Course Title

1. Introduction to Hemorrhage Control

• Uncontrolled hemorrhage is the leading cause of preventable traumatic death — approximately 35% of pre-hospital fatalities

• The 3–5 minute survivability window — why the bystander is the most critical first responder

• The Hartford Consensus and the national call to train non-medical personnel in bleeding control

• Stop the Bleed — BCon program origin and the ACS COT training framework

• TCCC military origins — 67% reduction in preventable extremity hemorrhage deaths from tourniquet use in combat

• TECC — Tactical Emergency Casualty Care — the civilian adaptation of TCCC for mass casualty and workplace trauma

• Workplace bleeding emergency obligations per OSHA 29 CFR 1910.151 and ISO 45001:2018 Clause 8.2

• The three actions every bystander must take — call, compress, and tourniquet when needed

2. Recognizing Life-Threatening Bleeding

• Life-threatening hemorrhage recognition — blood soaking through clothing, pooling on the floor, or spurting from the wound

• Arterial versus venous bleeding — spurting bright red blood indicates arterial injury and highest urgency

• Wound types requiring immediate control — extremity lacerations, amputations, and deep puncture wounds

• Junctional wounds — groin, armpit, and neck — where a tourniquet cannot be applied

• Signs of hemorrhagic shock — pale skin, rapid weak pulse, confusion, and loss of consciousness

• Scene safety assessment applying HIRARC — confirm the area is safe before approaching the casualty

• Personal Protective Equipment — disposable gloves — before any contact with the casualty

3. Direct Pressure and Wound Packing

• Direct pressure — the first and primary control technique for all external bleeding

• Correct hand placement — cover the entire wound with a clean cloth or dressing and press firmly

• Pressure must be sustained — do not lift the cloth to check — add layers if blood soaks through

• Minimum sustained pressure time — hold firm pressure for at least 3–5 minutes before assessing

• Wound packing indication — deep wounds, junctional wounds, and wounds where direct pressure alone is inadequate

• Wound packing technique — pack gauze tightly into the wound cavity, apply pressure on top, and hold firmly

• Hemostatic gauze — gauze impregnated with hemostatic agent — for severe deep wound packing where available

• Do not remove packed gauze — adding more gauze on top if saturation occurs

4. Tourniquet Application

• Tourniquet indication — extremity hemorrhage that cannot be controlled by direct pressure

• Tourniquet site — high and tight above the wound on the limb, not over a joint

• Commercial tourniquet types — CAT — Combat Application Tourniquet and SOFTT-W — Special Operations Forces Tactical Tourniquet Wide

• CAT application sequence — position, self-adhere, route, tighten, twist windlass, secure, and note the time

• Tourniquet effectiveness confirmation — bleeding stops and the distal pulse is absent

• Target application time — tourniquet applied and effective within 30 seconds per CoTCCC standard

• Time documentation — mark the tourniquet application time on the tourniquet or the casualty's forehead

• Never remove the tourniquet once applied — only a medical professional removes it in a clinical setting

5. Improvised Tourniquet and Junctional Hemorrhage

• Improvised tourniquet — used only when a commercial device is unavailable

• Suitable improvised materials — belt, fabric strips, or cable ties — minimum 4 cm width to prevent tissue damage

• Improvised tourniquet application — wrap twice above the wound, tie a half knot, place a stick, tie over the stick, and windlass tight

• Improvised tourniquet limitation — lower effectiveness than commercial devices — replace with commercial tourniquet when available

• Junctional hemorrhage — groin, axilla, and neck — cannot be controlled with a tourniquet

• Junctional wound management — pack with gauze as deeply as possible and apply firm sustained pressure

• Neck wound caution — apply direct pressure without compressing both carotid arteries simultaneously

6. Bleeding Control Kit and Emergency Activation

• Standard bleeding control kit contents per ACS BCon — windlass tourniquet, gauze, pressure dressing, trauma shears, gloves, and marker

• Bleeding control kit location — mounted adjacent to AED in public and workplace settings per Hartford Consensus recommendation

• Kit inspection and maintenance — monthly check of tourniquet condition, expiry dates, and seal integrity per ISO 9001

• Emergency services activation — call immediately, provide location, number of casualties, and nature of injury

• Information to give arriving EMS — tourniquet application time, blood loss estimate, and casualty consciousness level

• Casualty positioning — lay flat, elevate the legs if conscious and not suspected spinal injury, and keep warm

• Emotional support during waiting — speak calmly to the conscious casualty, reassure, and maintain pressure

• Handover to EMS — provide a clear verbal handover and do not remove any applied dressings or tourniquet

7. HSE Integration, Case Studies, and Practical Exercises

• Bleeding control training as an emergency preparedness obligation per ISO 45001:2018 Clause 8.2

• Workplace bleeding control kit placement and inspection records per ISO 9001 and OSHA 29 CFR 1910.151

• Training record management — documenting participant completion, refresher intervals, and skill validation

• Skill decay awareness — tourniquet application proficiency reduces significantly after 9 months without refresher practice

• Refresher training recommendation — practical tourniquet re-assessment every 6–12 months

• Case studies from traumatic bleeding events in Middle East industrial, construction, and public environments and the importance of proper bleeding control training in converting bystanders into effective immediate responders

• Group discussion on workplace hemorrhage preparedness including kit placement, multilingual responder training, and integration with site emergency response plans

• Practical simulation exercise — participants apply direct pressure, pack a simulated wound, and apply a commercial tourniquet on a training manikin within the 30-second target — assessed by the facilitator and repeated until proficient