10d • Daily TACMED Trainings
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.
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Massive Hemorrhage – Reassessment Matters
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