COMBAT LIFESAVER

TACTICAL COMBAT CASUALTY CARE

MODULE 09:
CIRCULATION/
HEMORRHAGE
CONTROL IN TFC
SKILL INSTRUCTIONS

12 APR 2024
 COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE

SKILL INSTRUCTIONS

WOUND PACKING AND PRESSURE BANDAGE INSTRUCTION

TASK: Pack a wound with a hemostatic dressing and apply a pressure bandage
CONDITION: Given a Tactical Field Care scenario where casualty and responder are in combat gear
and a casualty has a non-life-threatening bleed in a location where a tourniquet cannot
be applied or bleeding adequately controlled, and given a hemostatic dressing and an
elastic or pressure bandage
STANDARD: Apply a hemostatic dressing and an effective pressure bandage to control bleeding
following all steps and performance measures without further injuring the casualty
EQUIPMENT: A Joint First Aid Kit or materials for a hemostatic dressing and pressure bandage

PERFORMANCE MEASURES: step-by-step instructions

NOTE: Consider body substance isolation.
NOTE: If a Combat Lifesaver is available, direct them to assist.
01 Expose the wound, if not previously exposed.
NOTE: Remove clothing and equipment as required.
02 Locate the source of the most active bleeding and apply direct pressure.
03 Remove the hemostatic dressing from its sterile package.
NOTE: If a hemostatic dressing is not available, use gauze or clean, dry cloth material.
04 Pack the hemostatic dressing tightly into the wound directly over the site of the most active bleeding.
NOTE: Fill and pack the whole wound cavity tightly while keeping firm pressure on the wound.
NOTE: More than one hemostatic dressing or gauze may be required to stop the blood flow.
CAUTION: If a penetrating object is lodged in the casualty’s body, bandage it in place. Do not remove
the object.
05 Ensure the hemostatic dressing or gauze extends 1–2 inches above the skin.
NOTE: If the hemostatic dressing or gauze does not extend 1–2 inches above the skin, place additional
hemostatic dressing or gauze.
06 After packing, continue to apply firm, manual pressure until the bleeding stops. Hold continuous direct
pressure for a minimum of 3 minutes.
07 Reassess to ensure bleeding has been controlled while maintaining pressure.
NOTE: Ensure blood is not seeping through or around the hemostatic dressing. If bleeding has stopped,
leave the hemostatic dressing in place while still maintaining pressure.
08 If bleeding has not been controlled:
(a) If packed with hemostatic dressing, remove prior packing material and repack starting at step 3.
(b) If packed with gauze or other materials, apply additional gauze/materials and pressure (for another 3
minutes) until bleeding has stopped.
09 Remove the pressure bandage from its package.
10 Place the pad (bandage) directly over the wound on previously applied hemostatic dressing while
continuing to apply direct pressure.
11 Wrap the pressure/elastic bandage tightly around the extremity, focusing pressure over the wound and
ensuring that the edges of the pad are covered.
NOTE: If the bandage has a pressure bar, insert the elastic wrap completely into the pressure bar, pull
the bandage tight, and reverse it back over the top of the pressure bar forcing it down onto the pad.
12 Secure the hooking ends of the hook and loop straps or closure bar onto the last wrap of the bandage.
13 Check for circulation below the pressure bandage by feeling for distal pulse.
NOTE: If the skin below the pressure bandage becomes cool to the touch, bluish, or numb, or if
the distal pulse is no longer present, the pressure bandage may be too tight and should be
loosened and reapplied; if bleeding reoccurs you may need to apply a limb or junctional
tourniquet.
14 Document all findings and treatments on a DD Form 1380 TCCC Casualty Card and attach it to the
casualty.

TCCC CLS SKILLS INSTRUCTIONS #TCCC-CLS-09-01 17 APR 24

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 COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE

SKILL INSTRUCTIONS

TOURNIQUET REPLACEMENT INSTRUCTION

TASK: Replace a tourniquet

CONDITION: Given a scenario in the Tactical Field Care phase where you have a casualty with a
previously applied high & tight limb tourniquet during Care Under Fire, whose
bleeding is controlled but requires a more appropriately placed Committee on Tactical
Combat Casualty Care (CoTCCC)-recommended tourniquet
STANDARD: Maintain hemorrhage control while applying a new appropriately placed CoTCCC-
recommended tourniquet
EQUIPMENT: CoTCCC-recommended limb tourniquet, casualty’s Joint First Aid Kit and/or medic
aid bag

PERFORMANCE MEASURES: step-by-step instructions

NOTE: Consider body substance isolation.

NOTE: If a Combat Lifesaver is available, direct them to assist.

01 Expose the injury and assess the bleeding source.

02 Assess previously applied tourniquet(s) for effectiveness at controlling bleeding and proximity to the
bleeding site.
03 Check for distal pulse.
NOTE: If distal pulse is present or bleeding is not controlled, attempt to tighten the tourniquet(s) further.
If distal pulse is still present or bleeding persists, proceed immediately to step 4.
04 Apply a CoTCCC-recommended tourniquet directly on the skin 2-3 inches above the bleeding
site if possible (see Tourniquet Application Instructions).
05 Slowly release original tourniquet(s) over one minute.
06 Watch the area where bleeding originally took place, ensuring no bleeding reoccurs.
NOTE: If bleeding reoccurs, immediately retighten initial tourniquet(s), ensuring bleeding is
controlled, and further tighten the newly applied tourniquet. Repeat steps 5 and 6 until the new
tourniquet controls bleeding; however, if repeated attempts to establish a new tourniquet fail,
retighten the original tourniquet(s) and leave in place, remove the new tourniquet, and proceed with
the remainder of your assessment.
07 Assess to ensure distal pulse is absent, and bleeding is still controlled.
08 Slide originally placed tourniquet(s) down, but leave in place proximal to the newly placed tourniquet.
NOTE: If relocated, replaced tourniquets should not be fully tightened, but excess slack should be
removed to avoid interfering with future treatments and casualty movement.
09 Annotate the time of the new tourniquet placement on the tourniquet.
10 Document all findings and treatments on a DD Form 1380 TCCC Casualty Card and attach it to the
casualty.

TCCC CLS SKILLS INSTRUCTIONS #TCCC-CLS-09-01 17 APR 24

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 COMBAT LIFESAVER TACTICAL COMBAT CASUALTY CARE

SKILL INSTRUCTIONS

TOURNIQUET CONVERSION INSTRUCTION

TASK: Convert a tourniquet to a hemostatic dressing and pressure bandage

CONDITION: Given a scenario in the Tactical Field Care phase where you encounter a casualty
who is bleeding from a non-amputated limb that has been controlled by a tourniquet,
is not in shock, and you have assessed the wound to be amendable to a hemostatic
dressing and pressure bandage and/or extended evacuation is expected
STANDARD: Convert the tourniquet to an effective hemostatic dressing and pressure bandage
that controls bleeding in 4 minutes or less
EQUIPMENT: Committee on Tactical Combat Casualty Care-recommended tourniquet, hemostatic
dressing, and pressure bandage

PERFORMANCE MEASURES: step-by-step instructions

NOTE: Consider body substance isolation.

NOTE: If a Combat Lifesaver is available, direct them to assist.

01 Expose the wound, if not previously exposed.

NOTE: Remove clothing and equipment as required.
02 Remove the hemostatic dressing or gauze from its sterile package.
NOTE: If hemostatic dressing or gauze is not available, use clean, dry cloth material.
03 Pack the dressing tightly into the wound.
NOTE: Fill and pack the whole wound cavity tightly while keeping firm pressure on the wound.
More than one hemostatic dressing or gauze may be required.
04 Ensure the hemostatic dressing or gauze extends 1–2 inches above the skin.
NOTE: If the hemostatic dressing or gauze does not extend 1–2 inches above the skin, place
additional hemostatic dressing or gauze.
NOTE: If a penetrating object is lodged in the casualty’s body, bandage it in place. Do not remove
the object.
05 After packing, continue to apply firm, manual pressure for a minimum of 3 minutes.
06 Remove the pressure bandage from its package.
07 Place the pad of the pressure bandage directly over the wound or previously applied hemostatic
dressing while continuing to apply direct pressure.
08 Wrap the pressure/elastic bandage tightly around the extremity, focusing pressure over the wound
and ensuring that the edges of the pad are covered.
NOTE: If the bandage has a pressure bar, insert the elastic wrap completely into the pressure bar,
pull the bandage tight, and reverse it back over the top of the pressure bar, forcing it down onto the
pad.
09 Secure the hooking ends of the hook and loop straps or closure bar onto the last wrap of
the bandage.
10 Slowly release the tourniquet (over one minute); observe the bandage for bleeding.
NOTE: Convert tourniquets in less than 2 hours, if possible, but do not remove a tourniquet that has
been in place more than 6 hours.
NOTE: If bleeding reoccurs, retighten the original tourniquet, ensuring bleeding is controlled and the
distal pulse is absent.
11 Document all findings and treatments on a DD Form 1380 TCCC Casualty Card and attach it to the
casualty.

TCCC CLS SKILLS INSTRUCTIONS #TCCC-CLS-09-01 17 APR 24

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 Developed by the

JOINT TRAUMA SYSTEM