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081-831-1032 (SL1) - Perform First Aid for Bleeding of an Extremity

Standards: Controlled bleeding from the wound following the correct sequence. Placed a field dressing over the wound with the sides of the dressing sealed so it did not slip. Checked to ensure the field and pressure dressing did not have a tourniquet-like effect. Applied a tourniquet to stop profuse bleeding not stopped by the dressings, or for missing arms and legs.

Conditions: You have a casualty who has a bleeding wound of the arm
or leg. 
The casualty is breathing. 
Necessary equipment and materials: 
casualty’s first aid packet,
materials to improvise a pressure dressing
(wadding and cravat or strip of cloth),
materials to elevate the extremity (blanket,
shelter half, poncho, log, or any available
material), rigid object (stick, tent peg, or
similar object), and a strip of cloth.

Standards:
Controlled bleeding from the wound following
the correct sequence. 
Placed a field dressing over the
wound with the sides of the dressing sealed
so it did not slip. 
Checked to ensure the field and
pressure dressing did not have a
tourniquet-like effect. 
Applied a tourniquet to stop profuse
bleeding not stopped by the dressings, or
for missing arms and legs.

 

 

Performance
Steps

 

1.   Uncover the wound unless clothing is stuck to the
wound or in a chemical environment.

WARNING

Do
not remove protective clothing in a
chemical environment. 
Apply dressings over the
protective clothing.

Note. If an arm or leg has been cut off, go to step 5.

 

 

2.   Apply the casualty’s field dressing.

 

a.
Apply
the dressing, white side down,
directly over the wound.

 

b.
Wrap
each tail, one at a time, in
opposite directions around the wound
so the dressing is covered and both
sides are sealed.

 

c.
Tie
the tails into a nonslip knot over
the outer edge of the dressing, not
over the wound.

 

d.
Check
the dressing to make sure it is tied
firmly enough to prevent slipping
without causing a tourniquet-like
effect.

 

WARNING

Field
and pressure dressings should not have
a tourniquet-like effect. 
The dressing must be loosened
if the skin beyond the injury becomes
cool, blue, or numb

 

3.   Apply manual pressure and elevate the arm or leg to
reduce bleeding, if necessary.

 

a.
Apply
firm manual pressure over the
dressing for 5 to 10 minutes.

 

b.
Elevate
the injured part above the level of
the heart unless a fracture is
suspected and has not been splinted.

 

4.   Apply a pressure dressing if the bleeding
continues.

 

a.
Keep
the arm or leg elevated.

 

b.
Place
a wad of padding directly over the
wound.

 

c.
Place
an improvised dressing over the wad
of padding and wrap it tightly
around the limb.

 

d.
Tie
the ends in a nonslip knot directly
over the wound.

 

e.
Check
the dressing to make sure it does
not have a tourniquet-like effect.

Note. If the bleeding stops, watch the casualty closely, and
check for other injuries.

Note. If heavy bleeding continues, apply a tourniquet.

WARNING

The
only time a tourniquet should be
applied is when an arm or leg has been
cut off or when heavy bleeding cannot
be stopped by a pressure dressing. If
only part of a hand or foot has been
cut off, the bleeding should be
stopped using a pressure dressing.

 

5.   Apply a tourniquet.

 

a.
Make a tourniquet at
least 
two inches wide.

 

b.
Position
the tourniquet.

 

(1) 
Place the tourniquet
over the smoothed sleeve or
trouser leg if possible.

 

(2) 
Place the tourniquet
around the limb two to four inches
above the wound between the wound
and the heart but not on a joint
or directly over a wound or a
fracture.

 

(3) 
Place the tourniquet
just above, and as close to the
joint as possible, when wounds are
just below a joint.

 

c.
Put
on the tourniquet.

 

(1) 
Tie a half knot.

 

(2) 
Place a stick (or
similar object) on top of the half
knot.

 

(3) 
Tie a full knot over
the stick.

 

(4) 
Twist the stick until
the tourniquet is tight around the
limb and bright red bleeding has
stopped.

 

Note. In
case of an amputation, dark oozing
blood may continue for a short time.

 

d.
Secure the tourniquet. 
The tourniquet can be secured
using the ends of the tourniquet
band or with another piece of cloth
as long as the stick does not
unwind.

 

Note.  If a limb
is completely amputated, the stump
should be padded and bandaged (do not
cover the tourniquet).

Note.  If
possible, severed limbs or body parts
should be saved and transported with,
but out of sight of, the casualty. 
The body parts should be
wrapped in dry, sterile dressing and
placed in a dry, plastic bag and in
turn placed in a cool container (do
not soak in water or saline or allow
to freeze). 
It is entirely possible that
your location in the field/combat may
not allow for the correct preserving
of parts; do what you can.

WARNING

Do
not loosen or release a tourniquet
once it has been applied

 

e.
Mark
the casualty’s forehead with a
letter T using a pen, mud, the
casualty’s blood, or whatever is
available.

 

6.   Watch the casualty closely for life-threatening
conditions, check for other injuries,
if necessary, and treat for shock.

Evaluation Preparation: 

Setup:  Use the same
field dressing repeatedly. 
Have materials available for a
pressure dressing (wadding and cravat or a
strip of cloth). 
Have one soldier play the part of the
casualty and another apply the field and
pressure dressing. 
Use a moulage or mark a place on the
casualty’s arm or leg to simulate a wound. 
For applying a tourniquet, use a
mannequin or simulated arm or leg (padded
length of 2-inch by 4-inch wood with a glove
or boot on one end) with a field dressing
appropriately placed on the arm or leg. 
Under no circumstances will a live
simulated casualty be used to evaluate the
application of a tourniquet. 
Place the tourniquet materials (a
stick and one or two pieces of cloth)
nearby.

Brief
Soldier: 
Tell the soldier to do, in order, the
first aid steps required to put on a field
dressing and, if necessary, a pressure
dressing on the casualty’s wound. 
When testing step 1, you can vary the
test by telling the soldier that clothing is
stuck to the wound or that a chemical
environment exists. 
After step 2 and 3, tell the soldier
that the bleeding has not stopped. 
After step 4, tell the soldier the
bleeding is continuing and ask the soldier
to describe and perform first aid on the
simulated arm or leg provided.

Performance
Measures

GO

NO
GO

1.   Uncovered the wound.

2.   Applied a field dressing.

3.   Applied manual pressure and elevated the arm or
leg, if necessary.

4.   Applied a pressure dressing, if necessary.

5.   Applied a tourniquet, if necessary.

6.   Performed steps 1 through 5, as necessary, in
sequence.

Evaluation
Guidance: 
Score the soldier GO if all
performance measures are passed. 
Score the soldier NO GO if any
performance measure is failed. 
If the soldier scores NO GO, show
what was done wrong and how to do it
correctly.

References

 

Required

Related

 

 

FM
4-25.11


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