02/09/2015
This is what we at Reality Based Tactical also study and replicate for you here locally... If interested contact Brian Wi******er 865 274 7029.
DoD is increasingly focused on Extended Care in Austere Environments as combat missions shift to AOs with fewer established resources. This is mirrored in updated recommendations from the CoTCCC and CoTECC in regards to Tourniquet (TQ) usage.
In overview:
TCCC:
During CUF (Care Under Fire) place TQ over uniform clearly proximal to the bleeding site. If not able to tell, then go high & tight over uniform.
During TFC (Tactical Field Care) apply TQ directly to skin 2-3 inches above wound. If a TQ was placed over the uniform during CUF high & tight, replace with a TQ applied directly to the skin 2-3 inches above wound.
Do not place TQ’s over joints.
TECC:
During Direct Threat place TQ high and tight over clothing.
During Indirect Threat place TQ directly on the skin 2-3 inches above wound.
Do not apply over the joint.
Here is the specifics cut and pasted from both guidelines:
TCCC:
Care Under Fire (CUF)
Stop life-threatening external hemorrhage if tactically feasible:
- Direct casualty to control hemorrhage by self-aid if able.
- Use a CoTCCC-recommended limb tourniquet for hemorrhage that is anatomically amenable to tourniquet use.
- Apply the limb tourniquet over the uniform clearly proximal to the bleeding site(s). If the site of the life-threatening bleeding is not readily apparent, place the tourniquet “high and tight” (as proximal as possible) on the injured limb and move the casualty to cover.
Tactical Field Care (TFC)
Bleeding
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 hemorrhage that is anatomically amenable to tourniquet use or for any traumatic amputation. Apply directly to the skin 2-3 inches above the wound. If bleeding is not controlled with the first tourniquet, apply a second tourniquet side-by-side with the first.
b. For compressible hemorrhage not amenable to limb tourniquet use or as an adjunct to tourniquet removal, use Combat Gauze as the CoTCCC hemostatic dressing of choice. Celox Gauze and ChitoGauze may also be used if Combat Gauze is not available. Hemostatic dressings should be applied with at least 3 minutes of direct pressure. 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 tourniquet once it is ready for use. Apply hemostatic dressings with direct pressure if a junctional tourniquet is not available or while the junctional tourniquet is being readied for use.
c. Reassess prior tourniquet application. Expose the wound and determine if a tourniquet is needed. If it is, replace any limb tourniquet placed over the uniform with one applied directly to the skin 2-3 inches above wound. Ensure that bleeding is stopped. When possible, a distal pulse should be checked. If bleeding persists or a distal pulse is still present, consider additional tightening of the tourniquet or the use of a second tourniquet side-by-side with the first to eliminate both bleeding and the distal pulse.
d. Limb tourniquets and junctional tourniquets should be converted to hemostatic or pressure dressings as soon as possible if three criteria are met: the casualty is not in shock; it is possible to monitor the wound closely for bleeding; and the tourniquet is not being used to control bleeding from an amputated extremity. Every effort should be made to convert tourniquets in less than 2 hours if bleeding can be controlled with other means. Do not remove a tourniquet that has been in place more than 6 hours unless close monitoring and lab capability are available.
e. Expose and clearly mark all tourniquet sites with the time of tourniquet application. Use an indelible marker.
