COURSE SUMMARY
ANNEX: B
COURSE: GENERAL MEDICAL SUBJECTS
PHASE: 1 VER: C
PREPARATION DATE: 2012/01/31
COURSE TITLE: TREAT UNIT CASUALTIES
REFERENCES: ANA-STP-8-86C-E4-5-SM-TG / (U.S. DOCTRINE STP 8-68W13-SM-TG)
ACADEMIC TITLE
CONTROL BLEEDING
HOURS
081-86A-0161
4 HRS
Terminal Learning Objective:
Understand how to examine the casualty for life threatening bleeding and treat the injuries using
appropriate techniques insuring all open (or penetrating) wounds are checked for a point of entry
and exit and first aid measures applied accordingly.
Enabling Learning Objectives:
1. Soldier understands how to determine if the bleeding is external or internal.
2. Soldier understands how to expose casualty to find entry and exit wounds.
3. Soldier understands how to administer direct pressure to the wound site and elevate the
injured extremity.
4. Soldier understands how to apply an emergency bandage, hemostatic and/or pressure
dressing to the casualty.
5. Soldier understands how to locate and apply pressure to the appropriate arterial
pressure point, if the wound continues to bleed.
6. Soldier understands how to check for distal pulses on extremity
7. Soldier considers other conjunctive therapies to control bleeding if necessary.
8. Soldier understands how to apply a tourniquet to the casualty.
9. Soldier understands how to record the procedure on the Field Medical Card.
10. Soldier understands how to evacuate the casualty.
11. Soldier understands how to prevent further injury to the casualty
CONTROL BLEEDING
081-86A-0161
Conditions: You have encountered a casualty who is bleeding externally and may also be
bleeding internally. All other more serious injuries have been assessed and treated. Body
substance isolation precautions have been taken. You will need field dressings, emergency
bandages, cravats, gauze pads, gauze roller bandage, sterile dressing, Kerlix, ace wraps, air
splints, hemostatic bandage, windlass device, materials for a tourniquet, and an ANA Form 1380
(Field Medical Card).
Standards: Control bleeding without further harming the casualty.
Performance Steps
1. Determine if the bleeding is external or internal.
a. External bleeding (go to step 2).
b. Internal bleeding--suspicion should be based on mechanism of injury (MOI).
(1) Large bruises on the trunk or abdomen indicating injury to underlying organs.
(2) Painful, swollen or deformed extremities indicating underlying fractures.
(3) Rigid and/or tender abdomen may indicate bleeding into the abdomen.
(4) Bleeding from the mouth, rectum, or other body orifice.
(5) Vomiting bright red or dark (like coffee grounds) blood (hematemesis).
(6) Bloody stool that is dark and tarry (melena) or bright red (hematochezia).
2. Apply direct pressure to the wound with a gauze pad or field dressing.
NOTE: If bleeding is profuse, apply direct pressure to the wound with your gloved hand. Do not
waste time looking for a dressing.
NOTE: If in a tactical environment perform tactical casualty assessment.
3. Elevate the affected extremity above the level of the heart.
CAUTION: Do not elevate if there are suspected musculoskeletal injuries, impaled objects in
the extremity, or any suspected spinal injury.
4. Apply a pressure dressing or emergency bandage if the wound continues to bleed.
CAUTION: Once bleeding has been controlled it is important to check a distal pulse to make
sure that the dressing has not been applied too tightly. If a pulse is not palpable, adjust the
dressing to reestablish circulation.
5. Locate and apply pressure to the appropriate arterial pressure point, if the wound continues to
bleed.
NOTE: Pressure points may not be effective if the wound is at the distal end of the limb. Blood is
being sent to these areas from many smaller arteries.
a. Brachial artery--used to control bleeding from the distal end of an upper extremity.
(1) Hold the casualty's arm out at a right angle to his body with the palm facing up.
NOTE: Do not use force to raise the arm if the movement causes pain.
(2) Locate the groove between the humerus and the biceps muscle.
(3) Hold the upper arm in the palm of your hand with your fingers positioned in the medial
groove.
(4) Press your fingers into the groove to compress the artery against the underlying bone.
NOTE: If pressure is applied properly, the radial pulse will not be palpable.
b. Femoral artery--used to control bleeding of a lower extremity.
(1) Locate the femoral artery on the medial side of the anterior thigh, just below the groin.
(2) Place the heel of your hand over the site and apply pressure toward the bone.
NOTE: More pressure is needed to compress the femoral artery than the brachial artery due to
the amount of tissue and muscle in the thigh. Greater force is needed for obese and muscular
individuals. If pressure is applied properly, a distal pulse will not be palpable.
6. Consider other conjunctive therapies to control bleeding if necessary.
a. Splinting.
b. Hemostatic bandage.
7. Apply a tourniquet if the wound continues to bleed.
CAUTION: In combat while under enemy fire, a tourniquet is the primary means to control
bleeding. It allows the individual, his battle buddy, or the combat medic to quickly control life
threatening hemorrhage until the casualty can be moved away from the firefight. Always treat
life-threatening hemorrhage while you and the casualty are behind cover.
NOTE: If the source of bleeding was due to a traumatic amputation provide basic emergency
medical care for an amputation.
8. Initiate treatment for shock as needed.
9. Record treatment given on the FMC.
10. Evacuate the casualty.
Performance Measures
1. Determined the type of bleeding (external or internal).
2. Applied direct pressure to the wound with a gauze pad or field dressing.
3. Elevated the extremity above the level of the heart.
5. Located and applied pressure to the appropriate arterial pressure point, if
the wound continued to bleed.
6. Considered other conjunctive therapies to control bleeding if necessary.
7. Applied a tourniquet if the wound continued to bleed.
8. Initiated treatment for shock as needed.
9. Recorded treatment given on the FMC.
10. Evacuated the casualty.
PASS
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FAIL
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Evaluation Guidance: Score each Soldier according to the performance measures in the
evaluation guide. Unless otherwise stated in the task summary, the Soldier must pass all
performance measures to be scored PASS. If the Soldier fails any step, show what was done
wrong and how to do it correctly.