Page 41 - Journal of Special Operations Medicine - Spring 2016

scenarios in which the casualty has not yet arrived at Hemostatic dressings should be applied with at least 3
a military treatment facility with a surgical capability minutes of direct pressure (optional for XStat). Each
after 2 hours. This proposed use warrants further study. dressing works differently, so if one fails to control
bleeding, it may be removed and a fresh dressing of the
same type or a different type applied.
PROPOSED CHANGE TO THE TCCC GUIDELINES
Current Wording
If the bleeding site is amenable to use of a junctional tour-
niquet, immediately apply a CoTCCC- recommended
Tactical Field Care
junctional tourniquet. Do not delay in the application of
4. Bleeding the junctional tourniquet once it is ready for use. Apply
b. For compressible hemorrhage not amenable to limb hemostatic dressings with direct pressure if a junctional
tourniquet use or as an adjunct to tourniquet removal, tourniquet is not available or while the junctional tour-
use Combat Gauze as the CoTCCC hemostatic dress- niquet is being readied for use.
™
ing of choice. Celox Gauze and ChitoGauze may also
be used if Combat Gauze is not available. Hemostatic Tactical Evacuation Care
™
dressings should be applied with at least 3 minutes of 3. Bleeding
direct pressure. If the bleeding site is amenable to use of b. For compressible hemorrhage not amenable to limb
a junctional tourniquet, immediately apply a CoTCCC- tourniquet use or as an adjunct to tourniquet removal,
recommended junctional tourniquet. Do not delay in use Combat Gauze as the CoTCCC hemostatic dress-
™
the application of the junctional tourniquet once it is ing of choice.
ready for use. Apply hemostatic dressings with direct
pressure if a junctional tourniquet is not available or Alternative hemostatic adjuncts:
while the junctional tourniquet is being readied for use.
– Celox Gauze or
– ChitoGauze or
Tactical Evacuation Care
– XStat (best for deep, narrow-tract junctional wounds)
3. Bleeding
b. For compressible hemorrhage not amenable to limb Hemostatic dressings should be applied with at least 3
tourniquet use or as an adjunct to tourniquet removal, minutes of direct pressure (optional for XStat). Each
use Combat Gauze as the CoTCCC hemostatic dress- dressing works differently, so if one fails to control
™
ing of choice. Celox Gauze and ChitoGauze may also bleeding, it may be removed and a fresh dressing of the
be used if Combat Gauze is not available. Hemostatic same type or a different type applied.
™
dressings should be applied with at least 3 minutes of
direct pressure. If the bleeding site is amenable to use of If the bleeding site is amenable to use of a junctional tour-
a junctional tourniquet, immediately apply a CoTCCC- niquet, immediately apply a CoTCCC- recommended
recommended junctional tourniquet. Do not delay in junctional tourniquet. Do not delay in the application of
the application of the junctional tourniquet once it is the junctional tourniquet once it is ready for use. Apply
ready for use. Apply hemostatic dressings with direct hemostatic dressings with direct pressure if a junctional
pressure if a junctional tourniquet is not available or tourniquet is not available or while the junctional tour-
while the junctional tourniquet is being readied for use. niquet is being readied for use.

Proposed Change Vote
(New proposed material is in red text)
This proposed change to the TCCC Guidelines was ap-
Tactical Field Care proved by the required two-thirds or greater majority of
the voting members of the CoTCCC.
4. Bleeding
b. For compressible hemorrhage not amenable to limb Level of Evidence
tourniquet use or as an adjunct to tourniquet removal,
use Combat Gauze as the CoTCCC hemostatic dress- The levels of evidence used by the American College of
™
ing of choice. Cardiology and the American Heart Association were
outlined by Tricoci in 2009 :
33
Alternative hemostatic adjuncts:
– Level A: Evidence from multiple randomized trials or
– Celox Gauze or meta-analyses.
– ChitoGauze or – Level B: Evidence from a single randomized trial or
– XStat (best for deep, narrow-tract junctional wounds) nonrandomized studies.

TCCC Guidelines: XStat Sponge for External Hemorrhage 25