Before moving on to talk about tourniquet conversion, let’s review some of the points from the massive hemorrhage discussion about wound packing and pressure bandages.

Tourniquets are not required for all extremity bleeding. Occasionally, some lacerations that can be controlled by hemostatic dressings will have a tourniquet applied during the massive hemorrhage phase.38 If you assess that a wound is amenable to control without a tourniquet, the skills taught in the massive hemorrhage module can be used.

CoTCCC-recommended hemostatic dressings, including Combat Gauze®, ChitoGauze®, and Celox™ Gauze,39 are safe and contain active ingredients that assist with blood-clotting at the site of active bleeding.40 To effectively form a clot and stop bleeding, hemostatic dressing must be packed into the wound to maximize contact at the active source of bleeding with direct pressure applied over the wound for at least 3 minutes.41 Afterward, all dressings for significant bleeding should be secured with a pressure bandage while maintaining pressure on the wound throughout the process of applying the pressure bandage.42

Also, wound packing and pressure bandage application can be used at this stage for larger bleeding wounds that were not previously addressed, but that should be controlled prior to the wound phase (or the “W” of MARCH PAWS).