Page 37 - Journal of Special Operations Medicine - Spring 2015

minimum risk occurs only when both goals are Do not delay in the application of the junctional
attained. tourniquet once it is ready for use. Apply hemo­
4. Tourniquets placed during CUF should be positioned static dressings with direct pressure if a junctional
clearly proximal to the bleeding site(s). If the site of tourniquet is not available or while the junctional
life­threatening bleeding is not readily apparent, the tourniquet is being readied for use.
tourniquet should be placed high and tight (as proxi­ c. Reassess prior tourniquet application. Expose
mal as possible) on the injured extremity as soon as wound and determine if tourniquet is needed. If
possible. so, move tourniquet from over uniform and ap­
5. Single­slit routing of the C­A­T band through the ply directly to skin 2–3 inches above wound. If a
buckle is effective and may reduce blood loss and tourniquet is not needed, use other techniques to
time for application; this method is recommended control bleeding.
during the CUF phase. d. When time and the tactical situation permit, a dis­
tal pulse check should be accomplished. If a distal
pulse is still present, consider additional tighten­
Proposed Change ing of the tourniquet or the use of a second tour­
niquet, side by side and proximal to the first, to
Current Wording in the TCCC Guidelines eliminate the distal pulse.
e. Expose and clearly mark all tourniquet sites with
Care under fire the time of tourniquet application. Use an indel­
7. Stop life-threatening external hemorrhage if tacti­ ible marker.
cally feasible:
– Direct casualty to control hemorrhage by self­aid Tactical evacuation care
if able. 3. Bleeding
– Use a CoTCCC­recommended tourniquet for hem­ a. Assess for unrecognized hemorrhage and control
orrhage that is anatomically amenable to tourni­ all sources of bleeding. If not already done, use
quet application. a CoTCCC­recommended tourniquet to control
– Apply the tourniquet proximal to the bleeding life­threatening external hemorrhage that is ana­
site, over the uniform, tighten, and move the casu­ tomically amenable to tourniquet application or
alty to cover. for any traumatic amputation. Apply directly to
the skin 2–3 inches above wound.
Tactical field care b. For compressible hemorrhage not amenable to
4. Bleeding tourniquet use or as an adjunct to tourniquet
a. Assess for unrecognized hemorrhage and control removal (if evacuation time is anticipated to be
all sources of bleeding. If not already done, use longer than 2 hours), use Combat Gauze as the
a CoTCCC­recommended tourniquet to control CoTCCC hemostatic dressing of choice. Celox
life­threatening 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 2–3 inches above wound. pressure.
b. For compressible hemorrhage not amenable to Before releasing any tourniquet on a casualty
tourniquet use or as an adjunct to tourniquet who has been resuscitated for hemorrhagic shock,
removal (if evacuation time is anticipated to be ensure a positive response to resuscitation ef­
longer than 2 hours), use Combat Gauze as the forts (i.e., a peripheral pulse normal in character
CoTCCC hemostatic dressing of choice. Celox and normal mentation if there is no TBI.) If the
™
Gauze and ChitoGauze may also be used if bleeding site is appropriate for use of a junctional
Combat Gauze is not available. Hemostatic dress­ tourniquet, immediately apply a CoTCCC recom­
ings should be applied with at least 3 minutes of mended junctional tourniquet. Do not delay in the
direct pressure. application of the junctional tourniquet once it is
Before releasing any tourniquet on a casualty ready for use. Apply hemostatic dressings with
who has been resuscitated for hemorrhagic shock, direct pressure if a junctional tourniquet is not
ensure a positive response to resuscitation efforts available or while the junctional tourniquet is be­
(i.e., a peripheral pulse normal in character and ing readied for use.
normal mentation if there is no traumatic brain c. Reassess prior tourniquet application. Expose
injury (TBI). If the bleeding site is appropriate for wound and determine if tourniquet is needed. If
use of a junctional tourniquet, immediately apply so, move tourniquet from over uniform and ap­
a CoTCCC­recommended junctional tourniquet. ply directly to skin 2–3 inches above wound. If a

TCCC Limb Tourniquet Guidelines Change 14-02 27