourniquet  281 , the buckle  301  has, attached to its frame, the male portion  302  of a side release buckle that is releasably mateable with the buckle receptacle  289  mounted at the first end portion  436  of the main body portion  434 . When the tourniquet device  430  is packed buckle  301  is kept near the outer end of the strap member, between a soft stop  478 , which may be a short piece of fabric or plastic, attached to the strap member  476  and extending to each side far enough to impede movement of the buckle  301  without application of some amount of force, and a retainer  480  located near the outer end of the strap member  476  to keep the buckle  301  on the strap member  476 . A handle  482 , in the form of a loop of webbing material such as that of which the strap member  476  is formed, may be provided at the outer end of the strap member  476 . 
     At least one face of the strap member  476  may include a layer of hook-and-loop fastener material  484 , and a patch of such fastener material may also be provided on the loop  482 . 
     As shown in  FIGS. 53 and 60 , the stabilizing carrier assembly  435  is attached to the first end portion  436  of the main body portion  434 . This may be accomplished by connection with the buckle receptacle  468 , since this manner of mounting the point pressure application device  244  to the main body portion gives greater stability than when a point pressure application device is mounted on a flexible strap attached to the main body portion through a D-ring  291  as shown in  FIG. 38  above. 
     As shown in greater detail in  FIGS. 57 and 58 , the stabilizer member  440  of the stabilizing carrier assembly  435  is rigid and may conveniently be of molded plastic in the form of an elongate bar-like member including an inner end  486  at which a fastener  488  such as a male portion of a side release buckle is provided. The fastener  488  may be oriented at an angle  490  of, for example, about 30°, to the plane of the stabilizer member  440 , or, as shown in  FIG. 59 , the fastener  488  may extend in the same plane as the stabilizer member  440 . 
     A carrier  492 , which may also be of molded plastic, includes a loop  494  disposed slidably around the stabilizer member  440  as shown in  FIGS. 57 and 60 , so that the carrier  492  can be moved along the stabilizer member  440 , between the fastener  488  located at the inner end  486  and the outer end  446  of the stabilizer member  440 , where the auxiliary strap  442  is attached, keeping the carrier  492  on the stabilizer member  440 . 
     The carrier  492  includes a nest-like receptacle  496  of a size and shape appropriate for receiving a selectively inflatable hemostatic pressure application device  432  and attaching it to the stabilizer member  440 . For example, the receptacle  496  may be generally circular and planar, with a shallow upstanding rim  498  of a size to fit closely around a selectively inflatable pressure application device  432  such as the point pressure application device  244  described above. The receptacle may be made of a molded, generally rigid, but resilient plastic material and may have catches  500  provided at locations spaced apart along the rim  498  so as to engage and hold a point pressure application device  244 . A base of the receptacle may define a pair of notches  502  providing space for the inflation nipple or spigot  278  of the point pressure device  244 , so that the point pressure device  244  can be held in the receptacle with the inflation nipple  278  extending in either of two opposite orientations. 
     As may be seen in  FIGS. 57, 58 and 61 , a pressure-concentrating member  504 , basically similar to the pressure-concentrating member  408 , may be attached to the central part  288  of the bladder  274  of the inflatable point pressure device  244  in order to provide concentrated pressure to the axilla of a patient. A top member  506  of the pressure-concentrating member  504  may be relatively long and narrow, with a width of  508  of about 0.75 inch and a length  510  of about 3.5 inches, for example, so as to press against the patient beneath and parallel with the patient&#39;s clavicle and thereby occlude a deeply located blood vessel in order to stem a flow of blood to a hemorrhaging wound. 
     With the male fastener  488  oriented at the angle  490  to the stabilizer member  440 , the stabilizer member  440  has some room to be utilized as a lever to push the point pressure application device  244 , carrying the pressure-concentrating member  504 , deeply into the axilla of even a heavily-muscled patient when the outer end  446  of the stabilizer member  440  is pulled toward the patient by tension in the auxiliary strap  442 . 
     As with the tourniquet  281 , when using the tourniquet device  430 , the main body portion  434  is placed around the torso of the patient and the first and second end portions  436  and  438  are interconnected by the strap  476  and the buckle  301 , forming a loop surrounding the patient&#39;s torso. The loop is placed in tension, either to a level determined by the force-control buckle  301 , or with another amount of tension determined to be appropriate by the attending medical personnel, and the outer portion of the strap  297  may be attached to the first end portion of the main body portion by the hook-and-loop fastener material  484  to retain the hoop tension in the tourniquet device  430 . 
     The point pressure application device  244  is placed in the receptacle  496  of the carrier  492 , in the orientation that leaves the inflation nipple  278  best available. The carrier  492  is then placed in a desired position along the stabilizer member  440  and the snap hook  448  or other fastener in that location is attached to the cord  458  on the main body portion  434  at the patient&#39;s back, as shown in  FIGS. 54 and 61 . The auxiliary strap  442  is pulled through the loop  450  to create tension in the auxiliary strap  442  between the cord  458  on the main body portion  434  and the outer end  446  of the stabilizer member, and the free outer portion of the auxiliary strap  442  is secured to the portion under tension. Thereafter, the bladder  274  of the point pressure application device  244  is inflated, as by using a small pump such as the squeeze bulb  226 , shown in  FIG. 20 , or an equivalent, until the pressure-concentrating member  504  has been forced into the patient&#39;s torso deeply enough to stem the flow of blood to the hemorrhaging wound. 
     The terms and expressions which have been employed in the foregoing specification are used therein as terms of description and not of limitation, and there is no intention in the use of such terms and expressions of excluding equivalents of the features shown and described or portions thereof, it being recognized that the scope of the invention is defined and limited only by the claims which follow.