Circulation Assessment and Hemorrhage Control - NREMT: EMT Level

Stabilize the object; control bleeding with dressings around it. Stabilizing prevents further tissue damage or bleeding exacerbation, while surrounding dressings control external hemorrhage without removal.

Hold firm pressure for at least 3 minutes (follow protocol). Sustained pressure allows time for clot formation or hemostatic agent activation, aligning with manufacturer and protocol recommendations.

Severe bleeding not controlled with direct pressure alone. Hemostatic dressings are indicated when standard methods fail, as they enhance clotting through chemical agents in high-risk bleeds.

Pack gauze firmly into the wound cavity, then hold pressure. Firm packing fills the wound tract to tamponade bleeding vessels internally, followed by pressure to maintain compression.

Pack the wound and apply firm direct pressure. Junctional wounds require packing to fill the cavity and compress internal vessels, as tourniquets are ineffective in these areas.

Time of application (and reassessment findings per protocol). Documentation of application time and reassessments is required for continuity of care and to guide hospital management.

To evaluate perfusion and possible shock. Skin assessment provides key indicators of circulatory status, helping identify hypoperfusion or compensatory shock mechanisms.

Wrap in sterile gauze, seal in bag, keep cool; do not freeze. This preservation method maintains tissue viability for potential reattachment by protecting from contamination and extreme temperatures.

Treat for shock and transport rapidly; request ALS as needed. Suspected internal bleeding necessitates shock management and expedited care, as it can lead to rapid decompensation without visible signs.

Uncontrolled bleeding with rapid blood loss (spurting or pooling). Rapid, uncontrolled blood loss signals arterial involvement and potential hypovolemic shock, requiring immediate intervention.

Poor peripheral perfusion (possible shock). Delayed refill with these signs indicates vasoconstriction and reduced perfusion, common in hypovolemic or distributive shock states.

Brachial pulse. The brachial pulse is preferred in infants due to its accessibility and reliability for assessing central circulation in small anatomies.

Carotid pulse. The carotid pulse is central and reliable in unresponsive adults, reflecting cardiac output when peripheral pulses may be absent due to shock.

Direct pressure, wound packing, pressure dressing, tourniquet. This sequence follows EMT protocols by starting with the least invasive method and escalating to more aggressive interventions only if necessary to achieve hemostasis.

Apply firm direct pressure with a dressing. EMT guidelines prioritize direct pressure as the initial intervention to promote clotting and minimize blood loss without requiring advanced tools.

Direct pressure. Direct pressure is favored in EMT practice because it effectively compresses vessels to stop bleeding while being simple and immediately applicable.

Use gloved hand and dressing; press firmly and continuously. This technique ensures safe, effective compression of bleeding vessels to promote clot formation while preventing contamination.

Add more dressings on top; do not remove the original. Adding dressings preserves any forming clot beneath the original layer, maintaining pressure and avoiding disruption of hemostasis.

To maintain continuous direct pressure over a wound. A pressure dressing secures the initial direct pressure, allowing hands-free maintenance of compression to control ongoing bleeding.

Apply a tourniquet proximal to the wound. EMT protocols escalate to tourniquet use when direct pressure is insufficient, as it reliably occludes arterial flow in extremities.

2–3 inches proximal to the wound, not over a joint. Placement proximal to the wound ensures occlusion of major vessels supplying the bleed, while avoiding joints prevents slippage and inefficacy.

Tighten until bleeding stops and distal pulse is absent. Adequate tightening is confirmed by cessation of bleeding and loss of distal pulse, indicating complete arterial occlusion.

Apply a second tourniquet proximal to the first. A second tourniquet addresses potential incomplete occlusion or anatomical variations, ensuring effective hemorrhage control per EMT guidelines.

Do not remove or loosen it; reassess and document time. EMT protocols prohibit removal to avoid disrupting clots and causing re-bleeding, emphasizing ongoing monitoring and documentation.