M — Massive Hemorrhage

M Massive Hemorrhage

The #1 preventable cause of death in trauma

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Identify

• Blood pooling on ground or soaking clothing
• Bright red, pulsatile (spurting) = arterial
• Dark red, flowing = venous
• Either can be life-threatening at high volume

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Extremity Hemorrhage

TOURNIQUET — HIGH and TIGHT

1. Place 2-3 inches above wound (or as high as possible)
2. Tighten windlass until bleeding stops
3. Lock windlass and secure
4. Note the time on TQ and casualty card
5. If bleeding continues: add second TQ above the first

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Junctional Hemorrhage

Groin, axilla, neck — TQ can’t be applied

1. Expose the wound completely
2. Pack wound with hemostatic gauze (Combat Gauze)
   • Pack deep into wound cavity
   • Fill completely, don’t just cover
3. Direct pressure — hard, sustained, minimum 3 minutes
4. Pressure dressing to maintain pressure

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Decision Points

Situation	Action
Extremity + arterial	Tourniquet immediately
Extremity + venous	Pressure first, TQ if not controlled
Junctional	Pack + pressure, no TQ
Truncal (chest/abdomen)	Pressure if external, expedite evacuation

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Common Errors

• ❌ TQ placed too low (over wound)
• ❌ TQ not tight enough (venous stops, arterial continues)
• ❌ Releasing pressure on wound pack too early
• ❌ Not documenting TQ time
• ❌ Hesitating when TQ is needed

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Reassess

After application:

• Is bleeding stopped?
• Is distal pulse absent? (extremity TQ)
• Is the TQ secure?

Before/after any movement:

• Recheck all hemorrhage control