Page 185 - 2026 SMOG

HEMORRHAGE CONTROL PROCEDURES
Clinical Indications
• Hemorrhage
Contraindications
• None
Procedure
• Rapid bleeding and/or arterial source recognized (extremities, axial, inguinal)
˚ Immediate application of extremity and/or junctional tourniquets, as appropriately needed, to
stop bleeding.
• For compressible (external) hemorrhage not amenable to a limb tourniquet, use Combat Gauze,
the CoTCCC hemostatic dressing of choice.
˚ Alternative hemostatic adjuncts:
■ Celox Gauze, ChitoGauze, XStat (best for deep, narrow-tract junctional wounds) or
iTClamp (may be used alone or in conjunction with hemostatic dressing or XStat).
• Hemostatic dressings should be applied with at least 3min of direct pressure (optional for
XStat). Must apply adequate force to compress vessels. If the size of the wound and bleeding
are concerning for adequate control, place a hemostatic dressing as close to the bleeding vessel
as possible, followed by 5min of direct pressure. Each dressing works differently, so if one fails
to control bleeding, it may be removed and a fresh dressing of the same type or a different type
applied. (Note: XStat is not to be removed in the field, but additional XStat, other hemostatic
adjuncts, or trauma dressings may be applied over it.) If bleeding continues, apply a pressure
dressing to the wound if applicable.
• If unable to control bleeding in extremity wounds with the above, apply a tourniquet. Note:
immediate transition to a tourniquet in an extremity hemorrhage is preferred.
• In penetrating injuries to the abdomen, after clearing blood, hemostatic dressings should be
pushed into the wound and pressure held for 5min to encourage clotting. Do not remove the
bandage after placement. Penetrating abdominal/thoracic injuries require a large amount of
pressure to compress vessels.
• In pelvic wounds—utilize pelvic binding to limit capacity for hemorrhage (tie pelvis with
sheet/commercial binder).
˚ For external hemorrhage of the head and neck where the wound edges can be easily
reapproximated, the iTClamp may be used as a primary option for hemorrhage control.
Wounds should be packed with a hemostatic dressing or XStat, if appropriate, prior to
iTClamp application. DO NOT APPLY on or near the eye or eyelid (within 1cm of the orbit).
■ The iTClamp does not require additional direct pressure, either when used alone or in
combination with other hemostatic adjuncts.
■ If the iTClamp is applied to the neck, perform frequent airway monitoring and evaluate
for an expanding hematoma that may compromise the airway. Consider placing a
definitive airway if there is evidence of an expanding hematoma.
PROCEDURES
• Document procedure, results, and vital signs.

2026 Standard Medical Operating Guidelines (SMOG) • 177