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Bleeding Control

Lesson Five
MSTC, FT LEWIS WA

Overview
Review methods of controlling bleeding in a

tactical environment

Hemorrhage is the leading cause of

preventable death on the battlefield

Hemorrhage control save lives


New Hemostatic agents

Extremity Hemorrhage
Control
Extremity Hemorrhage continues to
be the leading cause of preventable
death on the battlefield.

Extremity Hemorrhage
Control
Over 2500
deaths
occurred in
Vietnam
secondary to
hemorrhage
from
extremity
wounds.
These
casualties
had no other
injuries.

The tactical situation may


not allow the time nor
safety for conventional
methods of controlling the

Blood
Hemorrhage or bleeding:

Escape of blood from capillaries, veins, and arteries


Adult body:

Contains approximately 5 to 6 liters of blood


1 pint of blood without harmful effects
2 pints may cause shock

External Bleeding

Incision

Laceration

Abrasion

Puncture wounds

Amputation

Laceration

Puncture Wound

Amputation

Abrasion

Incision

Internal Bleeding

Injured Internal Organs

Sources of Bleeding

Arterial
Rapid, profuse and pulsating
Bright red in color

Venous
Steady flow
Dark red or maroon in color

Capillary
Slow and oozing
Often clots spontaneously

Arterial Bleed

Internal Signs of
Hemorrhage
Soft

tissue bruising

Abdominal

tenderness

Hemoptysis

(blood from lungs)

Hematemesis
Melena

(blood from stomach)

(bloody stools)

Treatment

Assess the tactical situation

Expose the wound, cut away loose clothing

Do not remove clothing that is stuck to the wound

Check for exit wound

Place a Emergency Bandage over the wound and apply


pressure.

If under enemy fire rapid apply a tourniquet and move


casualty to cover

Expose the Wound


Do

not attempt to clean the wound

Do

not probe the wound in order to


remove an object from the wound

Do

not attempt to remove


an object impaled in the
wound

Treatment
Bleeding normally can
be controlled by:
Emergency

Dressing

First-aid,

Trauma

Manual
pressure and
elevation

Tourniquet

Emergency Trauma
Dressing
All

in one dressing used as a


field/pressure dressing to stop mild to
severe bleeding

May
Not

be used on any part of the body

recommended for use as a


tourniquet for severe arterial bleeding,
although the same procedure can be
used to increase pressure on the wound

Emergency Trauma
Dressing

Tourniquet
The need for immediate
access to a tourniquet
in such situations
makes it clear that all
soldiers on combat
missions should have a
suitable tourniquet
readily available in a
standard location in
their battle gear and be
trained to use it.
As the tactical situation permits and more time
and safety is available, consider loosening the
tourniquet ( DO NOT REMOVE ), and using direct
pressure and/or a pressure dressing to control the

Tourniquet Removal
REMEMBER: If unable
to control bleeding
except with a
tourniquet, it is better
to sacrifice a limb than
to lose a life to
excessive bleeding.

Combat Application
Tourniquet

Tourniquet of
Controls Bleeding
choice
Lightweig
Easy to
ht
use
The recommended means to control
bleeding in a tactical environment.

Combat Application
Tourniquet

Step 1

Place the
wounded
extremity
through the loop
of the Selfadhering Band
Step 2

Place
tourniqu
et above
the

Step 3

Pull the freerunning end


of the Selfadhering
Band tight
and securely
fasten it back
on itself.

Step 4
Adhere Selfadhering Band
completely
around the limb
until the clip is
reached.

Step 5

Twist the
Windlass Rod
until the
bleeding has
stopped.

Step 6
Lock the Rod in
place with the
Windlass Clip

Step 7

For small extremities,


continue to adhere
the Self-adhering
Band around the
extremity and over
the Windlass Rod.

Step 8
Grasp the
Windlass
Strap, pull it
tight, and
adhere it to
the velcro on
the Windlass
Clip.

Combat Application
Tourniquet
The CAT Tourniquet is now ready for
transport.

Combat Application
Tourniquet
NOTE:
The friction adaptor
buckle is not
necessary for
proper C.A.T.
application to an
arm. It MUST be
used with two
hands when
applying to a leg.

Combat Application
Tourniquet

Large Extremity Application


Combat Application
Tourniquet

To use, wrap
the Selfadhering Band
through the
friction
adaptor
buckle.

Large Extremity Application


Combat Application
Tourniquet

This prevents
the Selfadhering Band
from loosening
during
transport.

The Special Operations


Forces Tactical Tourniquet

Tourniquet
Forceful,

arterial bleeding
(amputation) may require early
use of a tourniquet.

DO

NOT WASTE TIME attempting a


pressure dressing in these cases

Apply an Improvised
Tourniquet
Use

any material to make an


improvised tourniquet:

Cravats,

grenade ring, rigid object


such as a strong stick, tape, zip
ties, riggers belt, etc.

Apply a Tourniquet
Never

cover a tourniquet

'T"

on casualty's forehead or somewhere


(Sharpie pen).

In

combat when the tactical situation


allows, loosening a tourniquet is
appropriate.

Tourniquet Removal
When

loosening a tourniquet do not remove it


from the limb.

If

the tourniquet has been in place for > 6


hours do not remove.

If

fluid resuscitation is required it should be


accomplished before the tourniquet is
removed.

Tourniquets

are very painful, provide pain


meds as needed.

Tourniquet Removal
Once

the tactical situation allows,


tourniquets should be loosened and
other methods to stop bleeding applied

Direct

pressure-pressure dressing

HemCon

Chitosan Bandage

Tourniquet Removal
If

tourniquet has been in place for only 1-2


hours, loosening and other methods to
control hemorrhage can salvage limbs.

Remember:

if unable to control hemorrhage


by other means re-tighten the tourniquet.

It

is better to sacrifice the limb than to lose


a life to hemorrhage.

Amputation
Apply pressure dressing to cover end of the

stump.

Kerlix and 6in Ace wrap for effective pressure

dressing.

Rinse amputated part free of debris


Wrap loosely in saline-moistened sterile gauze

Preservation of
Amputation Parts
Seal amputated part in a plastic bag or cravat
Place in a cool container, do not freeze
Never place amputated part in water
Never place amputated part directly on ice
Never use dry ice to cool an amputated part

Dressing an Amputation
Place

a dressing (soft / absorbent)


over the end of the stump

Secure

the dressing with bandages

Prevents
Protects

contamination

from additional injury

Ace Wrap/Kerlix
Pack

large wounds with Kerlix gauze


and wrap with an Ace Wrap

Secure

end of Ace Wrap via two means:

Circumferential tape
Cut 10 down center of Ace Wrap and tie
Check

distal pulse after application to


an extremity

QuickClot

HemCon Chitosan
Dressing

Chitosan Hemostatic
Dressing

Hold the foil overpouch so that


instructions can be
read. Identify
unsealed edges at the
top of the over-pouch

Peel open over-pouch by pulling


the unsealed edges apart

Chitosan Hemostatic
Dressing

Trap dressing between


bottom foil and nonabsorbable green/black
polyester backing with
your hand and thumb

Hold dressing by the


non-absorbable
polyester backing and
discard the foil overpouch. Hands must be

Chitosan Hemostatic
Dressing

Chitosan Hemostatic
Dressing
Place

the light colored sponge portion of


the dressing directly to the wound area
with the most severe bleeding. Apply
pressure for 2 minutes or until the dressing
adheres and bleeding stops. Once applied
and in contact with the blood and other
fluids, the dressing cannot be repositioned.

new dressing should be applied to other


exposed bleeding sites Each new dressing
must be in contact with tissue where
bleeding is heaviest. Care must be taken to
avoid contact with the patients eyes.

Chitosan Hemostatic
Dressing
If

dressing is not effective in stopping


bleeding after 4 minutes, remove original
and apply a new dressing. Additional
dressings cannot be applied over
ineffective dressing

Apply

a battle dressing/bandage to
secure hemostatic dressing in place

Hemostatic

dressings should only be


removed by responsible persons after
evacuation to the next level of care

Iraqi National;
No Bleeding;
Survived

Female Iraqi patient

Questions????

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