Stop the Bleeding and Protect the Wound
In evaluating the casualty for location, type, and size of the
wound or injury, cut or tear his clothing and carefully expose
the entire area of the wound. This procedure is necessary to avoid
further contamination. Clothing stuck to the wound should be left
in place to avoid further injury. DO NOT touch the wound; keep
it as clean as possible.
DO NOT REMOVE protective clothing in a chemical environment.
over the protective clothing.
Before applying the dressing, carefully examine the casualty to
determine if there is more than one wound. A missile may have
entered at one point and exited at another point. The EXIT
wound is usually LARGER than the entrance wound.
Casualty should be continually monitored for development of conditions which may
require the performance of necessary basic lifesaving measures, such as clearing
airway and mouth-to-mouth resuscitation. All open (or penetrating)
wounds should be
checked for a point of entry and exit and treated
If the missile lodges in the body (fails to exit), DO NOT attempt to remove it or probe
wound. Apply a dressing. If there is an object extending from
(impaled in) the
wound, DO NOT remove the object. Apply a dressing
around the object and use
additional improvised bulky materials/dressings
(use the cleanest material available) to
build up the area around
the object. Apply a supporting bandage over the bulky
to hold them in place.
a. Use the casualty's field dressing; remove it from
the wrapper and grasp the tails of the dressing with both hands
DO NOT touch the white (sterile) side of the dressing, and DO NOT allow the white
of the dressing to come in contact with any surface other than the wound.
|b. Hold the dressing directly
over the wound with the white side down. Pull the dressing open
(Figure 2-29) and place it directly
over the wound (Figure 2-30).|
c. Hold the dressing in place with one hand. Use the
other hand to wrap one of the tails around the injured part, covering
about one-half of the dressing (Figure 2-31).
Leave enough of the tail for a knot. If the casualty is able,
he may assist by holding the dressing in place.
|d. Wrap the other tail in the
opposite direction until the remainder of the dressing is covered.
The tails should seal the sides of the dressing to keep foreign
material from getting under it.
e. Tie the tails into a nonslip knot over the outer edge
of the dressing (Figure 2-32). DO
NOT TIE THE KNOT OVER THE WOUND. In order to allow blood
to flow to the rest of an injured limb, tie the dressing firmly
enough to prevent it from slipping but without causing a tourniquet-like
effect; that is, the skin beyond the injury becomes cool blue,
2-18. Manual Pressure (081-831-1016)
|a. If bleeding continues after
applying the sterile field dressing, direct manual pressure may
be used to help control bleeding. Apply such pressure by placing
a hand on the dressing and exerting firm pressure for 5 to 10
minutes (Figure 2-33). The casualty
may be asked to do this himself if he is conscious and can follow
|b. Elevate an injured limb slightly
above the level of the heart to reduce the bleeding (Figure 2-34).
DO NOT elevate a suspected fractured limb unless it has been
properly splinted. (To
splint a fracture before elevating, see
task 081-831-1034, Splint a Suspected
c. If the bleeding stops, check and treat for shock.
If the bleeding continues, apply a pressure dressing.
2-19. Pressure Dressing (081-831-1016)
Pressure dressings aid in blood clotting and compress the open
blood vessel. If bleeding continues after the application of a
field dressing, manual pressure, and elevation, then a pressure
dressing must be applied as follows:
a. Place a wad of padding on top of the field dressing,
directly over the wound (Figure 2-35).
Keep injured extremity elevated.
Improvised bandages may be made from strips of cloth. These
strips may be made from T-shirts, socks, or other garments.
|b. Place an improvised dressing
(or cravat, if available) over the wad of padding (Figure 2-36).
Wrap the ends tightly around the injured limb, covering the previously
placed field dressing (Figure 2-37).
|c. Tie the ends together in a
nonslip knot directly over the wound site (Figure 2-38).
DO NOT tie so tightly that it has a tourniquet-like effect. If
bleeding continues and all other measures have failed, or if the
limb is severed, then apply a tourniquet. Use the tourniquet as
a LAST RESORT. When the bleeding stops, check
and treat for shock. |
Wounded extremities should be checked periodically for adequate
dressing must be loosened if the extremity becomes
cool, blue or numb.
If bleeding continues and all other measures have failed (dressing and covering wound, applying direct manual pressure, elevating limb above heart level, and applying pressure dressing maintaining limb elevation), then apply digital pressure. See Appendix E for appropriate pressure points.
2-20. Tourniquet (081-831-1017)
A tourniquet is a constricting band placed around an arm or leg to control bleeding. A soldier whose arm or leg has been completely amputated may not
be bleeding when first discovered, but a tourniquet should be
applied anyway. This absence of bleeding is due to the body's
normal defenses (contraction of blood vessels) as a result of
the amputation, but after a period of time bleeding will start
as the blood vessels relax. Bleeding from a major artery of the
thigh, lower leg, or arm and bleeding from multiple arteries (which
occurs in a traumatic amputation) may prove to be beyond control
by manual pressure. If the pressure dressing under firm hand pressure
becomes soaked with blood and the wound continues to bleed, apply
Casualty should be continually monitored for development of
conditions which may
require the performance of necessary basic
life-saving measures, such as: clearing the
mouth-to-mouth resuscitation, preventing shock, and/or bleeding
control. All open (or penetrating) wounds should be checked for
a point of entry or exit
and treated accordingly.
|*The tourniquet should not be used
unless a pressure dressing has failed to stop the bleeding or
an arm or leg has been cut off. On occasion, tourniquets have
injured blood vessels and nerves. If left in place too long, a
tourniquet can cause loss of an arm or leg. Once applied, it must
stay in place, and the casualty must be taken to the nearest medical
treatment facility as soon as possible. DO NOT loosen or release
a tourniquet after it has been applied and the bleeding has stopped.
a. Improvising a Tourniquet (081-831-1017). In the absence
of a specially designed tourniquet, a tourniquet may be made from
a strong, pliable material, such as gauze or muslin bandages,
clothing, or kerchiefs. An improvised tourniquet is used with
a rigid stick-like object. To minimize skin damage, ensure that
the improvised tourniquet is at least 2 inches wide.
The tourniquet must be easily identified or easily seen.
DO NOT use wire or shoestring for a tourniquet band.
A tourniquet is only used on arm(s) or leg(s) where there
is danger of loss of casualty's
|b. Placing the Improvised Tourniquet
(1) Place the tourniquet around the limb, between the wound and
the body trunk (or between the wound and the heart). Place the
tourniquet 2 to 4 inches from the edge of the wound site (Figure 2-39). Never place it directly over a wound or fracture or directly on
a joint (wrist, elbow, or knee). For wounds just below a joint,
place the tourniquet just above and as close to the joint as possible.
(2) The tourniquet should have padding
underneath. If possible, place the tourniquet over the smoothed
sleeve or trouser leg to prevent the skin from being pinched or
twisted. If the tourniquet is long enough, wrap it around the
limb several times, keeping the material as flat as possible.
Damaging the skin may deprive the surgeon of skin required to
cover an amputation. Protection of the skin also reduces pain.
c. Applying the Tourniquet (081-831-1017).
(3) Tie a full knot over the stick (Figure 2-41).
(4) Twist the stick (Figure 2-42)
until the tourniquet is tight around the limb and/or the bright
red bleeding has stopped. In the case of amputation, dark oozing
blood may continue for a short time. This is the blood trapped
in the area between the wound and tourniquet.
(5) Fasten the tourniquet to the limb
by looping the free ends of the tourniquet over the ends of the
stick. Then bring the ends around the limb to prevent the stick
from loosening. Tie them together under the limb (Figure 2-43A
Other methods of securing the stick may be used as long as
the stick does not unwind and no further injury results.
If possible, save and transport any severed (amputated) limbs
or body parts with (but
out of sight of) the casualty.
(6) DO NOT cover the tourniquet--you should leave it in full view.
If the limb is missing (total amputation), apply a dressing to
(7) Mark the casualty's forehead, if possible, with a "T"
to indicate a tourniquet has been applied. If necessary, use the
casualty's blood to make this mark.
(8) Check and treat for shock.
(9) Seek medical aid.
DO NOT LOOSEN OR RELEASE THE TOURNIQUET ONCE IT HAS BEEN APPLIED
BECAUSE IT COULD ENHANCE THE PROBABILITY OF SHOCK.
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