Hemorrhage Control
Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE HANDBOOK here
In the tactical field care phase, hemorrhage control includes addressing any significant bleeding sites not previously controlled. When evaluating the casualty for bleeding sites, only remove the absolute minimum of clothing needed to expose and treat injuries.
Stop significant extremity bleeding as quickly as possible, using a tourniquet without hesitation if necessary.
It is important to note that after tourniquet application, a distal pulse must be assessed to ensure the arterial blood flow has been stopped.
If a distal pulse remains after tourniquet application( see video), then a second tourniquet must be applied side by side and just above the original tourniquet.
This second tourniquet applies pressure over a wider area and more easily stops the arterial flow. There have been a number of reports of compartment syndrome in distal extremities when the tourniquet is not applied tightly enough to stop arterial blood flow.
In addition, there have been tourniquet failures when the care provider has attempted to tighten the tourniquet to the extreme.
If a tourniquet is applied around the limb as snuggly as possible before the windlass is tightened, it should only take three revolutions (540 degrees) of the windlass to stop blood flow.
If a distal pulse is still present, it is more prudent to apply a second tourniquet as described above than to try and tighten the original one too tightly.
It must be pointed out that the additional step of checking a distal pulse should only be accomplished when the tactical situation permits
. Otherwise, direct pressure, pressure dressings, or homeostatic dressings (combat gauze) should be used to control bleeding.
Tourniquets should remain in place until the casualty has been transported to the evacuation point. Once the patient has been transported to the site where evacuation is anticipated, and any time the casualty is moved, reassess any tourniquets previously applied.
If evacuation is significantly delayed (greater than two hours), the medic should make a determination if the tourniquet should be loosened and bleeding control replaced with some other technique.
Hemostatic bandages, pressure bandages, etc. may be able to control the bleeding and lower the risk to the extremity that a tourniquet poses.
However, it needs to be emphasized that there is no evidence that tourniquets have caused the loss of any limbs in hundreds of tourniquet applications.
If a decision to remove a tourniquet is made, the medic must be sure to complete any required fluid resuscitation prior to tourniquet discontinuation.
It is not necessary to remove the tourniquet, only to loosen it. This allows the tourniquet to be reapplied if the hemorrhage cannot be controlled by other methods. Data from research done in theater have demonstrated tourniquet application before the casualty goes into shock significantly improves survival statistics.
The training emphasis must continue to be on the control of bleeding in all casualties.
Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE HANDBOOK here
In the tactical field care phase, hemorrhage control includes addressing any significant bleeding sites not previously controlled. When evaluating the casualty for bleeding sites, only remove the absolute minimum of clothing needed to expose and treat injuries.
Stop significant extremity bleeding as quickly as possible, using a tourniquet without hesitation if necessary.
It is important to note that after tourniquet application, a distal pulse must be assessed to ensure the arterial blood flow has been stopped.
If a distal pulse remains after tourniquet application( see video), then a second tourniquet must be applied side by side and just above the original tourniquet.
This second tourniquet applies pressure over a wider area and more easily stops the arterial flow. There have been a number of reports of compartment syndrome in distal extremities when the tourniquet is not applied tightly enough to stop arterial blood flow.
In addition, there have been tourniquet failures when the care provider has attempted to tighten the tourniquet to the extreme.
If a tourniquet is applied around the limb as snuggly as possible before the windlass is tightened, it should only take three revolutions (540 degrees) of the windlass to stop blood flow.
If a distal pulse is still present, it is more prudent to apply a second tourniquet as described above than to try and tighten the original one too tightly.
It must be pointed out that the additional step of checking a distal pulse should only be accomplished when the tactical situation permits
. Otherwise, direct pressure, pressure dressings, or homeostatic dressings (combat gauze) should be used to control bleeding.
Tourniquets should remain in place until the casualty has been transported to the evacuation point. Once the patient has been transported to the site where evacuation is anticipated, and any time the casualty is moved, reassess any tourniquets previously applied.
If evacuation is significantly delayed (greater than two hours), the medic should make a determination if the tourniquet should be loosened and bleeding control replaced with some other technique.
Hemostatic bandages, pressure bandages, etc. may be able to control the bleeding and lower the risk to the extremity that a tourniquet poses.
However, it needs to be emphasized that there is no evidence that tourniquets have caused the loss of any limbs in hundreds of tourniquet applications.
If a decision to remove a tourniquet is made, the medic must be sure to complete any required fluid resuscitation prior to tourniquet discontinuation.
It is not necessary to remove the tourniquet, only to loosen it. This allows the tourniquet to be reapplied if the hemorrhage cannot be controlled by other methods. Data from research done in theater have demonstrated tourniquet application before the casualty goes into shock significantly improves survival statistics.
The training emphasis must continue to be on the control of bleeding in all casualties.
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