Massive Hemorrhage

What are the different parts of the massive hemorrhage skill check?

1. TCCC bleed sweep

2. delegation

3. well-aimed direct digital pressure

4. tourniquet

5. wound packing

How should a TCCC bleed sweep be performed correctly?

Palpate the following areas intentionally, making sure to check hands between:

• front/back of neck

• armpits

• circumferentially down the arms

• groin area (both sides of thighs)

• circumferentially down the legs

How can marks be lost during the TCCC sweep?

• sweep is done out of order (i.e., checked legs before arms)

• takes more than 15 seconds

• areas such as the head/chest/back/abdomen are checke

• body areas are missed

What are the steps required during the delegation portion of the massive hemorrhage skill check?

• request your partner to expose the first area of bleeding

• request your partner to apply well-aimed direct pressure while the learner continues their TCCC sweep

• request that your partner gather the following vitals (and inform you of any abnormalities/concerns) after they have dealt with bleeds and required pressure

  • ECG

  • SpO2

  • BP

  • RR

How can marks be lost during the delegation portion of the massive hemorrhage scenario?

• slows down TCCC sweep by exposing and applying pressure to the first bleed yourself (i.e., didn’t make your partner do it)

• no delegation at all to partner regarding the first exposed bleed and/or the vitals

• does not ask partner to jump to vitals when they are done with the first exposed bleed

What are the steps required during the direct pressure section of the massive hemorrhage skill check?

• once the EXTREMITY (not the initial bleed) bleed is exposed, apply constant, well-aimed direct digital pressure until there is confirmation that the TQ stopped the bleeding by checking the distal pulse

• once the JUNCTIONAL (not the initial bleed) bleed is exposed, apply constant, well-aimed direct pressure to it until packing is completed and pressure dressing is applied

How can marks be lost during the direct pressure section of the massive hemorrhage skill check?

• pressure is momentarily withdrawn

• switchover between hands is poorly performed

• more than 5 seconds cumulatively (since exposure) with pressure off the bleed prior to packing

• uses palm to maintain the pressure

How is the tourniquet to be applied during the massive hemorrhage skill check?

• 1 hand width above the bleed

• cinched down very tight

• turn windlass until bleeding stops

• secures windlass (wraps around the little hooks sticking out)

• secures strap tail (tuck it away)

• “events” placement

  • Double check this…believe it means writing the time?

• distal pulse is checked to ensure that blood flow has been stopped effectively

How can points be lost during the tourniquet portion of the massive hemorrhage skill check?

• tail not secured

• forgets to “event” or write the placement time

• tourniquet is placed more (or less) than a hand’s width above the bleed

• tourniquet is not cinched down tight before windlass turned

• does not perform a distal pulse check

• does not confirm the bleeding has stopped

What are the different steps required during the wound packing section of the major hemorrhage skill check?

• create a tight wad of hemostatic gauze

• pack deep into wound on site of bleeding

• pack in the next wad without relieving pressure

• pack until dressing mounds over the wound

• hold direct pressure for 3 minutes (or 10 minutes if non-hemostatic gauze)

• secure pressure dressing with provided triangular bandage

How can points be lost during the wound packing section of the massive hemorrhage skill check?

• normal roller gauze is selected instead of the hemostatic gauze

• wound is packed loosely

• wound packing is stopped before the packing mounds over the wound

• incorrect time is given for length of time required to hold the wound before applying pressure dressing

• roller gauze is used instead of pressure (triangle) bandage

What equipment will be made available during this skill check?

• tourniquet (x2)

• hemostatic dressing

• normal roller gauze

• triangular bandage

What prompt will be given at the start of the scenario?

“Perform a TCCC deadly bleed sweep on this unresponsive patient with a pulse. Find the 2 bleeds and treat accordingly”

How much time will be allotted for the entirety of the massive hemorrhage skill check?

5 minutes in total (2 minutes of coaching once your time is up)