TCCC Hemorrhage Control & Wound Management 2 — Questions and Answers
Question 1: If a single tourniquet fails to control hemorrhage from an extremity wound, what is the correct TCCC action?
- Remove and reapply the tourniquet at a lower position on the limb
- Convert immediately to wound packing with hemostatic gauze only
- Apply a second tourniquet immediately proximal to the first (Correct answer)
- Apply maximum manual pressure over the existing tourniquet and wait
Correct answer: Apply a second tourniquet immediately proximal to the first
When a single tourniquet fails to stop bleeding, TCCC protocol calls for applying a second tourniquet immediately proximal to the first to increase pressure and achieve arterial occlusion.
Question 2: A casualty has severe hemorrhage from a wound in the inguinal (groin) area. Which device is most appropriate per TCCC guidelines?
- Standard limb tourniquet applied around the waist
- Pressure dressing with wound packing alone
- Junctional Emergency Treatment Tool (JETT) or Combat Ready Clamp (CRoC) (Correct answer)
- Improvised circumferential compression bandage
Correct answer: Junctional Emergency Treatment Tool (JETT) or Combat Ready Clamp (CRoC)
Junctional hemorrhage control devices such as the JETT or CRoC are specifically designed for groin, axillary, and neck wounds where standard limb tourniquets cannot be applied.
Question 3: Which combination of findings confirms that a limb tourniquet has been applied with sufficient tightness?
- Patient reports significant pain and limb turns pale
- The tourniquet windlass is fully tightened and secured
- Bleeding has completely stopped and distal pulse is absent (Correct answer)
- Skin distal to the tourniquet becomes cyanotic
Correct answer: Bleeding has completely stopped and distal pulse is absent
A correctly applied tourniquet should eliminate both active bleeding and the distal pulse, confirming complete arterial occlusion.
Question 4: When is wound packing preferred over tourniquet application in TCCC?
- When the patient is in Class III hemorrhagic shock
- For wounds in junctional areas or the torso where a tourniquet cannot be placed (Correct answer)
- Whenever a tourniquet is not immediately available in the kit
- For all soft tissue injuries regardless of location
Correct answer: For wounds in junctional areas or the torso where a tourniquet cannot be placed
Wound packing with hemostatic gauze is the preferred technique for junctional and torso wounds where anatomical constraints prevent tourniquet application.
Question 5: What is the correct wound-packing technique in TCCC?
- Loosely fill the wound cavity to avoid patient discomfort and tissue damage
- Layer gauze over the wound surface without inserting into the cavity
- Pack gauze tightly into the wound cavity and apply direct pressure for 3 minutes (Correct answer)
- Apply a wet dressing to promote wound drainage and prevent drying
Correct answer: Pack gauze tightly into the wound cavity and apply direct pressure for 3 minutes
Effective wound packing requires tightly packing hemostatic gauze into the wound cavity to contact the bleeding vessel, then applying firm pressure for 3 minutes to activate hemostasis.
Question 6: Which statement about tourniquet use is most consistent with current TCCC evidence from recent conflicts?
- Tourniquet use frequently results in permanent limb loss and should be used only as a last resort
- Tourniquets should only be applied after direct pressure has failed for at least 2 minutes
- Early tourniquet application in appropriate wounds significantly reduces mortality with low rates of tourniquet-related limb loss (Correct answer)
- Tourniquets cause more complications than benefits when applied before reaching definitive medical care
Correct answer: Early tourniquet application in appropriate wounds significantly reduces mortality with low rates of tourniquet-related limb loss
Combat casualty data from OIF and OEF demonstrated that early tourniquet application dramatically reduces hemorrhagic death, with tourniquet-related limb loss being rare when applied correctly.
Question 7: What does the 'M' in the TCCC MARCH assessment acronym represent?
- Movement and extraction
- Massive hemorrhage (Correct answer)
- Medical history
- Mental status evaluation
Correct answer: Massive hemorrhage
The 'M' in MARCH stands for Massive Hemorrhage, reflecting that controlling life-threatening bleeding is always the first priority in TCCC.
TCCC Hemorrhage Control & Wound Management 2
If a single tourniquet fails to control hemorrhage from an extremity wound, what is the correct TCCC action?