Page 224 - 2023 SMOG Digital

HEMORRHAGE

CONTROL PROCEDURES

CLINICAL INDICATIONS:
• Hemorrhage
CONTRAINIDICATIONS:
• None
PROCEDURE:
• Rapid bleeding and/or arterial source recognized (extremities, axial, inguinal) –
immediate application of extremity and/or junctional tourniquets, as appropriately
needed, to stop bleeding.
• For compressible (external) hemorrhage not amenable to limb tourniquet use
Combat Gauze, the CoTCCC hemostatic dressing of choice.
o Alternative hemostatic adjuncts:
 Celox Gauze, ChitoGauze, XStat (best for dep, narrow-tract junctional
wounds) or iTCLamp (may be used alone or in conjunction with
hemostatic dressing or XStat).

o Hemostatic dressings should be applied with at least 3 minutes of direct
pressure (optional for XStat). Must apply adequate force to compress
vessels. If size of wound and bleeding are concerning for adequate control,
place hemostatic dressing as close to the bleeding vessel as possible
followed by 5 min of direct pressure. 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.) If bleeding continues, apply a pressure dressing to
the wound if applicable.
o If unable to control bleeding in extremity wounds with above, apply
tourniquet. Note: immediate transition to a tourniquet in an extremity wound
hemorrhage is preferred.
o In penetrating injuries to the abdomen, after removing blood, hemostatic
dressings should be pushed into the wound and pressure held for five
minutes to encourage clotting. Do not remove bandage after placement.
Penetrating abdominal/thoracic injuries require a large amount of pressure to
compress vessels.

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