LESSON 7
PERFORM FIRST AID FOR BLEEDING OF AN EXTREMITY
(TASK 081-831-1032)

TASK:

Identify procedures for applying a field dressing, a pressure dressing, or a tourniquet to a bleeding extremity.

CONDITIONS:

Given multiple-choice examination items pertaining to controlling bleeding.

STANDARD:

Score 70 or more points on a 100-point comprehensive examination.

REFERENCES:

STP 21-1-SMCT, Soldiers Manual of Common Tasks: Skill Level 1.
FM 21-11, First Aid for Soldiers.

NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.

7-1. INTRODUCTION

A casualty who is loosing blood rapidly (hemorrhaging) may die unless the bleeding is stopped. Bleeding from an extremity (arm or leg) can usually be controlled by applying a dressing and bandage, applying manual pressure, elevating the injured limb, and (if necessary) applying a pressure dressing. If these methods do not control the bleeding, a tourniquet may be required. (NOTE: The procedures in this lesson are used to control bleeding from an upper arm, forearm, thigh, or lower leg. Bleeding from the head or trunk is discussed in other lessons.)

A dressing is the material that is placed directly over the wound. The dressing absorbs some of the blood and helps to cause a clot to form. The clot helps to "plug" the wound and stop the bleeding. The dressing also helps to prevent further contamination of the wound and provides protection to the injured area.

A bandage is the material used to hold (secure) the dressing in place so the dressing will not slip off the wound. The ends of the bandage are called the "tails."

Each soldier is issued a field dressing, which is carried in a plastic case (individual field first aid case). The field dressing consists of a sterile (germ-free) white pad of dressing with a bandage (usually olive-drab in color) already attached to the dressing pad. The dressing and bandage combination is wrapped in paper and then sealed in a plastic envelope. The field dressing is also called the field first aid dressing and the combat dressing.

FIGURE 7-1. FIELD DRESSING WITH CASE

7-2. EXPOSE THE WOUND

Expose the wound by tearing, cutting, and/or lifting the casualty's clothing and other material away from the wound. The entire wound area is exposed so that you can see the full extent of the injury. If clothing is stuck to the wound area, do not try to remove that part of the clothing from the wound. Do not try to remove objects from the wound.

Avoid causing additional damage to the wound.

If the wound was caused by a bullet, shrapnel, or other projectile, look for both an entry wound and an exit wound.

7-3. APPLY AND SECURE FIELD DRESSING

After you have exposed the wound, remove the field dressing from the casualty's first aid case. (You need to keep your field dressing in case you are injured.)

Tear the plastic envelope and remove its contents.

Twist the paper wrapper until it breaks or tear it open.

Grasp the folded bandages/tails with both hands.

FIGURE 7-2. APPLYING AND SECURING A FIELD DRESSING

Hold the field dressing above the exposed wound with the white side of the dressing material toward the wound.

Pull on the tails so that the dressing opens and flattens.

Place the dressing over the wound. Remember, the white side of the dressing goes next to the wound.

Use one hand to hold the dressing in place. If the casualty is conscious, you can have him hold the dressing in place while you secure it.

Wrap one of the bandages around the injured limb with your free hand. As you wrap, cover one of the exposed sides of the dressing with the bandage. (The bandage can usually be wrapped around the limb more than once.) Bring the tail back over the dressing.

Wrap the other bandage around the injured limb in the opposite direction. As you wrap, cover the remaining exposed side of the dressing with the bandage. Bring the tail back to the dressing.

Tie the tails into a nonslip knot over the outer edge of the dressing, not over the wound itself. (Tying the knot over the wound could cause additional injury to the wound site.) The tails should be tight enough so that the dressing will not slip, but not tight enough to interfere with blood circulation.

Check the circulation below (distal to) the bandage. If the skin below the bandage becomes cool to the touch, bluish, or numb, the bandage may be too tight and interfering with circulation. Loosen and retie the tails, then check the circulation again. If circulation is not restored, evacuate the casualty as soon as possible.

7-4. APPLY MANUAL PRESSURE

FIGURE 7-3. APPLYING MANUAL PRESSURE

Apply direct pressure over the dressing with your hand. This pressure will help to compress the damaged blood vessels and control the bleeding. Maintain this pressure for five to ten minutes. If the casualty is conscious and can follow instructions, you can have him apply the manual pressure himself.

7-5. ELEVATE THE WOUND

FIGURE 7-4. ELEVATING THE WOUND

Elevate the injured limb above the level of the casualty's heart. Elevating the limb will help to decrease the bleeding. For example, an injured leg can be raised by placing the foot on a pack, log, rock, or other object. An injured forearm can be elevated by placing the forearm on the casualty's chest if he is lying on his back or by having the casualty place his arm on top of his head if he is sitting up. Elevating the injured limb and applying manual pressure should be done at the same time when no fracture is involved.

7-6. APPLY A PRESSURE DRESSING

If blood continues to seep from the dressing even after you secure the dressing, apply manual pressure, and elevate the wound (if applicable), then a pressure dressing is needed to help stop the bleeding. The objective of applying a pressure dressing is to stop bleeding, not to stop all blood circulation below the wound. (Stopping all blood circulation would endanger the body tissue located below the bandage since these tissues would not receive the oxygen and nutrients carried by the blood.)

Place a wad of material on top of the dressing and directly over the wound. The wad can be made by folding a rag, material torn from clothing, or any other bulky material.

Place a bandage over the wad of padding and wrap the bandage tightly around the wound. The bandage can be a triangular bandage folded into a cravat (see figure 7-6), handkerchief, sock, strip of cloth torn from a shirt, or other similar material. Narrow materials like shoestrings are not used since they are likely to damage blood vessels and nerve tissue.

Tie the ends of the bandage to secure the padding. A nonslip knot should be tied directly over the wound. The bandage should be tight enough so that only the tip of one finger can be inserted under the bandage. Do not tie the bandage so tight that it cuts off all blood circulation.

FIGURE 7-5. APPLYING A PRESSURE DRESSING

Tie the ends of the bandage to secure the padding. A nonslip knot should be tied directly over the wound. The bandage should be tight enough so that only the tip of one finger can be inserted under the bandage. Do not tie the bandage so tight that it cuts off all blood circulation.

Check the circulation below the pressure dressing. If the skin below the bandage becomes cool to the touch, bluish, or numb, the pressure dressing may be too tight. If so, loosen and retie the tails. If circulation is not restored, evacuate the casualty as soon as possible. (The pressure dressing can be loosened and retied without disturbing the blood clot forming under the field dressing.)

Apply manual pressure over the pressure dressing.

If use of a pressure dressing controls the bleeding, proceed to check the casualty for other injuries. If the wound continues to bleed profusely, apply a tourniquet.

7-7. TOURNIQUET

A tourniquet is placed around an arm (upper arm or forearm) or leg (thigh or lower leg) in order to stop the flow of the blood below the tourniquet. It is used only when the amount of blood being lost endangers the casualty's life and the bleeding cannot be stopped by the application of a field dressing, manual pressure, elevation, and pressure dressing.

7-8. GATHER MATERIALS FOR MAKING A TOURNIQUET

Tourniquet Band

You will need a band of strong, pliable material which is at least two inches wide when folded. A folded muslin bandage (usually called a cravat), a folded handkerchief, or a folded strip of clothing will do. Do not use wire or shoestrings for a tourniquet band. A two-inch wide tourniquet will protect the tissue beneath the tourniquet when it is tightened. If a very narrow tourniquet is used, the nerves and blood vessels beneath the tourniquet may be seriously damaged.

Rigid Object

A rigid object, usually a stick, is needed to tighten the tourniquet.

Securing Materials

Material is needed to secure the rigid object once the tourniquet has been tightened. A piece of cloth such as is used for the tourniquet will do. If the tourniquet band is long enough, the tails can be used to secure the rigid object.

Padding

Padding is placed between the limb and the tourniquet band to protect the skin from being pinched and twisted when the band is tightened. Soft, smooth material should be used for padding. The casualty's shirt sleeve or trouser leg can be used as padding.

7-9. APPLY A TOURNIQUET TO A WOUND

The tourniquet should be placed two to four inches above the edge of the wound (between the wound and the heart). If the wound is just below the elbow or knee, the tourniquet should be placed above the joint and as close to the joint as possible. Do not place the tourniquet over the elbow or knee.

Place padding around the limb where the tourniquet will be applied. If the casualty's shirt sleeve or pants leg is covering the tourniquet site, smooth the shirt or pants material and apply the tourniquet over the clothing.

Place the tourniquet band material around the tourniquet site.

Tie the band with a half knot. (A half knot is the same as the first part of tying a shoe.)

Place the rigid object on top of the half knot.

Tie a full knot over the rigid object.

Twist the rigid object either clockwise or counterclockwise until the tourniquet is tight and the bright red bleeding has stopped. (Bright red blood is from a severed artery. Darker blood is from a vein. Dark blood may continue to ooze even after the tourniquet has been properly applied.)

Wrap the tails of the tourniquet band around the end of the rigid object so the rigid object will not untwist.

Wrap the tails around the limb (arm or leg) and tie the tails so that the rigid object stays secure.

If the rigid object cannot be secured with the tails of the tourniquet band, wrap a piece of material around the limb below the tourniquet, wrap the material around one end of the rigid object so that the tourniquet will not unwind, and tie the tails of the material in a nonslip knot. (NOTE: The rigid object is secured below the tourniquet so the securing material will not interfere with blood circulation above the tourniquet.)

FIGURE 7-7. APPLYING A TOURNIQUET

7-10. APPLY A TOURNIQUET TO AN AMPUTATION

An upper arm, forearm, thigh, or lower leg that has been completely severed (amputated) requires a tourniquet. A tourniquet is to be applied to an arm or leg that has been amputated even if the stump is not bleeding. The absence of blood is due to the body's normal defenses (constriction of blood vessels), but the stump will begin to bleed profusely when the blood vessels relax.

The tourniquet should be applied two to four inches above the edge of the amputation. If the limb has been amputated just below the knee or elbow, apply the tourniquet just above the joint. Do not attempt to control the bleeding by applying field and pressure dressings prior to applying the tourniquet.

If possible, place padding around the tourniquet site.

Place the tourniquet band around the tourniquet site. Use the rigid object to tighten the band and stop the blood flow. Then secure the rigid object to prevent the tourniquet from loosening. The procedures are the same as given in the previous paragraphs.

After the tourniquet has been applied, place a dressing made of soft, absorbent material over the end of the stump and secure the dressing with bandages. The dressing will help prevent additional contamination of the wound and will help to protect the wound from additional injury.

If possible, locate and save the severed body part. When the casualty is evacuated, transport the body part with the casualty.

7-11. MARK THE CASUALTY

Write a "T" on the casualty's forehead using a pen, the casualty's blood, mud, or other substance. The "T" alerts medical personnel that a tourniquet has been applied. Also include the time and date the tourniquet was applied, if possible. This information is important to medical personnel who treat the casualty.