Page 61 - Journal of Special Operations Medicine - Fall 2014

Military Special Operations Forces, NATO militaries, e. Expose and clearly mark all tourniquet sites with
and EMS and law enforcement agencies have already the time of tourniquet application. Use an indel-
implemented wide use of these new recommended chi- ible marker.
tosan-based hemostatic dressings. Based on the larger
experience of the US Military with Combat Gauze, this Tactical Evacuation Care
dressing should remain in the guidelines as the hemo-
static dressing of choice but with the knowledge that 3. Bleeding
both Celox Gauze and ChitoGauze show similar efficacy a. Assess for unrecognized hemorrhage and control
and are viable alternatives. Therefore, the TCCC Guide- all sources of bleeding. If not already done, use
lines should continue to include Combat Gauze, with the a CoTCCC-recommended tourniquet to con-
addition of Celox Gauze and ChitoGauze dressings. trol life-threatening external hemorrhage that is
anatomically amenable to tourniquet application
or for any traumatic amputation. Apply directly
PROPOSED CHANGE TO THE TCCC GUIDELINES to the skin 2–3 inches above wound.
b. For compressible hemorrhage not amenable to tour-
Current Wording niquet use or as an adjunct to tourniquet removal
(if evacuation time is anticipated to be longer than 2
Tactical Field Care hours), use Combat Gauze as the hemostatic dress-
3. Bleeding ing of choice. Combat Gauze should be applied with
a. Assess for unrecognized hemorrhage and control at least 3 minutes of direct pressure. Before releas-
all sources of bleeding. If not already done, use ing any tourniquet on a casualty who has been re-
a CoTCCC-recommended tourniquet to control suscitated for hemorrhagic shock, ensure a positive
life-threatening external hemorrhage that is ana- response to resuscitation efforts (i.e., a peripheral
tomically amenable to tourniquet application or pulse normal in character and normal mentation if
for any traumatic amputation. Apply directly to there is no TBI). If the bleeding site is appropriate for
the skin 2–3 inches above wound. use of a junctional tourniquet, immediately apply a
b. For compressible hemorrhage not amenable to tour- CoTCCC- recommended junctional tourniquet. Do
niquet use or as an adjunct to tourniquet removal not delay in the application of the junctional tourni-
(if evacuation time is anticipated to be longer than 2 quet once it is ready for use. Combat Gauze applied
hours), use Combat Gauze as the hemostatic dress- with direct pressure should be used if a junctional
ing of choice. Combat Gauze should be applied with tourniquet is not available or while the junctional
at least 3 minutes of direct pressure. Before releas- tourniquet is being readied for use.
ing any tourniquet on a casualty who has been re- c. Reassess prior tourniquet application. Expose
suscitated for hemorrhagic shock, ensure a positive wound and determine if tourniquet is needed. If
response to resuscitation efforts (i.e., a peripheral so, move tourniquet from over uniform and ap-
pulse normal in character and normal mentation if ply directly to skin 2–3 inches above wound. If a
there is no TBI). If the bleeding site is appropriate for tourniquet is not needed, use other techniques to
use of a junctional tourniquet, immediately apply a control bleeding.
CoTCCC- recommended junctional tourniquet. Do d. When time and the tactical situation permit, a dis-
not delay in the application of the junctional tourni- tal pulse check should be accomplished. If a distal
quet once it is ready for use. Combat Gauze applied pulse is still present, consider additional tighten-
with direct pressure should be used if a junctional ing of the tourniquet or the use of a second tour-
tourniquet is not available or while the junctional niquet, side-by-side and proximal to the first, to
tourniquet is being readied for use. eliminate the distal pulse.
c. Reassess prior tourniquet application. Expose e. Expose and clearly mark all tourniquet sites with
wound and determine if tourniquet is needed. If the time of tourniquet application. Use an indel-
so, move tourniquet from over uniform and ap- ible marker.
ply directly to skin 2–3 inches above wound. If a
tourniquet is not needed, use other techniques to Proposed wording (Changes in red)
control bleeding.
d. When time and the tactical situation permit, a dis- Tactical Field Care
tal pulse check should be performed after apply-
ing a tourniquet. If a distal pulse is still present, 3. Bleeding
consider additional tightening of the tourniquet or a. Assess for unrecognized hemorrhage and control
the use of a second tourniquet, side-by-side and all sources of bleeding. If not already done, use
proximal to the first, to eliminate the distal pulse. a CoTCCC-recommended tourniquet to control

Chitosan-Based Hemostatic Gauze Dressings 53