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 (blood from stomach)

 Melena (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

► Donot 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 Trauma
Dressing

► First-aid,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 be used on any part of the body

► Notrecommended 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
 Place the
Step 1 wounded
extremity
through the loop
of the Self-
adhering Band

Step 2

Place
tourniqu
et above
the
 Pull the free-
running end
Step 3 of the Self-
adhering
Band tight
and securely
fasten it back
on itself.

Step 4
Adhere Self-
adhering Band
completely
around the limb
until the clip is
reached.
 Twist the
Step 5 Windlass Rod
until the
bleeding has
stopped.

Step 6

Lock the Rod in

place with the
Windlass Clip
 For small extremities,
Step 7 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 Self-
adhering Band
through the
friction
adaptor
buckle.
 Large Extremity Application
Combat Application
Tourniquet

This prevents
the Self-
adhering 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
► Useany 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.

► Ifthe tourniquet has been in place for > 6

hours do not remove.

► Iffluid resuscitation is required it should be

accomplished before the tourniquet is
removed.

► Tourniquetsare 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
► Iftourniquet 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 contamination

► Protects from additional injury

 Ace Wrap/Kerlix
► Packlarge 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

► Checkdistal pulse after application to an

extremity
QuickClot
HemCon Chitosan
Dressing
 Chitosan Hemostatic
Dressing

Hold the foil over-pouch

so that instructions can Peel open over-pouch by pulling
be read. Identify the unsealed edges apart
unsealed edges at the
top of the over-pouch
 Chitosan Hemostatic
Dressing

Trap dressing between bottom

foil and non-absorbable
green/black polyester backing
with your hand and thumb
Hold dressing by the
non-absorbable
polyester backing and
discard the foil over-
pouch. Hands must be
Chitosan Hemostatic
Dressing
 Chitosan Hemostatic
Dressing
► Placethe 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.

►A 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 patient’s eyes.
 Chitosan Hemostatic
Dressing
► Ifdressing 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????