ATP 4-02.11 Reference

MASSIVE HEMORRHAGE CONTROL

Source: ATP 4-02.11, Chapter 4 — Massive Bleeding Control, 23 March 2026

Key Points

  • Femoral/brachial artery injury = death in as few as 3 minutes
  • CUF tourniquet must be applied in less than 1 minute, HIGH and TIGHT
  • Do NOT place tourniquet over the knee or elbow joint
  • Junctional wounds (neck, axilla, groin) are NOT treated in CUF — wait for TFC
  • In TFC: expose and evaluate the wound; convert tourniquet if appropriate
  • Always use the casualty's first aid kit, not your own
  • Direct pressure should be applied 3 minutes minimum for junctional hemostatic dressings

Common Mistakes

  • Tourniquet NOT high and tight — must be as proximal as possible
  • Placing TQ over joint, holster, or bulky cargo pocket
  • Forgetting to mark "T" and time on casualty's forehead
  • Not reassessing TQ effectiveness in TFC
  • Using own first aid kit instead of casualty's
  • Attempting hemostatic junctional treatment during CUF

Life-Threatening Bleeding — Signs

  • Pulsing or steady bleeding from wound
  • Clothing soaked with blood
  • Blood pooling on ground
  • Traumatic amputation
  • Bandages steadily soaking through
  • Prior bleeding + casualty now in shock (unconscious, confused, pale)
#1 Priority in TCCC

The number one medical priority in TCCC is early control of severe bleeding. Extremity hemorrhage is the most frequent cause of preventable battlefield deaths. Injury to a major blood vessel can quickly lead to shock and death. (ATP 4-02.11, para 4-1 to 4-2)

The Blood Sweep

The initial casualty evaluation in TFC should be a rapid head-to-toe check for any unrecognized life-threatening bleeding. This systematic blood sweep includes visual and hands-on (palpation) inspection of:

  1. 1

    Neck — Check for penetrating wounds or arterial bleeding

  2. 2

    Axillary (armpit) — Junctional area not accessible in CUF; address now

  3. 3

    Inguinal (groin) — Femoral artery is highly vulnerable; check both sides

  4. 4

    Legs — Run hands down both legs checking for hidden bleeding

  5. 5

    Arms — Check both arms including elbow and axilla

  6. 6

    Back — Log-roll if possible; check for exit wounds and posterior injuries

Tourniquet Application — Care Under Fire

During CUF, the tourniquet is the only medical intervention available to stop life-threatening extremity bleeding. (ATP 4-02.11, para 4-7)

CAT Tourniquet — CUF Application (Hasty)

  1. 1

    Place tourniquet over clothing as HIGH and TIGHT as possible on the injured extremity. Must be applied in less than one minute.

  2. 2

    Do NOT place over the knee or elbow joint, over a holster, or over a cargo pocket with bulky items.

  3. 3

    Route band around limb and pass red tip through inside slit in buckle. Pull band as tight as possible.

  4. 4

    Twist windlass until bleeding stops. Lock windlass in windlass clip. Route self-adhering band. Secure with windlass strap.

  5. 5

    Mark "T" and time of application on casualty's forehead or TCCC card. Secure CAT with tape.

Tourniquet Reassessment — Tactical Field Care

Every tourniquet applied in CUF must be re-evaluated in TFC. (ATP 4-02.11, para 4-11)

  • Expose the wound — confirm whether tourniquet is still required
  • Check for effectiveness — if three fingertips slide under the band, it is not tight enough: retighten
  • If tourniquet is on for more than 2 hours, note the time and do not remove without medical personnel oversight
  • Reassess at frequent time intervals and any time the casualty is moved or status changes
  • Consider conversion to pressure dressing if the wound allows, but only under TFC conditions when bleeding is fully controlled

Junctional Hemorrhage — TFC Treatment

Junctional wounds (neck, axillary, and inguinal areas) cannot be treated with a tourniquet. They require hemostatic dressings in TFC. (ATP 4-02.11, para 4-2)

Hemostatic Dressing Application

  1. 1

    Pack the wound cavity tightly with the hemostatic dressing (Combat Gauze or similar CoTCCC-approved product).

  2. 2

    Apply direct pressure with 3 minutes minimum to the packed wound. Do not lift the dressing to check — this disrupts the clot.

  3. 3

    Apply a pressure bandage over the hemostatic dressing to maintain pressure. Note time of application on TCCC card.

  4. 4

    If bleeding is not controlled, add more hemostatic gauze on top and apply additional direct pressure. Do not remove saturated dressings — add more.

Direct Pressure

Direct pressure can and should be used as a temporary measure until a tourniquet or dressing is in place. It is difficult to use direct pressure alone to control significant bleeding or while moving the casualty. Direct pressure can be used if treatment no longer maintains control of the bleeding while a new treatment is started. (ATP 4-02.11, para 4-10)

ATP 4-02.11 Source

Chapter 4: Massive Bleeding Control — Army Techniques Publication 4-02.11, Casualty Response, Tactical Combat Casualty Care, and First Aid. Headquarters, Department of the Army, 23 March 2026.

See It in Practice — ESB Tasks

These ESB Medical Lane tasks apply this doctrine directly:

M5: Control Bleeding M2: Care Under Fire
TCCC Phases Overview Airway Management