Page 43 - ATP-P 11th Ed

Table 5 PCC Level for Circulation and Resuscitation
PCC Level for Circulation and Resuscitation
T T T T *All Personnel - Complete Basic TCCC Management Plan for Massive Hemorrhage
C C C C then: SECTION 1
C C C C Role 1a
C C C C • Re-assess all tourniquets and wound dressings.
- - - - • Ensure that bleeding has stopped.
A C C C • If bleeding persists, consider additional tightening of the tourniquet, the use of an ad-
S L M P ditional tourniquet, or the use of hemostatic dresssings with wound packing to stem the
M S C P hemorrhage.
• Conduct the principles of wound care to avoid infection and possible follow-on sepsis.
• Initiate hypothermia prevention measures.
Role 1b/1c
• Continue and/or initiate above circulation interventions.
• Initiate hypothermia prevention measures, if not already completed.
• Perform all recommended interventions from guidelines for above Tier level.
• Additional interventions include:
Role 1a
• Re-assess all tourniquets and wound dressings.
• Ensure that bleeding has stopped.
• If bleeding persists, consider additional tightening of the tourniquet, the use of an ad-
ditional tourniquet or the use of hemostatic dressings with wound packing to stem the
hemorrhage.
• Replace any limb tourniquet placed proximal over the uniform with one applied directly to
the skin 2–3 inches above the wound.
• Assess extremities distal to pressure dressings.
• Check pulses and the skin color distal to the dressing.
• Decreased pulses or skin mottling may indicate the dressing is acting as a venous tourniquet.
• If present, dressing may need to be replaced or readjusted.
• Ongoing venous tourniquet could result in limb damage or development of compartment
syndrome.
• Conduct the principles of wound care to avoid infection and possible follow-on sepsis.
• Initiate hypothermia prevention measures.
Roles 1b/1c
• Continue and/or initiate above circulation interventions.
• Initiate hypothermia prevention measures, if not already completed.
• Re-assess and re-apply MARCH interventions.
• Review transfusion transmitted disease (TTD)/titer of present unit members.
• Ensure all interventions noted above are completed by TCCC ASM and CLS personnel
• Conduct inventory of all shock treatment supplies including whole blood, testing equip-
ment, IVs, and other resources.
• Document all pertinent information on PCC Flowsheet (attached).
• Additional interventions include:
(continues)

32 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 33