Page 38 - Journal of Special Operations Medicine - Spring 2015

tourniquet is not needed, use other techniques to c. Reassess prior tourniquet application. Expose the
control bleeding. wound and determine if a tourniquet is needed. If it
d. When time and the tactical situation permit, a dis­ is, replace any limb tourniquet placed over the uni­
tal pulse check should be accomplished. If a distal form with one applied directly to the skin 2–3 inches
pulse is still present, consider additional tighten­ above wound. Ensure that bleeding is stopped.
ing of the tourniquet or the use of a second tour­ When possible, a distal pulse should be checked.
niquet, side by side and proximal to the first, to If bleeding persists or a distal pulse is still present,
eliminate the distal pulse. consider additional tightening of the tourniquet or
e. Expose and clearly mark all tourniquet sites with the use of a second tourniquet side by side with the
the time of tourniquet application. Use an indel­ first to eliminate both bleeding and the distal pulse.
ible marker. d. Limb tourniquets and junctional tourniquets
should be converted to hemostatic or pressure
dressings as soon as possible if three criteria are
Proposed New Wording in the TCCC Guidelines met: the casualty is not in shock; it is possible to
monitor the wound closely for bleeding; and the
Care under fire tourniquet is not being used to control bleeding
7. Stop life­threatening external hemorrhage if tacti­ from an amputated extremity. Every effort should
cally feasible: be made to convert tourniquets in less than 2
– Direct casualty to control hemorrhage by self­aid, hours if bleeding can be controlled with other
if able. means. Do not remove a tourniquet that has been
– Use a CoTCCC­recommended limb tourniquet in place more than 6 hours unless close monitor-
for hemorrhage that is anatomically amenable to ing and lab capability are available.
tourniquet use. e. Expose and clearly mark all tourniquet sites with
– Apply the limb tourniquet over the uniform clearly the time of tourniquet application. Use an indel­
proximal to the bleeding site(s). If the site of the ible marker.
life-threatening bleeding is not readily apparent,
place the tourniquet “high and tight” (as proxi- Tactical evacuation care
mal as possible) on the injured limb and move the 3. Bleeding
casualty to cover. a. Assess for unrecognized hemorrhage and control
all sources of bleeding. If not already done, use a
Tactical field care CoTCCC­recommended limb tourniquet to con­
4. Bleeding trol life­threatening external hemorrhage that is
a. Assess for unrecognized hemorrhage and control anatomically amenable to tourniquet use or for
all sources of bleeding. If not already done, use a any traumatic amputation. Apply directly to the
CoTCCC­recommended limb tourniquet to con­ skin 2–3 inches above the wound. If bleeding is
trol life­threatening external hemorrhage that is not controlled with the first tourniquet, apply a
anatomically amenable to tourniquet use or for second tourniquet side by side with the first.
any traumatic amputation. Apply directly to the b. For compressible hemorrhage not amenable to
skin 2–3 inches above the wound. If bleeding is limb tourniquet use or as an adjunct to tourniquet
not controlled with the first tourniquet, apply a removal, use Combat Gauze as the CoTCCC he­
second tourniquet side by side with the first. mostatic dressing of choice. Celox Gauze and Chito­
b. For compressible hemorrhage not amenable to Gauze may also be used if Combat Gauze is not

limb tourniquet use or as an adjunct to tourni­ available. Hemostatic dressings should be applied
quet removal, use Combat Gauze as the CoTCCC with at least 3 minutes of direct pressure. If the bleed­
hemostatic dressing of choice. Celox Gauze and ing site is amenable to use of a junctional tourniquet,
ChitoGauze may also be used if Combat Gauze immediately apply a CoTCCC­recommended junc­

is not available. Hemostatic dressings should be tional tourniquet. Do not delay in the application
applied with at least 3 minutes of direct pressure. of the junctional tourniquet once it is ready for use.
If the bleeding site is amenable to use of a junc­ Apply hemostatic dressings with direct pressure if a
tional tourniquet, immediately apply a CoTCCC­ junctional tourniquet is not available or while the
recommended junctional tourniquet. Do not delay junctional tourniquet is being readied for use.
in the application of the junctional tourniquet c. Reassess prior tourniquet application. Expose the
once it is ready for use. Apply hemostatic dress­ wound and determine if a tourniquet is needed.
ings with direct pressure if a junctional tourniquet If it is, replace any limb tourniquet placed over
is not available or while the junctional tourniquet the uniform with one applied directly to the skin
is being readied for use. 2–3 inches above wound. Ensure that bleeding is

28 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015