Massive Hemorrhage – Reassessment Matters
MARCH: Massive Hemorrhage – Reassessment Matters 🔴 Scenario You arrive first on scene of a vehicle vs pedestrian crash. A bystander applied a tourniquet to the patient’s left thigh. EMS is 6–8 minutes out. The patient is conscious, pale, and anxious. M – Massive Hemorrhage ✅ What To Do - Reassess the tourniquet Is it high and tight? Is bleeding fully controlled? - If bleeding continues: Tighten the tourniquet until bleeding stops Apply a second tourniquet above the first if needed - Check for hidden bleeding Groin, buttocks, armpits, behind knees - If a tourniquet can’t be placed: Pack the wound and apply direct pressure 👀 What To Look For - Blood soaking through clothing or bandages - Pooling blood beneath the patient - Pale or clammy skin - Fast pulse or increasing anxiety (early shock signs) 🆚 Civilian vs Law Enforcement Response 🧍♂️Civilian Focus - Prioritize personal safety - Call 911 early - Use commercial or improvised tourniquets - Apply direct pressure if unsure - Reassess only if safe to do so Goal: Stop the bleeding until help arrives Law Enforcement / First Responder Focus - Ensure scene security - Apply rapid hemorrhage control - Carry and use department-issued TQs and hemostatic gauze - Perform systematic MARCH reassessments - Prepare for handoff to EMS Goal: Stabilize, reassess, and maintain control until transport 👨🏫 Instructor Note Tourniquets fail more often from poor placement or hesitation than from overuse. Pain is expected. Bleeding control always comes first. Reassess after movement, stress, or time passes. 🔑 Key Takeaway The first tourniquet isn’t the finish line — reassessment saves lives.