Page 62 - Journal of Special Operations Medicine - Fall 2014

life-threatening external hemorrhage that is ana- Gauze and ChitoGauze may also be used if Com-
tomically amenable to tourniquet application or bat Gauze is not available. Hemostatic dressings
for any traumatic amputation. Apply directly to should be applied with at least 3 minutes of direct
the skin 2 to 3 inches above wound. pressure. Before releasing any tourniquet on a ca-
b. For compressible hemorrhage not amenable to sualty who has been resuscitated for hemorrhagic
tourniquet use or as an adjunct to tourniquet shock, ensure a positive response to resuscitation
removal (if evacuation time is anticipated to be efforts (i.e., a peripheral pulse normal in charac-
longer than 2 hours), use Combat Gauze as the ter and normal mentation if there is no traumatic
CoTCCC hemostatic dressing of choice. Celox brain injury [TBI]). If the bleeding site is appropri-
Gauze and ChitoGauze may also be used if Com- ate for use of a junctional tourniquet, immediately
bat Gauze is not available. Hemostatic dressings apply a CoTCCC-recommended junctional tour-
should be applied with at least 3 minutes of direct niquet. Do not delay in the application of the
pressure. Before releasing any tourniquet on a ca- junctional tourniquet once it is ready for use. Ap-
sualty who has been resuscitated for hemorrhagic ply hemostatic dressings with direct pressure if a
shock, ensure a positive response to resuscitation junctional tourniquet is not available or while the
efforts (i.e., a peripheral pulse normal in charac- junctional tourniquet is being readied for use.
ter and normal mentation if there is no traumatic c. Reassess prior tourniquet application. Expose
brain injury [TBI]). If the bleeding site is appro- wound and determine if tourniquet is needed. If
priate for use of a junctional tourniquet, immedi- so, move tourniquet from over uniform and apply
ately apply a CoTCCC-recommended junctional directly to skin 2 to 3 inches above wound. If a
tourniquet. Do not delay in the application of the tourniquet is not needed, use other techniques to
junctional tourniquet once it is ready for use. Ap- control bleeding.
ply hemostatic dressings with direct pressure if a d. When time and the tactical situation permit, a dis-
junctional tourniquet is not available or while the tal pulse check should be accomplished. If a distal
junctional tourniquet is being readied for use. pulse is still present, consider additional tighten-
c. Reassess prior tourniquet application. Expose ing of the tourniquet or the use of a second tour-
wound and determine if tourniquet is needed. If niquet, side-by-side and proximal to the first, to
so, move tourniquet from over uniform and apply eliminate the distal pulse.
directly to skin 2 to 3 inches above wound. If a e. Expose and clearly mark all tourniquet sites with
tourniquet is not needed, use other techniques to the time of tourniquet application. Use an indel-
control bleeding. ible marker.
d. When time and the tactical situation permit, a dis-
tal pulse check should be accomplished. If a distal Vote: The proposed change noted above was approved
pulse is still present, consider additional tighten- by the required 2/3 or greater majority of the voting
ing of the tourniquet or the use of a second tour- members of the CoTCCC on 23 March 2014.
niquet, side-by-side and proximal to the first, to
eliminate the distal pulse. Level of Evidence (AHA): C.
e. Expose and clearly mark all tourniquet sites with
the time of tourniquet application. Use an indel-
ible marker. Considerations for Further Research
1. A Performance Improvement study reviewing the in-
formation in the DoD Trauma Registry pertaining to
Tactical Evacuation Care
the prehospital use of hemostatic dressings should be
3. Bleeding undertaken.
a. Assess for unrecognized hemorrhage and control 2. The information above should be supplemented by
all sources of bleeding. If not already done, use direct input from Combat medics, corpsmen, and
a CoTCCC-recommended tourniquet to control pararescuemen regarding the efficacy of the hemo-
life-threatening external hemorrhage that is ana- static dressings that they have personally used to
tomically amenable to tourniquet application or treat combat injuries on the battlefield. The TCCC
for any traumatic amputation. Apply directly to Equipment Feedback project done by the Navy Med-
the skin 2 to 3 inches above wound. ical Lessons Learned Center is the best current model
b. For compressible hemorrhage not amenable to for gathering this type of information. This project
tourniquet use or as an adjunct to tourniquet should be sustained.
removal (if evacuation time is anticipated to be 3. New hemostatic dressings should continue to be as-
longer than 2 hours), use Combat Gauze as the sessed for efficacy by the USAISR, NMRU-SA, and
CoTCCC hemo static dressing of choice. Celox other laboratories using the standardized bleeding

54 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014