carry tourniquets and hemostatic dressings in a kit on their person
when responding. EMS equipment in the ambulance or helicopter
should include hemorrhage control kits. All trauma centers should
have these devices in their emergency departments. Training is
paramount. Larger pre-positioned trauma kits should be placed
at optimal locations for medical coverage of local events or locations. These larger kits would supply immediate needs in an active
shooter event or mass casualty situation. Examples of locations
where pre-positioned trauma kits would be of value are malls,
movie theaters, schools, and sporting events. There is a growing
recognition that the hemorrhage control kits should be positioned
next to automated external defibrillators.
External hemorrhage control can be accomplished easily by well-trained and well-equipped people, whether they are professional
first responders or civilians. Tourniquets and hemostatic dressings should reduce preventable deaths from external hemorrhage
in the civilian sector, just as they have done in the military. The
recommendations for early effective hemorrhage control with
commercial devices are important and similar to those of the
Co TCCC, the U.S. military, the American College of Surgeons
Committee on Trauma, the American College of Emergency
Physicians, the National Association of Emergency Medical Technicians, and the Hartford Consensus III. The lessons learned in
early hemorrhage control have been gained and applied in the
crucible of battle. Widespread application of tourniquets and
hemostatic dressings for hemorrhage control after civilian injury
will save lives. ♦
The opinions or assertions contained herein are the private views of
the authors and are not to be construed as official or as reflecting the
views of the Department of Defense. This recommendation is intended
to be a guideline only and is not a substitute for clinical judgment.
All professional first responders should be equipped with
bleeding control kits.
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Technicians. TCCC Guidelines and
Curriculum. Available at: www.naemt.org/
Accessed June 9, 2015.
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Effectiveness of self-applied tourniquets
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3. Kragh JF Jr, Walters TJ, Baer DG, et al.
Survival with emergency tourniquet use to
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4. Butler FK Jr, Blackbourne LH. Battlefield
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6. Bennett BL, Littlejohn LF, Kheirabadi BS,
et al. Management of external hemorrhage
in tactical combat casualty care: Chitosan-based hemostatic gauze dressings—TCCC
guidelines–Change 13–05. J Spec Oper Med.
2014; 14( 3): 40-57.
7. Bulger E, Snyder D, Schoelles K, et al. An
evidence-based prehospital guideline for
external hemorrhage control. American College
of Surgeons Committee on Trauma. Prehosp
Emerg Care. 2014; 18( 2):163-173.
8. Butler FK, Giebner SD, McSwain N, Pons P,
eds. Prehospital Trauma Life Support Manual. 8th
ed., military version. Burlington, MA: Jones
and Bartlett Learning; 2014.