Continuing from the last article we have just moved out casualty to our CCP (Casualty Collection Point) and are beginning Tactical Field Care. TFC is the second phase of TCCC and the one where we will do the most to keep our casualty from dying. From this point on we will be talking about the algorithm MARCH or SMARCH. The S is covered in the last post. Shoot back! After that, we have M for Massive Hemorrhage.

As I had started to say in the last post after we have moved our casualty we need to find out if the hasty tourniquet we applied earlier is actually doing anything for the blood we saw initially. In order to do this, and to see if there are any other injuries we need to worry about, we need to perform a blood sweep.

The blood sweep is where we are going to start to remove clothing in order to fully expose all of the junctions and the extremities. The junctions are the groin, armpits, and base of the neck. Basically anywhere that a limb meets the body. Our starting point depends on if we placed a hasty tourniquet in Care Under Fire. If we did apply on then we are going to start out blood sweep on that extremity because we haven’t actually identified the source of the bleeding. Just because you see blood at a certain place on the clothing does not mean the wound is there. If we did not apply a hasty tourniquet we would start with the junctions because wound packing takes a few minutes in order to do correctly. We want to treat those wounds first instead of hyper-fixating on extremities.

In order to remove the clothing, we are going to use shears. Not a knife, not a strap cutter, but shears. Using a knife is a great way to stab either the casualty or yourself, strap cutters are only for cutting straps. Use shears, and good quality ones. At the PLS Course, students not only get to see but get to experience firsthand how well shears can cut through ACU’s (including the zippers). The shears used in class are the NAR Trauma shears, the same ones that are in the IFAK. I have used a few different brands of shears over my career as a medic and the NAR ones are by far my favorite. We will cut up to (but not through) the tourniquet and then do the same from the top, cutting down to the tourniquet in order to expose above and below the tourniquet. If the wound is at least 2-3 inches below the tourniquet then we can leave it alone and move on to the junctional areas. If it is not then we need to switch to wound packing, which will be the subject of another article.

If no hasty tourniquet was applied or we have already assessed it, we will sweep the junctions. Don’t get hung up on which one to start with, just pick whatever junction is closest to you and move on from there. Make sure to cut away any clothing in your way and fully assess the entire junction. If you see a wound in the junction then we would pack the wound with gauze and wrap it with a pressure dressing in order to keep pressure applied to the gauze.

Once we have swept all the junctions we move to sweep the extremities. The same idea as the junctions. Fully expose and if you identify any wounds either place a deliberate tourniquet or wound pack depending on the location on the extremity of the wound.  Those are the only places we are sweeping in Massive Hemorrhage. I’ll explain the two treatment methods in the next article.

What trauma shears are you using?

To fully learn how to do a blood sweep, and the rest of the MARCH algorithm come on out to a class.