Page 43 - JSOM Fall 2019

recommended junctional tourniquet. Do not delay in – Celox Gauze or
the application of the junctional tourniquet once it is – ChitoGauze or
ready for use. Apply hemostatic dressings with direct – XStat (best for deep, narrow-tract junctional
pressure if a junctional tourniquet is not available or wounds)
while the junctional tourniquet is being readied for – iTClamp (may be used alone or in conjunction
use. with hemostatic dressing or XStat)
• Hemostatic dressings should be applied with at least
Tactical Evacuation Care 3 minutes of direct pressure (optional for XStat).
Each dressing works differently, so if one fails to con-
2. Massive Hemorrhage trol bleeding, it may be removed and a fresh dressing
a. Assess for unrecognized hemorrhage and control of the same type or a different type applied. (Note:
all sources of bleeding. If not already done, use a XStat is not to be removed in the field, but additional
CoTCCC-recommended limb tourniquet to control XStat, other hemostatic adjuncts, or trauma dress-
life-threatening external hemorrhage that is anatomi- ings may be applied over it.)
cally amenable to tourniquet use or for any traumatic • If the bleeding site is amenable to use of a junc-
amputation. Apply directly to the skin 2 to 3 inches tional tourniquet, immediately apply a CoTCCC-
above the bleeding site. If bleeding is not controlled with recommended junctional tourniquet. Do not delay in
the first tourniquet, apply a second tourniquet side-by- the application of the junctional tourniquet once it is
side with the first. ready for use. Apply hemostatic dressings with direct
b. For compressible (external) hemorrhage not amenable pressure if a junctional tourniquet is not available or
to limb tourniquet use or as an adjunct to tourniquet while the junctional tourniquet is being readied for
removal, use Combat Gauze as the CoTCCC hemostatic use.
dressing of choice. c. For external hemorrhage of the head and neck where
• Alternative hemostatic adjuncts: the wound edges can be easily re-approximated, the
– Celox Gauze or iTClamp may be used as a primary option for hemor-
– ChitoGauze or rhage control. Wounds should be packed with a hemo-
– XStat (best for deep, narrow-tract junctional static dressing or XStat, if appropriate, prior to iTClamp
wounds) application.
• Hemostatic dressings should be applied with at least • The iTClamp does not require additional direct pres-
3 minutes of direct pressure (optional for XStat). sure, either when used alone or in combination with
Each dressing works differently, so if one fails to con- other hemostatic adjuncts.
trol bleeding, it may be removed and a fresh dressing • If the iTClamp is applied to the neck, perform
of the same type or a different type applied. (Note: frequent airway monitoring and evaluate for an
XStat is not to be removed in the field, but additional expanding hematoma that may compromise the air-
XStat, other hemostatic adjuncts, or trauma dress- way. Consider placing a definitive airway if there is
ings may be applied over it.) evidence of an expanding hematoma.
• If the bleeding site is amenable to use of a junctional • DO NOT APPLY on or near the eye or eyelid (within
tourniquet, immediately apply a CoTCCC-recom- 1cm of the orbit).
mended junctional tourniquet. Do not delay in the
application of the junctional tourniquet once it is Tactical Evacuation Care
ready for use. Apply hemostatic dressings with direct 2. Massive Hemorrhage
pressure if a junctional tourniquet is not available or a. Assess for unrecognized hemorrhage and control
while the junctional tourniquet is being readied for all sources of bleeding. If not already done, use a
use.
CoTCCC-recommended limb tourniquet to control life-
threatening external hemorrhage that is anatomically
Proposed Change amenable to tourniquet use or for any traumatic ampu-
(New proposed material is in red text.)
tation. Apply directly to the skin 2 to 3 inches above the
bleeding site. If bleeding is not controlled with the first
Tactical Field Care tourniquet, apply a second tourniquet side-by-side with
3. Massive Hemorrhage the first.
a. Assess for unrecognized hemorrhage and control b. For compressible (external) hemorrhage not amenable
all sources of bleeding. If not already done, use a to limb tourniquet use or as an adjunct to tourniquet
CoTCCC-recommended limb tourniquet to control removal, use Combat Gauze as the CoTCCC hemostatic
life-threatening external hemorrhage that is anatomi- dressing of choice.
cally amenable to tourniquet use or for any traumatic • Alternative hemostatic adjuncts:
amputation. Apply directly to the skin 2–3 inches above – Celox Gauze or
the bleeding site. If bleeding is not controlled with the – ChitoGauze or
first tourniquet, apply a second tourniquet side-by-side – XStat (best for deep, narrow-tract junctional
with the first. wounds)
b. For compressible (external) hemorrhage not amenable – iTClamp (may be used alone or in conjunction
to limb tourniquet use or as an adjunct to tourniquet with a hemostatic dressing or XStat)
removal, use Combat Gauze as the CoTCCC hemostatic • Hemostatic dressings should be applied with at least
dressing of choice. 3 minutes of direct pressure (optional for XStat).
• Alternative hemostatic adjuncts:
Each dressing works differently, so if one fails to

iTClamp Mechanical Wound Closure Device | 41