Massive Hemorrhage Control in TFC

What to remember

• Massive bleeding is the M in MARCH PAWS and the number one priority, ahead of airway and breathing problems.CLS M06 Slides, PDF p.8
• A bleed is life-threatening if it spurts or flows steadily, blood pools on the ground, clothes are soaked, a bandage keeps soaking through, or a limb is amputated.CLS M06 Slides, PDF p.14
• In TFC, put the tourniquet directly on bare skin 2-3 inches above the wound, not over clothing.CLS M06 Slides, PDF p.19
• Work fast: the bleeding should stop within 1 minute and the tourniquet should be fully secured within 3 minutes, with the time written down.CLS M06 Slides, PDF p.20
• A tourniquet works only if the bleeding has stopped and there is no pulse below it; if not, add a second one right next to the first.CLS M06 Slides, PDF p.20-21
• For wounds a tourniquet cannot cover, pack hemostatic gauze into the wound within 90 seconds, hold pressure for at least 3 minutes, then wrap a pressure bandage.CLS M06 Slides, PDF p.31-32
• The neck, armpit and groin are junctional areas where a limb tourniquet cannot be used; a packed groin wound also needs an improvised pressure delivery device (PDD) pressing on the gauze.CLS M06 Notes, PDF p.15-17

Where people go wrong

• Not pulling all the slack out before tightening, so the tourniquet never gets tight enough to stop the bleeding and the pulse below.CLS M06 Slides, PDF p.24
• Loosening a tourniquet for a while to let blood flow back, or taking it off yourself; only medical personnel at a higher level of care remove it.CLS M06 Slides, PDF p.24
• Putting a tourniquet over a joint, or over a bulky pocket; it will not work there.CLS M06 Notes, PDF p.8-10
• Using an improvised tourniquet when you have no real one; it can damage skin, loosen and fail to stop the bleeding. Pack the wound and press instead.CLS M06 Slides, PDF p.25

Check yourself

Questions on this module, each with the reason and the slide it came from.