MODULE 09: CIRCULATION /
HEMORRHAGE CONTROL
TCCC TIER 1 TCCC TIER 2 TCCC TIER 3 TCCC TIER 4
All Service Members Combat Lifesaver Medic/Corpsman Combat Paramedic/Provider
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TACTICAL COMBAT CASUALTY CARE (TCCC)
ROLE-BASED TRAINING SPECTRUM
ROLE 1 CARE
NONMEDICAL MEDICAL
PERSONNEL PERSONNEL
YOU ARE HERE
STANDARDIZED JOINT CURRICULUM
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STUDENT LEARNING OBJECTIVES
TERMINAL LEARNING OBJECTIVE
Given a combat or noncombat scenario, perform hemorrhage control during Tactical Field Care in
10
accordance with CoTCCC Guidelines
60 Identify the principles of wound packing and applying pressure bandages
61 Demonstrate wound packing and applying a pressure bandage
62 Identify the signs, symptoms, and considerations of a pelvic fracture
63 Identify the indications and methods of tourniquet replacement in Tactical Field Care
64 Identify the indications and methods of tourniquet conversion in Tactical Field Care
65 Demonstrate limb tourniquet replacement in Tactical Field Care
66 Demonstrate limb tourniquet conversion in Tactical Field Care
ENABLING LEARNING OBJECTIVES (ELOs)
08 = Cognitive ELOs = Performance ELOs
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Three PHASES of TCCC
1 CARE UNDER 2 TACTICAL 3 TACTICAL
FIRE FIELD CARE EVACUATION
RETURN FIRE
AND TAKE COVER
COVER AND
CONCEALMENT
CARE
Quick decision-making: Basic management plan: More deliberate assessment and
Maintain tactical situational treatment of unrecognized
▪ Consider scene safety
awareness life-threatening injuries
▪ Identify and control life- Pre-evacuation procedures
Triage casualties as required
threatening bleeding
Conduct MARCH PAWS Continuation of documentation
▪ Move casualty to safety assessment
NOTE: This is covered in more
advanced TCCC training!
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TACTICAL FIELD CARE
MARCH PAWS
DURING LIFE-THREATENING AFTER LIFE-THREATENING
M MASSIVE BLEEDING #1 Priority
P PAIN
A AIRWAY
A ANTIBIOTICS
R RESPIRATION (breathing)
W WOUNDS
C CIRCULATION
S SPLINTING
H HYPOTHERMIA /
HEAD INJURIES
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HEMORRHAGE CONTROL IN TFC
Video can be found on DeployedMedicine.com
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HEMORRHAGE CONTROL
PELVIC FRACTURES
Pelvic fracture may be suspected if the casualty's injuries are a
result of blunt force or blast with ONE OR MORE of the following:
Physical signs suggesting a pelvic fracture:
▪ Pelvic pain
▪ Major lower limb amputation OR lower near amputations
▪ Deformities, penetrating injuries, bruising near the pelvis
▪ Pelvic instability or crepitus (crinkly or grating feeling or
sound under the skin)
▪ Unconsciousness or shock
If a pelvic fracture is suspected, the
casualty WILL REQUIRE advanced
evaluation by medical personnel
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HEMORRHAGE CONTROL
REASSESSMENT
Reassess all PREVIOUS and CURRENT applied
TQ’s and ensure they are tight and effective
If ineffective, apply a second TQ side-by-side with
the first
Reassess all PREVIOUS and CURRENT hemostatic
dressings applied for effectiveness
If you placed a TQ above a casualty’s elbow, for
instance, you should expect to find no pulse at the
wrist below if the TQ was properly applied
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HEMORRHAGE CONTROL
REASSESSMENT Cont.
EARLY CONTROL OF SEVERE HEMORRHAGE IS CRITICAL
▪ CoTCCC-recommended tourniquets are to be applied directly to the
skin in TFC 2-3 inches above the bleeding site
▪ Casualty’s hemorrhage control interventions must be FREQUENTLY
REASSESSED to ensure continued hemorrhage control
DO NOT EVER APPLY IT
AND FORGET IT!
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TOURNIQUET REPLACEMENT
INDICATIONS AND METHODS
INDICATIONS
for tourniquet
replacement:
Tourniquets applied
over the uniform
Tourniquets applied Determine if a Apply replacement Slowly release Slide original Annotate time of
tourniquet tourniquet 2-3” original tourniquet, tourniquet down new tourniquet
too proximal on the proximal to the
replacement is proximal to wound ensuring no placement
extremity (>3” indicated directly on the skin newly placed
rebleeding occurs
above the wound tourniquet and
annotate time
>2 hours to surgery
If tourniquet replacement cannot prevent bleeding, revert back to original tourniquet
MAR C H
Module 9: Circulatory Hemorrhage Control in TFC
TOURNIQUET
REPLACEMENT
Video can be found on deployedmedicine.com
TOURNIQUET CONVERSION
INDICATIONS AND METHODS
CONTRAINDICATIONS
for tourniquet conversion:
Shock
Inability to closely monitor
for rebleeding
Amputation
Also, consider not
converting a tourniquet if: Pack wound and Apply pressure Slowly release Document all findings
hold pressure for bandage tourniquet over 1 and treatments on a
If the tourniquet has been 3 minutes minute, ensuring no DD Form 1380
in place more than 6 hours rebleeding occurs TCCC Casualty Card
Tactical or medical
considerations make
If tourniquet conversion does not control bleeding, revert back to a tourniquet
transition inadvisable
MAR C H
Module 9: Circulatory Hemorrhage Control in TFC
TOURNIQUET
CONVERSION
Video can be found on deployedmedicine.com
Module 9: Circulatory Hemorrhage Control in TFC
SKILL STATION
Tourniquet Replacement
and Tourniquet Conversion
Tourniquet Replacement
Tourniquet Conversion
(Using Wound Packing With Hemostatic
Dressing and Pressure Bandages)
HEMORRHAGE CONTROL
WOUND PACKING and PRESSURE BANDAGE
▪ Identify the exact ▪ Apply direct pressure for ▪ Secure with bandage
source of bleeding 3 MINUTES
▪ If the bandage has a pressure bar,
▪ Pack the wound pull the bandage TIGHT, and
reverse it back over the top of the
pressure bar, forcing it down onto
the pad
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HEMORRHAGE CONTROL
WOUND PACKING
▪ Identify the exact source of bleeding
and APPLY direct pressure as a ▪ Once you are sure the
temporary measure UNTIL gauze is bleeding has stopped,
placed apply a pressure bandage
▪ Pack the wound maintaining ▪ HOLD direct pressure on the gauze over
CONSTANT direct pressure the wound for at least 3 MINUTES (this is
at the source of bleeding within necessary, even with the active ingredient
90 SECONDS to be effective in hemostatic dressings)
▪ When packing a large wound, more than
one hemostatic gauze and/or additional
gauze may be needed
▪ Carefully observe to determine if bleeding
has been controlled #TCCC-CLS-PPT-09 17 Apr 24
HEMORRHAGE CONTROL
PRESSURE BANDAGE REASSESSMENT
Key Points:
▪ Check for circulation BELOW the pressure
bandage by feeling for distal pulse (a pulse below
the bandage)
▪ If the skin BELOW the pressure bandage becomes
cool to the touch, bluish, or numb, or if the pulse
below the pressure dressing is no longer present,
the pressure bandage may be too tight
▪ If circulation is BLOCKED or STOPPED, loosen
and retie the bandage
▪ Dressings and bandages should be reassessed
and checked routinely and EVERY TIME a
casualty is moved
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HEMORRHAGE CONTROL
IF THE PRESSURE BANDAGE IS INEFFECTIVE
▪ If the pressure bandage or hemostatic dressing is
ineffective, APPLY a tourniquet 2-3 inches above the
bleeding site
▪ If the pressure bandage is ineffective AND/OR
blood soaked, REPLACE pressure dressing with
hemostatic dressing
▪ Pack the wound, maintaining CONSTANT direct
pressure at the source of bleeding within 90 SECONDS
to be effective
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PRESSURE BANDAGE
Video can be found on DeployedMedicine.com
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SKILL STATION
Circulation/Hemorrhage Control (Skills)
Wound Packing With Hemostatic Dressing and Pressure Bandage
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HEMORRHAGE CONTROL
SUMMARY
▪ If not already done, clearly mark ALL TQs with the time
of TQ application and document that on the DD Form
1380 TCCC Casualty Card
▪ Check for radial pulse
▪ Assess for shock
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CHECK ON LEARNING
During Circulation in the MARCH PAWS sequence, what
interventions should be reassessed?
What are the signs and symptoms of a pelvic fracture?
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ANY QUESTIONS?
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