TCCC Guidelines: Tourniquets & Hemostatic Agents (Paraphrased) Basic Management Plan for Care Under Fire: Bleeding Stop life-threatening external hemorrhage if tactically feasible Direct casualty to control hemorrhage by self-aid, if able Use a CoTCCC-recommended TQ for hemorrhage that is anatomically amenable to TQ application Apply the TQ proximal to bleeding site, over uniform, tighten, and move the casualty to cover

TCCC Guidelines: Tourniquets & Hemostatic Agents (Paraphrased) Basic Management Plan for Tactical Field Care: Bleeding Step A Assess for unrecognized hemorrhage, control all bleeding Use a CoTCCC-recommended TQ to control life-threatening external hemorrhage that is amenable to TQ application Apply TQ directly to the skin, 2-3 inches above wound

TCCC Guidelines: Tourniquets & Hemostatic Agents (Paraphrased) Step B For compressible hemorrhage not amenable to TQ, use Combat Gauze® as the hemostatic agent of choice Apply Combat Gauze ® with at least 3 minutes of direct pressure Step C Reassess prior application of TQ. Expose wound, determine if TQ is needed If so, replace TQ over uniform with another applied directly to skin 2-3 inches above wound

TCCC Guidelines: Tourniquets & Hemostatic Agents (Paraphrased) Step D When time and the tactical situation permit, check for distal pulse If a distal pulse is still present, consider tightening the TQ or use a second TQ, side by side and proximal to the first, to eliminate the distal pulse Step E Expose & clearly mark all TQ sites with the time of tourniquet application. Use an indelible marker

(TCCC Guidelines: Full Version) Backup Slides (TCCC Guidelines: Full Version)

TCCC Guidelines on Tourniquets and Hemostatic Agents Basic Management Plan for Tactical Field Care (Bleeding): Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done, use a CoTCCC-recommended tourniquet to control life-threatening external hemorrhage that is anatomically amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin 2-3 inches above wound.

TCCC Guidelines “Bleeding” continued: b. For compressible hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet removal (if evacuation time is anticipated to be longer than two hours), use Combat Gauze® as the hemostatic agent of choice. Combat Gauze ® should be applied with at least 3 minutes of direct pressure. Before releasing any tourniquet on a casualty who has been resuscitated for hemorrhagic shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in character and normal mentation if there is no traumatic brain injury (TBI)).

TCCC Guidelines “Bleeding” continued: Step b cont’d: “If a lower extremity wound is not amenable to tourniquet application and cannot be controlled by hemostatics/dressings, consider immediate application of mechanical direct pressure, including CoTCCC -recommended devices such as the Combat Ready Clamp (CRoC®).”

TCCC Guidelines “Bleeding” continued: c. Reassess prior tourniquet application. Expose wound and determine if tourniquet is needed. If so, replace tourniquet over uniform with another applied directly to skin 2-3 inches above wound. If tourniquet is not needed, use other techniques to control bleeding. d. When time and the tactical situation permit, a distal pulse check should be accomplished. If a distal pulse is still present, consider additional tightening of the tourniquet or the use of a second tourniquet, side by side and proximal to the first, to eliminate the distal pulse. e. Expose and clearly mark all tourniquet sites with the time of tourniquet application. Use an indelible marker.

Combat Gauze ™ Application Directions: Open clothing around the wound. If possible, remove excess pooled blood from the wound while preserving any clots already formed in the wound. Locate the source of the most active bleeding. Pack Combat Gauze™ tightly into wound and directly onto the source of bleeding. More than one gauze may be required to stem blood flow. Combat Gauze™ may be re-packed or adjusted in the wound to ensure proper placement. Quickly apply pressure until bleeding stops. Source: http://www.health.mil/Education_And_Training/TCCC.aspx

Combat Gauze ™ Application Directions: Hold continuous pressure for 3 minutes. Reassess to ensure bleeding is controlled. Combat Gauze™ may be repacked or a second gauze used if initial application fails to provide hemostasis. Leave Combat Gauze™ in place. Wrap to effectively secure the dressing in the wound. Do not remove the bandage or Combat Gauze™. Transport casualty to next level of medical care as soon as possible. Source: http://www.health.mil/Education_And_Training/TCCC.aspx