f. Bleeding. Identify and control major bleeding (see Lesson 5).
Apply a tourniquet to a major amputation of the extremity.
(2) Apply an emergency trauma bandage and direct pressure to a severely
(a) If conventional methods of controlling severe bleeding (emergency
trauma bandage, direct pressure, pressure dressing, hemostatic dressing, and so forth)
do not control the bleeding on an extremity, apply a tourniquet.
(b) If a tourniquet was previously applied, consider changing the
tourniquet to a pressure dressing and/or using a hemostatic dressing to control
bleeding. Loosen the tourniquet, but do not remove the tourniquet while applying
conventional methods of controlling bleeding. If conventional methods are not able to
control hemorrhage, retighten the tourniquet until bleeding stops.
By converting the tourniquet to a pressure dressing or controlling the bleeding
by other methods, you may be able to save the limb of the casualty if the
tourniquet has not been in place for 6 hours. If tourniquet has been in place
for more than 6 hours, do not remove the tourniquet.
g. Intravenous Fluids. Determine if the casualty requires fluid resuscitation
(Lesson 6). Use your initial assessment, the casualty's radial pulse, and the casualty's
mental status to determine if fluid resuscitation is required. These can be determined
even in the typical noisy and chaotic battlefield environment.
(1) If the casualty has only superficial wounds, intravenous (IV) resuscitation
is not necessary, but oral fluid hydration should be encouraged. Over 50 percent of the
casualties will be in this category.
(2) If the casualty has a significant wound to an extremity or to the trunk
(neck, chest, abdomen, or pelvis) and the casualty is coherent and has a palpable radial
pulse, initiate a saline lock. Do not administer intravenous fluids at this time, but
continue to monitor the casualty. Begin administering fluids intravenously if the
casualty's mental status (AVPU) decreases or his radial pulse is no longer detectable.
(If you can no longer feel the casualty's radial pulse, his blood pressure has probably
dropped below 80 mmHg. This is a sign that the casualty is suffering from hypovolemic
An upper extremity is the preferred site for the saline lock. Do not use a site
distal to (below) a significant wound. See paragraph 5-2 for a definition of
the term "distal."