MASSIVE HAEMORRHAGE

Question 1

What is the first priority in Tactical Field Care?

Answer 1

Control of massive external hemorrhage.

Question 1

What does MARCH stand for in TCCC?

Answer 1

Massive Hemorrhage, Airway, Respiration, Circulation, Head injury/Hypothermia.

Question 1

What is the primary preventable cause of death on the battlefield?

Answer 1

Extremity hemorrhage.

Question 2

What is the first-line method for controlling external extremity bleeding?

Answer 2

Tourniquet application.

Question 3

When should a tourniquet be applied in care under fire?

Answer 3

Immediately if there is life-threatening extremity hemorrhage.

Question 4

Where should a tourniquet be placed?

Answer 4

2–3 inches above the bleeding site, not over a joint.

Question 5

What is the preferred tourniquet in TCCC?

Answer 5

Combat Application Tourniquet (CAT) or equivalent CoTCCC-recommended model.

Question 6

How tight should a tourniquet be applied?

Answer 6

Until bleeding stops and distal pulse is absent.

Question 7

Should the initial tourniquet be loosened during care under fire?

Answer 7

No. It remains in place until further assessment in Tactical Field Care.

Question 8

What is a ‘high-and-tight’ tourniquet application?

Answer 8

Placement at the proximal part of the limb if bleeding site is not visible.

Question 9

When is a hemostatic dressing used?

Answer 9

When direct pressure fails and a tourniquet is not appropriate (e.g., neck, groin).

Question 10

What are the CoTCCC-recommended hemostatic agents?

Answer 10

Combat Gauze, Celox Gauze, and ChitoGauze.

Question 11

How long should direct pressure be applied after packing a wound?

Answer 11

At least 3 minutes (preferably continuous).

Question 12

Should hemostatic dressings be removed once applied?

Answer 12

No, leave them in place and reinforce if needed.

Question 13

What should be done if bleeding persists after initial packing?

Answer 13

Remove and repack the wound with a fresh hemostatic dressing.

Question 14

What is a junctional hemorrhage?

Answer 14

Bleeding from areas like the groin, axilla, or neck where tourniquets can’t be used.

Question 15

What is the preferred treatment for junctional hemorrhage?

Answer 15

Wound packing with hemostatic agents and direct pressure.

Question 16

What device can be used for groin hemorrhage when packing fails?

Answer 16

Junctional tourniquet (e.g., SAM Junctional Tourniquet).

Question 17

Why is pressure applied after packing a junctional wound?

Answer 17

To help the hemostatic agent work by enhancing clot formation.

Question 18

What else can be used to control junctional hemorrhage if devices fail?

Answer 18

Manual pressure or improvisation with pressure dressings.

Question 19

What should be done after applying a tourniquet?

Answer 19

Record the time of application and monitor for effectiveness.

Question 20

Where is tourniquet time usually written?

Answer 20

On the casualty’s forehead or chest, or on the tourniquet.

Question 21

Why is recording tourniquet time important?

Answer 21

To prevent prolonged ischemia and guide further care.

Question 22

What does reassessment of hemorrhage control include?

Answer 22

Checking for continued bleeding and distal pulse.

Question 23

What should be done if bleeding recurs after tourniquet placement?

Answer 23

Apply a second tourniquet proximal to the first.

Question 24

How long can a tourniquet safely remain in place?

Answer 24

Ideally <2 hours; prolonged use may risk tissue damage.

Question 25

Should hemorrhage control take priority over airway in care under fire?

Answer 25

Yes, massive bleeding is addressed before airway.

Question 26

When should a tourniquet be converted to a pressure dressing?

Answer 26

If time, conditions, and medical supervision allow.

Question 27

What is the benefit of early hemorrhage control in tactical care?

Answer 27

Significantly improves survival rates.

Question 28

What is a critical factor in the success of hemostatic dressings?

Answer 28

Early application and firm, sustained pressure.

Question 29

What are the 3 phases of TCCC?

Answer 29

Care Under Fire, Tactical Field Care, Tactical Evacuation Care.

Question 30

Which TCCC phase involves tourniquet application under fire?

Answer 30

Care Under Fire.

Question 31

What is the goal of massive hemorrhage control in CUF?

Answer 31

Rapid application of tourniquet while minimizing exposure to hostile fire.

Question 32

Why is patient movement minimized after hemorrhage control?

Answer 32

To avoid dislodging clots and worsening bleeding.

Question 33

When should hemostatic agents be avoided?

Answer 33

When bleeding is not severe or direct pressure alone is sufficient.

Question 34

What is the significance of 'no distal pulse' after tourniquet use?

Answer 34

Confirms arterial occlusion and effective bleeding control.

Question 35

What is the role of hypothermia in hemorrhage?

Answer 35

It worsens coagulopathy and increases bleeding risk.

Question 36

What helps prevent hypothermia in bleeding casualties?

Answer 36

Use of warming blankets and minimizing exposure.

Question 37

What are signs of continued bleeding despite tourniquet use?

Answer 37

Oozing, soaking dressings, or visible blood flow.

Question 38

How can improvised tourniquets fail?

Answer 38

Insufficient pressure, narrow width, or poor placement.

Question 39

What is tourniquet conversion?

Answer 39

Replacing a tourniquet with a pressure dressing if the bleeding is controllable.

Question 40

When is tourniquet conversion appropriate?

Answer 40

Within 2 hours and when evacuation allows close monitoring.

Question 41

What must be confirmed before converting a tourniquet?

Answer 41

Bleeding has stopped with pressure dressing in place.

Question 42

What is done if bleeding restarts during conversion?

Answer 42

Reapply the tourniquet immediately.

Question 43

What factors influence decision to convert a tourniquet?

Answer 43

Environment, evacuation time, casualty condition, medical skill.

Question 44

What is the role of training in hemorrhage control?

Answer 44

Increases speed and accuracy, saving lives in real scenarios.

Question 45

What’s the consequence of not treating massive hemorrhage rapidly?

Answer 45

Rapid exsanguination and preventable death.

Question 46

What equipment should every operator carry for hemorrhage control?

Answer 46

At least one CoTCCC-recommended tourniquet and hemostatic gauze.

Question 47

Why is early intervention critical in hemorrhage control?

Answer 47

Most deaths from bleeding occur in minutes.

Question 48

What is the most important principle in treating massive hemorrhage in TCCC?

Answer 48

Immediate action using the best tools available under tactical constraints.