Page 20 - ATP-P 11th Ed

iii. Reassess prior tourniquet application. Expose the wound and determine if a
tourniquet is needed. If there is a vascular injury and the tourniquet is needed,
SECTION 1 to the skin 2–3 inches above the bleeding site. Ensure that bleeding is stopped.
replace any limb tourniquet placed over the uniform with one applied directly
If there is not a traumatic amputation, a distal pulse should be checked. If bleed-
ing persists or a distal pulse is still present, consider additional tightening of
the tourniquet or the use of a second tourniquet side-by-side with the first to
eliminate both bleeding and the distal pulse. If the reassessment determines that
the prior tourniquet was not needed, then remove the tourniquet and note time
of removal on the TCCC Casualty Card.
iv. Limb tourniquets and junctional tourniquets should be converted to hemostatic or
pressure dressings as soon as possible if three criteria are met: the casualty is not
in shock; it is possible to monitor the wound closely for bleeding; and the tour-
niquet is not being used to control bleeding from an amputated extremity. Every
effort should be made to convert tourniquets in less than 2 hours if bleeding can
be controlled with other means. Do not remove a tourniquet that has been in place
more than 6 hours unless close monitoring and lab capability are available.
v. Expose and clearly mark all tourniquets with the time of tourniquet application.
Note tourniquets applied and time of application; time of re-application; time of
conversion; and time of removal on the TCCC Casualty Card. Use a permanent
marker to mark on the tourniquet and the casualty card.
b. Assess for hemorrhagic shock (altered mental status in the absence of brain injury
and/or weak or absent radial pulse).
c. IV/IO Access
i. Intravenous (IV) or intraosseous (IO) access is indicated if the casualty is in
hemorrhagic shock or at significant risk of shock (and may therefore need fluid
resuscitation), or if the casualty needs medications, but cannot take them by
mouth.
(a) An 18-gauge IV or saline lock is preferred.
(b) If vascular access is needed but not quickly obtainable via the IV route, use
the IO route.
d. Tranexamic Acid (TXA)
i. If a casualty is anticipated to need significant blood transfusion (for example:
presents with hemorrhagic shock, one or more major amputations, penetrating
torso trauma, or evidence of severe bleeding)
OR
ii. If the casualty has signs or symptoms of significant TBI or has altered metal
status associated with blast injury or blunt trauma:
(a) Administer 2g of tranexamic acid via slow IV or IO push as soon as pos-
sible but NOT later than 3 hours after injury

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