Page 167 - Journal of Special Operations Medicine - Spring 2017

Alternative hemostatic adjuncts: Alternative hemostatic adjuncts:
– Celox Gauze or – Celox Gauze or
– ChitoGauze or – ChitoGauze or
– XStat (Best for deep, narrow-tract junctional wounds) – XStat (Best for deep, narrow-tract junctional wounds)
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Hemostatic dressings should be applied with at least Hemostatic dressings should be applied with at least
3 minutes of direct pressure (optional for XStat ). Each 3 minutes of direct pressure (optional for XStat ). Each
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dressing works differently, so if one fails to control dressing works differently, so if one fails to control
bleeding, it may be removed and a fresh dressing of the bleeding, it may be removed and a fresh dressing of the
same type or a different type applied. same type or a different type applied.
If the bleeding site is amenable to use of a junc- If the bleeding site is amenable to use of a junc-
tional tourniquet, immediately apply a CoTCCC- tional tourniquet, immediately apply a CoTCCC-
recommended junctional tourniquet. Do not delay in recommended junctional tourniquet. Do not delay in
the application of the junctional tourniquet once it is the application of the junctional tourniquet once it is
ready for use. Apply hemostatic dressings with direct ready for use. Apply hemostatic dressings with direct
pressure if a junctional tourniquet is not available or pressure if a junctional tourniquet is not available or
while the junctional tourniquet is being readied for use. while the junctional tourniquet is being readied for use.
c. Reassess prior tourniquet application. Expose the wound c. A pelvic binder should be applied for cases of suspected
and determine if a tourniquet is needed. If it is, replace pelvic fracture:
any limb tourniquet placed over the uniform with one – Severe blunt force or blast injury with one or more of
applied directly to the skin 2–3 inches above wound. the following indications:
Ensure that bleeding is stopped. When possible, a distal • Pelvic pain
pulse should be checked. If bleeding persists or a distal • Any major lower limb amputation or near
pulse is still present, consider additional tightening of amputation
the tourniquet or the use of a second tourniquet side- • Physical exam findings suggestive of a pelvic
by-side with the first to eliminate both bleeding and the fracture
distal pulse. • Unconsciousness
d. Limb tourniquets and junctional tourniquets should be • Shock
converted to hemostatic or pressure dressings as soon d. Reassess prior tourniquet application. Expose the wound
as possible if three criteria are met: the casualty is not and determine if a tourniquet is needed. If it is, replace
in shock; it is possible to monitor the wound closely for any limb tourniquet placed over the uniform with one ap-
bleeding; and the tourniquet is not being used to con- plied directly to the skin 2–3 inches above wound. Ensure
trol bleeding from an amputated extremity. Every effort that bleeding is stopped. When possible, a distal pulse
should be made to convert tourniquets in less than 2 should be checked. If bleeding persists or a distal pulse is
hours if bleeding can be controlled with other means. still present, consider additional tightening of the tourni-
Do not remove a tourniquet that has been in place more quet or the use of a second tourniquet side-by-side with
than 6 hours unless close monitoring and lab capability the first to eliminate both bleeding and the distal pulse.
are available. e. Limb tourniquets and junctional tourniquets should be
e. Expose and clearly mark all tourniquet sites with the converted to hemostatic or pressure dressings as soon
time of tourniquet application. Use an indelible marker as possible if three criteria are met: the casualty is not in
shock; it is possible to monitor the wound closely for bleed-
Proposed New Wording ing; and the tourniquet is not being used to control bleed-
Care Under Fire ing from an amputated extremity. Every effort should be
made to convert tourniquets in less than 2 hours if bleed-
N/A
ing can be controlled with other means. Do not remove a
tourniquet that has been in place more than 6 hours unless
Tactical Field Care close monitoring and lab capability are available.
(Proposed New material in red text) f. Expose and clearly mark all tourniquet sites with the
time of tourniquet application. Use an indelible marker.
4. Bleeding
a. Assess for unrecognized hemorrhage and control all
sources of bleeding. If not already done, use a CoTCCC- TACEVAC Care
recommended limb tourniquet to control life-threaten-
ing external hemorrhage that is anatomically amenable 3. Bleeding
to tourniquet use or for any traumatic amputation. Ap- a. Assess for unrecognized hemorrhage and control all
ply directly to the skin 2–3 inches above the wound. sources of bleeding. If not already done, use a CoTCCC-
If bleeding is not controlled with the first tourniquet, recommended limb tourniquet to control life-threaten-
apply a second tourniquet side-by-side with the first. ing external hemorrhage that is anatomically amenable
b. For compressible (external) hemorrhage not amenable to tourniquet use or for any traumatic amputation. Ap-
to limb tourniquet use or as an adjunct to tourniquet re- ply directly to the skin 2–3 inches above the wound.
moval, use Combat Gauze as the CoTCCC hemostatic If bleeding is not controlled with the first tourniquet,
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dressing of choice. apply a second tourniquet side-by-side with the first.

Pelvic Binders TCCC Guidelines Change 143