Page 16 - ATP-P 11th Ed

3. Massive Hemorrhage
a. Assess for unrecognized hemorrhage and control all sources of bleeding. If not already
SECTION 1 hemorrhage that is anatomically amenable to tourniquet use or for any traumatic ampu-
done, use a CoTCCC-recommended limb tourniquet to control life- threatening external
tation. Apply directly to the skin 2–3 inches above the bleeding site. If bleeding is not
controlled with the first tourniquet, apply a second tourniquet side-by-side with the first.
b. For compressible (external) hemorrhage not amenable to limb tourniquet use or as
™
an adjunct to tourniquet removal, use Combat Gauze as the CoTCCC hemostatic
dressing of choice.
Alternative hemostatic adjuncts:
™
i. Celox Gauze or
®
ii. ChitoGauze or
™
iii. XStat (best for deep, narrow-tract junctional wounds)
™
iv. iTClamp (may be used alone or in conjunction with hemostatic dressing or XStat )
c. Hemostatic dressings should be applied with at least 3 minutes of direct pressure
™
(optional for XStat ). 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, or trauma dressings may be applied.
d. If the bleeding site is amenable to use of a junctional tourniquet, immediately apply
a CoTCCC-recommended junctional tourniquet. Do not delay in the application of
the junctional tourniquet once it is ready for use. Apply hemostatic dressings with
direct pressure if a junctional tourniquet is not available or while the junctional
tourniquet is being readied for use.
e. 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 con-
trol. Wounds should be packed with a hemostatic dressing or XStat , if appropriate,
™
prior to iTClamp application.
i. The iTClamp does not require additional direct pressure, either when used alone
or in combination with other hemostatic adjuncts.
ii. If the iTClamp is applied to the neck, perform frequent airway monitoring and
evaluate for an expanding hematoma that may compromise the airway. Con-
sider placing a definitive airway if there is evidence of an expanding hematoma.
iii. DO NOT APPLY on or near the eye or eyelid (within 1cm of the orbit).
f. Perform initial assessment for hemorrhagic shock (altered mental status in the ab-
sence of brain injury and/or weak or absent radial pulse) and consider immediate
initiation of shock resuscitation efforts.
4. Airway Management
a. Conscious casualty with no airway problem identified:
i. No airway intervention required

6 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 7