This lesson is concerned with controlling bleeding from an extremity.
Bleeding from the trunk and from the head is covered in other lessons.
a. External bleeding will be controlled initially with a tourniquet during care
under fire. Once the medic has transitioned to the tactical field care phase, the
tourniquet will be evaluated for need in the following manner.
(1) If the bleeding seems significant (venous or arterial), then a tourniquet
should be applied during the care under fire phase.
(2) The tourniquet can be loosened during the care under fire phase under
the following conditions.
(a) Based on the tactical situation. When there is a lull in the battle or
the battle has moved away from the casualty collection point.
(b) More time in a safer setting. You have enough time and
protection to assess the need for a tourniquet and reapply it if you determine that it is
(c) More help is available. Additional hands may be needed to
assess and reapply the tourniquet.
(3) If you are unable to control bleeding with other methods, retighten the
tourniquet. The need to prevent further blood loss is greater than the potential risks
associated with tourniquet application.
Some other considerations involving tourniquets are given below.
(a) Can you see what you are doing? Enough light is essential to
adequately assess the bleeding.
(b) Does the casualty need fluid resuscitation? If so, do it before the
tourniquet is removed. Ensure a positive response is obtained; that is, the casualty
has good peripheral pulse and good mentation (mental ability).
(c) DO NOT periodically loosen the tourniquet to get blood to the
limb. This is an antiquated technique that will only cause the casualty to lose more
blood that can not be replaced on the front lines.
(d) Tourniquets are very painful. It has been documented that
patients have tried to remove tourniquets due to the pain they cause. Be prepared to
administer narcotic analgesic pain control to casualties to protect them and to provide
for their comfort.