After reassessing massive hemorrhage control and applying a PCD, if appropriate, the next step is to expose any wounds, if that has not already been accomplished. Wound exposure should be accomplished using trauma shears rather than an unguarded blade to prevent further injury to the extremity.22 A principal objective of exposing wounds is to determine if the bleeding might be controlled without a tourniquet and/or to assess whether a tourniquet might be applied closer to the wound to preserve as much viable tissue as possible.

There is no precise set of parameters that will universally help make the determination of whether a tourniquet is necessary, but typical injuries that will continue to require a tourniquet include some obvious injuries like amputations and deep wounds that resulted in severed arteries, whereas more superficial injuries not involving the arteries may be more easily controlled.23, 24 However, sometimes the extent of the wound isn’t clearly known just based on the external view of the wound.25, 26

The tactical considerations during Care Under Fire or the uncertainty of the extent of bleeding during the massive hemorrhage phase in Tactical Field Care will sometimes lead to a bleeding control decision that can be managed differently once the situation is more controlled and more information can be gathered from the exposed wound. If the reassessment determines that the prior tourniquet was not needed, then remove the tourniquet, dress the wound, and note the time of tourniquet removal on the TCCC Casualty Card.27

We’ll spend the next couple of minutes talking about the indications and processes for replacing tourniquets and for converting tourniquets.