Page 267 - PJ MED OPS Handbook 8th Ed

Basic Management Plan for Tactical Field Care

1. Establish a security perimeter in accordance with unit tactical standard operating procedures
and/or battle drills. Maintain tactical situational awareness.
2. Triage casualties as required. Casualties with an altered mental status should have weapons and
communications equipment taken away immediately.
3. Massive Hemorrhage:
a. Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done,
use a CoTCCC-recommended limb tourniquet to control life-threatening external hemor-
rhage that is anatomically amenable to tourniquet use or for any traumatic amputation. Ap-
ply directly to the skin 2–3 inches above the bleeding site. If bleeding is not controlled with
the first tourniquet, apply a second tourniquet side-by-side with the first.
b. For compressible (external) hemorrhage not amenable to limb tourniquet use or as an ad-
junct to tourniquet removal, use Combat Gauze as the CoTCCC hemostatic dressing of choice.
i) Alternative hemostatic adjuncts:
1) Celox Gauze or
2) ChitoGauze or
3) XStat (best for deep, narrow-tract junctional wounds)
4) iTClamp (may be used alone or in conjunction with hemostatic dressing or XStat)
ii) Hemostatic dressings should be applied with at least 3 minutes of direct pressure (op-
tional for XStat). Each 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.

NOTE: XStat is not to be removed in the field, but additional XStat, other hemostatic adjuncts,
or trauma dressings may be applied over it.

iii) If the bleeding site is amenable to use of a junctional tourniquet, immediately apply a CoTCCC
recommended junctional tourniquet. Do not delay in the application of the junctional tour-
niquet once it is ready for use. Apply hemostatic dressings with direct pressure if a junc-
tional tourniquet is not available or while the junctional tourniquet is being readied for use.
c. For external hemorrhage of the head and neck where the wound edges can be easily re-approx-
imated, the iTClamp may be used as a primary option for hemorrhage control. Wounds should
be packed with a hemostatic dressing or XStat, if appropriate, prior to iTClamp application.
i) The iTClamp does not require additional direct pressure, either when used alone or in
combination with other hemostatic adjuncts.
ii) If the iTClamp is applied to the neck, perform frequent airway monitoring and evaluate for
an expanding hematoma that may compromise the airway. Consider placing a definitive
airway if there is evidence of an expanding hematoma.
iii) DO NOT APPLY on or near the eye or eyelid (within 1cm of the orbit).
d. Perform initial assessment for hemorrhagic shock (altered mental status in the absence of
brain injury and/or weak or absent radial pulse) and consider immediate initiation of shock
resuscitation efforts.
4. Airway Management:
a. Conscious casualty with no airway problem identified:
i) No airway intervention required
b. Unconscious casualty without airway obstruction:
i) Place casualty in the recovery position
ii) Chin lift or jaw thrust maneuver OR
Appendix 1: TCCC Protocols n 265