# Summary

Identifying and controlling massive hemorrhage (the M in MARCH PAWS) remains the priority in Tactical Field Care.

All limb TQs hastily placed high and tight in CUF need to be reassessed and deliberate TQs placed for any extremity hemorrhage not previously addressed.

For external hemorrhage from sites not amenable to limb tourniquets (places where a tourniquet cannot be effectively applied) or for bleeding from wounds not requiring a tourniquet, direct or indirect pressure, a CoTCCC-recommended hemostatic dressing, and/or a pressure dressing can be used to control bleeding

Junctional hemorrhage is compressible external hemorrhage not amenable to limb TQs and must be treated without delay using CoTCCC-recommended junctional TQs or improvised junctional hemorrhage control techniques with hemostatic dressings and direct pressure.

Other methods for addressing massive hemorrhage include injectable hemostatic agents and wound closure devices.