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UNCLASSIFIED
UNCLASSIFIED
MASSIVE BLEEDING
MANAGEMENT
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MANAGEMENT
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UNCLASSIFIED
UNCLASSIFIED
The im)or!a"#e o hemorrhage #o"!rol i" )re*e"!a2le
#om2a! $ea!hs
A"a!om- a"$ )h-siolog-3 2loo$4 *essels a"$ 2loo$#ir#&la!io"
Bloo$ loss es!ima!io" #lasses o hemorrhage
HEMORRHAGE CONTROL METHODS
DIRECT PRESSURE ELEVATION PRESSURE POINTS
TOURNI5UETS COMBAT READ' CLAMP +CRoC. PRESSURE DRESSING PAC/ING DRESSING HAEMOSTATS TRANE6AMIC ACID
ENABLING LEARNING OBJECTIVES
3
NE6T CLASSES
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UNCLASSIFIED
UNCLASSIFIED
Pre Hos)i!al Tra&ma Lie S&))or! +PHTLS.Military 7thed. 2011 ISBN 978-0-323-06503-0 Cha)!er 74 ))8 99:;99< Cha)!er 9=4 )8 :>7
Cha)!er >;7?: Cha)!er >74 ))8 79@;79
Ta#!i#al Com2a! Cas&al!- Care g&i$eli"es
S)e#ial O)era!io"s For#es Me$i#al Ha"$2ooUS Special Operatio! "o##ad 2ded. 2010 ISBN 978-0-16-08$7$$-8
REFERENCES
$
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UNCLASSIFIED
UNCLASSIFIED
COMBAT DEATHS
/IA3 9 )e"e!ra!i"g hea$ !ra&ma
/IA3 >
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UNCLASSIFIED
UNCLASSIFIED
PREVENTABLE DEATHS STILL OCCUR
ON THE BATTLEFIELD BECAUSE OF
UNCONTROLLED HEMORRHAGE
6
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UNCLASSIFIED
UNCLASSIFIED
SEVERE BLEEDING IS THE SINGLE
GREATEST PREVENTABLE COMBAT DEATH
7
HEMORRHAGE = 9
Com)ressi2le E,!remi!ies >:8
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UNCLASSIFIED
UNCLASSIFIED
Blee$i"g is !he loss o 2loo$4 hemorrhage orhaemorrhage is THE MEDICAL TERM FOR BLEEDING
Al!ho&gh !e#h"i#all- hemorrhage mea"s es#a)e o2loo$ !o e,!ra;*as#&lar s)a#e4 i" #ommo" &sage i!
mea"s )ar!i#&larl- SEVERE BLEEDING
HEMORRHAGE DEFINITION
8
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UNCLASSIFIED
UNCLASSIFIED
BLOOD LOSS ESTIMATION
SEVERE (he" -o& #a" a#!&all- see 2loo$lo(i"g o&! o !he (o&"$
INDICATORS *i!al sig"s
hear! ra!e
res)ira!or- ra!e
2loo$ )ress&re
#a)illar- reill !ime +CRT. i"$i#a!or o )er&sio"
0RONG ESTIMATION o" #lo!hi"g gro&"$
"o";)oro&s a))ears lie a lo!
)oro&s soae$ see)i"g
i"!er"al hi$$e"
9
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UNCLASSIFIED
UNCLASSIFIED
CLASS I3 9
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UNCLASSIFIED
UNCLASSIFIED
CLASS III3 ?;:? o 2loo$ *ol&me
hear! ra!e4 2loo$ )ress&re4 )eri)heral
)er&sio" a"$ me"!al s!a!&s (orse" l&i$ res&s#i!a!io" (i!h BLOOD TRANSFUSION
is &s&all- "e#essar-
CLASS IV3 :? o 2loo$ *ol&me
all *i!al sig"s (orse" AGGRESSIVE RESUSCITATION IS RE5UIRED
11
CLASSES OF HEMORRHAGE +ATLS.
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UNCLASSIFIED
UNCLASSIFIED
TO COMPENSATEBLOOD LOSS4 THE BOD' REACTS3
HEART FRE5UENC'
VASOCONSTRICTION o )eri)heral 2loo$ *essels
FLUID SHIFT3 l&i$ is lo(i"g rom !he e,!ra;*as#&lars)a#e i"!o !he i"!ra;*as#&lar s)a#e
FLUID RETENTION +e8g8 i$"e-s4 $iges!i*e s-s!em.
12
HEMORRHAGE COMPENSATIONEARL' MECHANISMS
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UNCLASSIFIED
UNCLASSIFIED
MAJOR MECHANISM TO STOP PREVENT BLOOD LOSS
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COAGULATION +CLOTTING.ESSENTIALS
ACTIVATED PLATELETS
#olle#! o" !he 2lee$i"g si!e
a irs! so! a"$ ell-;lieUNSTABLERED CLOT
FIBRIN2i"$s !he )la!ele!s !oge!her !ra))i"g !he re$
#ells i"si$e +some ser&m #a" s!ill go !ro&gh !he #lo!. a irm a"$ SOLID 0HITE CLOT a#!s as a )l&g
H-)o!hermia ae#!s !he #lo!!i"g )ro#ess1
Ha"$le (i!h #are !o )reser*e !he irs! re$ #lo!1
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED
COAGULATION
1$
B' FAR MORE COMPLE6
BUT
'OU DONT NEED TO LEARN THIS
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED
T0O S'STEMS IN COMPETITION
15
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED
COAGULATION SIMPLIFIED
16
TISSUE FACTOR+release$ 2- $amage$ !iss&es*essels.lea$s !o
THE TRANSFORMATION FROM FIBRINOGEN TO FIBRIN
THIS S'STEM STARTS FIRST AND AIMS TO THE
DEVELOPMENT OF THE 0HITE CLOT
IT 0INS AGAINST HIS COMPETITOR
+THE PLASMINOGEN ; PLASMIN S'STEM.
UNLESS THE RED CLOT IS NOT PRESERVED
+e8g8 DIRECT PRESSURE RELEASED TOO SOON4
AGGRESSIVE FLUID RESUSCITATION4
IMPROPER HANDLING4 e!#8.
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED
TRANE6AMIC ACID
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IMPROVES THE CLOT
B' SLO0ING DO0N THE CLOT BREA/DO0N
Dea!hs $&e !o all #a&ses $e#rease$ 2-
Dea!hs $&e !o 2lee$i"g $e#rease$ 2- 9
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UNCLASSIFIED
UNCLASSIFIED
E6TERNAL
e.%. peetrati%& 'i(e) *S+) !hrapel) etc.
,e!!el! #ay e cateri!ed y hot (ra%#et! or pro/ectile!
INTERNAL
e.%. lt tra#a& la!t) a!!alt ith a cl) (all) M) etc.
18
TRAUMATIC BLEEDING
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED
I"!er*e"!io";Base$ Classii#a!io"
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THE BEST 'OU CAN DO E,!er"al hemorrhage
Lim2s To&r"i%&e!s +T5.
J&"#!io"al CRoC4 JETT
No" #om)ressi2le Pa#i"g +Haemos!a!i# ga&es.
S&ll4 a2$ome"4 #hes!4 e!#8
I"!er"al hemorrhage Clo! )reser*a!io"
I ra$ial )&lse )al)a2le re$e IV l&i$s
I a*aila2le hemorrhage #lass II Bloo$ T6A
A$$i!io"al #are Ha"$le (i!h #are
O"goi"g resear#h +i"!ra)eri!o"eal oam.
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED 20
E,!er"al hemorrhage is a mi, o
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED
ARTERIAL4 VENOUS OR CAPILLAR' BLEEDINGare $iere"! 2e#a&se o3
PRESSURE
VESSELS ANATOMICAL STRUCTURE
BLOOD COLOUR + OF O6'GENATION.
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!-)es o HEMORRHAGES
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED
ARTERIAL BLEEDING IS LIFE-THREATENING
AND DIFFICULT TO CONTROL
Ar!eries are 2loo$ *essels !ha! #arr- a HIGH PRESSURE
2loo$ a(a- rom !he hear!
Ar!eries ha*e a THIC/ER MUSCULAR 0ALL!o s!a"$
!he )ress&re8 Be#a&se o !heir !e"sio" a"$ elas!i#i!-
!he- #o"!ra#! a"$ re!ra#! (he" #&! s&$$e"l-
Ar!erial 2lee$i"g is BRIGHT RED
The BLOOD QSPURTSQ rom !he (o&"$
22
ARTERIAL 2lee$i"g
UNCLASSIFIED
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UNCLASSIFIED 23
ARTERIAL 2lee$i"g
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED
VENOUS BLEEDING IS NOT LIFE-THREATENING
UNLESS SEVERE OR NOT CONTROLLED
Vei"s are 2loo$ *essels !ha! #arr- a LO0 PRESSURE
2loo$ !o !he hear!
Vei"s ha*e THIN 0ALLS a"$ also 2e#a&se o !he lo(
i"!er"al )ress&re !he- !e"$ !o #olla)se (he" #&!
Ve"o&s 2lee$i"g is DAR/ RED OR MAROON
The BLOOD FLO0S IN A STEAD' STREAM
2$
VENOUS 2lee$i"g
UNCLASSIFIED
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UNCLASSIFIED
UNCLASSIFIED
Ca)illaries are *er- small 2loo$ *essels !ha! #arr- aLO0 PRESSURE 2loo$ !oa(a- rom all !iss&es o!he 2o$-
Ca)illaries ha*e THINNER 0ALLS +o"e la-er.
Ca)illar- 2lee$i"g is a MI6 OF DAR/ AND BRIGHTRED BLOOD
BLOOD OOES 2e#a&se o !he slo( lo( +e8g8
a2rasio"s s#ra)s.
25
CAPILLAR' 2lee$i"g
UNCLASSIFIED
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U C SS
UNCLASSIFIED
E,!er"al Hemorrhage
SIGNS S'MPTOMS
BLOOD E6ITING AN OPEN 0OUND= HEMORRHAGE
SHOC/= HYPOVOLEMIC SHOCK
)ale #lamm- si" $ii"ess (ea"ess
le*el o #o"s#io&s"ess
hear! ra!e tachycardia
2loo$ )ress&re +(eaa2se"! ra$ial. = hypotension
res)ira!or- re%&e"#- = tachypnea
#a)illar- reill !ime +CRT.
&ri"e o&!)&!
26
UNCLASSIFIED
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UNCLASSIFIED
SAFE APPROACH ELEVATE THE E6TREMIT' +LIMBS.
DIRECT MANUAL PRESSURE
PRESSURE POINTS
TOURNI5UET
COMBAT READ' CLAMP +CRoC.
PRESSURE DRESSING
PAC/ING DRESSING
HEMOSTATS
T6A
27
E,!er"al Hemorrhage CONTROL
NE6T CLASSES
UNCLASSIFIED
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UNCLASSIFIED
Be determined in achieving yourgoals
but understand the situation frst !!!but understand the situation frst !!!
SAFE APPROACH
28
UNCLASSIFIED
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UNCLASSIFIED
ELEVATION
I!s ee#! is o!e" UNDERESTIMATED
Raise !he (o&"$ +lim2. ABOVE HEART LEVEL
29
UNCLASSIFIED
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UNCLASSIFIED 30
DIRECT PRESSURE
UNCLASSIFIED
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UNCLASSIFIED
THE FIRST AND MOST IMPORTANT RESPONSE
IN AN' SETTING4 FOR ALL HEMORRHAGES
Press&re a))lie$ ON THE 0OUND AROUND IT #a"#o"!rol mos! o e,!er"al 2lee$i"gs 2- #om)ressi"g !hear!er- agai"s! !he &"$erl-i"g s!r!&res +m&s#le 2o"e.
Mai"!ai" )ress&re or AT LEAST < MINUTES 2eore#he#i"g !he ee#!i*e"ess o #lo!!i"g
USE AN'THING !ha! (ill assis! -o& i" a))l-i"g $ire#!
)ress&re +ga&e4 #lo!h4 $am) #lo!h4 (ha!e*er !he (o&"$ is "o!
s!erile4 a s!erile 2a"$age $oes "o! mae i! s!erile.
31
DIRECT PRESSURE
UNCLASSIFIED
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UNCLASSIFIED
DIRECT PRESSURE
IF 'OU SEE IT BLEED4'OU CAN STOP IT 0ITH DIRECT PRESSURE
DO NOT LET THEM BLEED TO DEATH
(hile assessi"g !he si!&a!io"4
$e#i$i"g o" a #o&rse o a#!io"4
looi"g or a"- !o&r"i%&e!
or haemos!a!i# age"!
32
UNCLASSIFIED
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UNCLASSIFIED 33
PRESSURE POINTS
APPL' PRESSURE-o&r !eam;ma!es or -o&r FIST OR /NEEo*er !he #as&al!-s ARMPIT GROINIOT OCCLUDE THE ARTER'+2ra#hial or emoral.
BU' TIME 2- slo(i"g $o(" !he hemorrhage rom
!he e,!remi!-
*roi pre!!re !hold e re%arded a! the (ir!t procedre to cotrol
leedi% (ro# a hi%h le% a#ptatio) hil!t a tori4et i! atte#pted adorother treat#et! e#o!tatic %ae to pac' the od (ield dre!!i%!: are
!ed to !top leedi%.
U; *ood practice %ide Sep 2010
UNCLASSIFIED
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UNCLASSIFIED 3$
PRESSURE POINTS
UNCLASSIFIED
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UNCLASSIFIED
DIFFUSE PRESSURE is !he e- +e8g8 EMThos)i!al T5. more ee#!i*e $&e !o !he s&ra#e area #o*ere$
allo(s or grea!er )ress&re !o 2e a))lie$
a2le !o 2e mai"!ai"e$ o*er lo"g )erio$s
less $amage !o !iss&es
FINGER TIP PRESSURE $oes "o! e"s&re &ll #o"!a#!
(i!h (o&"$ +"o ar!er- h&"!i"g (i!h i"ger !i)s.
GAUES haemos!a!i# ga&es m&s! 2e i" &ll #o"!a#!
(i!h !he (o&"$ 2lee$i"g si!e !o 2e ee#!i*e
35
PALM *s FINGER TIP )ress&re
UNCLASSIFIED
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UNCLASSIFIED
Oh4 "ooo more !o&r"i%&e!s1
BECAUSE TOURNI5UETS SAVE LIVES
I2" Si"a Hos)i!a4 Bag$a$4 >??7
9 li*es sa*e$ i" 7 mo"!hs )erio$ 2- !he &seo )re;hos)i!al !o&r"i%&e!s4 a&!hor es!ima!es
>??? LIVES SAVED IN OIF
;ra%h) et al) al! o( Sr%ery) 2009
36
UNCLASSIFIED
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UNCLASSIFIED
Oh4 "ooo more !o&r"i%&e!s1
PREVENTABLE COMBAT DEATHS FROMNOT USING TOURNI5UETS STILL OCCUR
Mo&gho" Mili!ar- Me$i#i"e4 9=?3 Vie!"am
9 o >47??
=8: o !o!al
/ell- Jo&r"al o Tra&ma4 >??@3 OIF K OEF
=> o @>
=8@ o !o!alEas!ri$ge Jo&r"al o Tra&ma4 >?9>3 OIF K OEF
99 o :487 o !o!al
37
UNCLASSIFIED
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UNCLASSIFIED
To&r"i%&e!s PRINCIPLES
A CONSTRICTING BAND si"gle &se "o";elas!i# a! leas!
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UNCLASSIFIED
No! all !-)es a*aila2le ha*e !he same EFFECTIVENESS
PATIENT MUST GET PAIN MEDICATION To&r"i%&e!s
are )ai"&l (he" a))lie$ 2&! !he (orse )ai" #omes
(he" is#hemia se!s i" a))ro, >? mi" a!er a))li#a!io"
The- ha*e LIMITATIONS TO LOCATION
39
To&r"i%&e!s CONSIDERATIONS
UNCLASSIFIED
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UNCLASSIFIED
M&s! STOP ARTERIAL BLOOD FLO0i" !he e,!remi!-
More ee#!i*e i" sa*i"g li*es (he" a))lie$ BEFORE
THE CASUALT' HAS GONE INTO SHOC/rom 2loo$
loss
IN THE CARE UNDER FIRE PHASEm&s! 2e a))lie$
irs!4 OVER THE CASUALT'S UNIFORM4 si"#e !here is
"o !ime or e,)osi"g !he (o&"$ a"$ or o!her me!ho$s
+!he- #o&l$ "o! 2e a$e%&a!e !o #o"!rol !he 2lee$i"g.
$0
Cri!eria or !o&r"i%&e!
EFFECTIVENESS
UNCLASSIFIED
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UNCLASSIFIED
Pi# a goo$ o"e1
Carr- i! (i!h -o& all !he !imea"$ more !ha" o"e4
i i! is )ermi!!e$
Lear" ho( !o a))l- i! )ro)erl- as %&i# a"$ as)ro,imal as )ossi2le
Trai"4 2&$$- ai$4 sel ai$4 i" !he $ar"ess
re%&e"!l-1 Use !he !o&r"i%&e! rom !he #as&al!-
E*e"!&all- #o"*er! !o )ress&re 2a"$age
$1
To&r"i%&e!s TRAINING
UNCLASSIFIED
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UNCLASSIFIED
DAMAGE TO THE LIMB is rare i !he !o&r"i%&e! is le!o" less !ha" !(o ho&rs8 A"-(a- i" !he a#e o massi*e
e,!remi!- hemorrhage i! is 2e!!er !o a##e)! a small ris
o $amage !o !he lim2 !ha" !o ha*e a #as&al!- 2lee$ !o
$ea!h +a))ro,ima!el- !ra"sie"! "er*e )aral-sis a"$"o am)&!a!io" $&e !o !o&r"i%&e! &se (ere re)or!e$.
)la#e i! >; INCHES ABOVE THE BLEEDING
A BELT ALONE IS EFFECTIVE
NEVER LOOSEN IT
$2
To&r"i%&e!s M'TH
UNCLASSIFIED
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UNCLASSIFIED
NOT USING ONE 0HEN 'OU SHOULD
NOT TIGHTENING IT ENOUGH TO STOP THE
ARTERIAL FLO0
NOT APPL'ING A SECOND ONE SIDE;B';SIDE IF
THE FIRST IS NOT COMPLETEL' EFFECTIVE +BIG
THIGHS OFTEN RE5UIRE T0O T5.
PUTTING IT ON TOO LO0 ON THE E6TREMIT'
PUTTING IT TOO CLOSE TO A JOINT
USING ONE 0HEN 'OU SHOULD NOT
NOT TA/ING IT OFF 0HEN 'OU COULD
NOT USING THE CASUALT'S T5 FIRST $3
To&r"i%&e!s MISTA/ES
UNCLASSIFIED
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UNCLASSIFIED
T0O TOURNI5UETS
UNCLASSIFIED
TIME OF APPLICATION
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UNCLASSIFIED
Some T5 ha*e a TAG(here !o (ri!e $o(" !he !ime
0ri!e a T +or To&r"i%&e!. o" !he #as&al!-s FOREHEAD(i!h a" i"$eli2le i" marer a"$ !he !ime o a))li#a!io"
10:45
TIME OF APPLICATION
T
$5
UNCLASSIFIED
CONVERTING !h ! i !
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UNCLASSIFIED
IN THE TACTICAL FIELD CARE PHASE4 o"#e -o& ha*e !ime !o
)ro)erl- e*al&a!e a"$ !rea! !he #as&al!- E6POSE a"$ re;e*al&a!e$ !he (o&"$
APPL' a !ra&ma 2a"$age or a )ress&re $ressi"g
a!er a))l-i"g a )ress&re 2a"$age4 LOOSEN THE T5 BUT
LEFT IN PLACE CHEC/ THE BANDAGE FOR BLEEDING a"$ i a"- mae !he
!o&r"i%&e! !igh! agai"
I" #ase o $ela-e$ e*a#&a!io"4 !o #o"*er! !he T5 (ill mae i!
more liel- !ha! !he lim2 #a" 2e sa*e$
Ne*er loose" a T5 i" #ase o am)&!a!io"s or i !he #as&al!- (ill
arri*e a! a hos)i!al i" > ho&rs or less a!er a))li#a!io"
$6
CONVERTING !he !o&r"i%&e!
UNCLASSIFIED
C 2 ! A li !i T i !
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UNCLASSIFIED$7
Com2a! A))li#a!io" To&r"i%&e!
+CAT.
UNCLASSIFIED
C 2 ! A li !i T i !
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UNCLASSIFIED$8
< THE MOST COMMONL' USED AND /NO0N
< Re$ !i) (here !o s!ar! &")a#i"g i!
< 0i"$lass s!ra) ma- 2e (hi!e +!ime o a))li#a!io" #a"
2e (ri!!e" o" i!.
< 0i"$lass ro$ ma$e o har$ )las!i# #o&l$ 2rea
< NOT COMPLETEL' RELIABLE 0HEN 0ET OR DIRT'
< Vel#ro #o&l$ mae !he a))li#a!io" $ii#&l!
Com2a! A))li#a!io" To&r"i%&e!
+CAT.
UNCLASSIFIED
S i l O !i F
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UNCLASSIFIED
S)e#ial O)era!io"s For#es
Ta#!i#al To&r"i%&e! +SOFTT.
$9
UNCLASSIFIED
S)e#ial O)era!io"s For#es
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UNCLASSIFIED50
< IT IS EFFECTIVE ON LARGER THIGHS
< IT HAS A SECONDAR' SECURIT' +s#re(.
< Same 2asi# #om)o"e"!s
< I! has a !ag (here !o (ri!e !ime o a))li#a!io"
< LESS SURFACE PRESSURE MORE TISSUE DAMAGE
0i"$lass s!ra) is !hi""er !ha" !he CAT o"e< HARDER TO SECURE THE ROD THROUGH THE V RING
< Me!al ro$ a"$ o!her me!al )ar!s #o&l$ #orro$e
< S#re( #a" loose"
S)e#ial O)era!io"s For#es
Ta#!i#al To&r"i%&e! +SOFTT.
UNCLASSIFIED
S)e#ial O)era!io"s For#es
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UNCLASSIFIED51
< Same 2asi# #om)o"e"!s 2&! THE BUC/LE
< MORE SURFACE PRESSURE LESS TISSUE DAMAGE
The (i"$lass s!ra) is (i$er
< Me!al ro$ a"$ o!her )ar!s ma$e o al&mi"&m
< HARDER TO SECURE THE ROD THROUGH THE V RING
S)e#ial O)era!io"s For#es
Ta#!i#al To&r"i%&e! +SOFTT0 .
UNCLASSIFIED
Emerge"#- a"$ Mili!ar-
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UNCLASSIFIED52
Emerge"#- a"$ Mili!ar-
To&r"i%&e! +EMT.
UNCLASSIFIED
Emerge"#- a"$ Mili!ar-
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UNCLASSIFIED
< HAS BEEN FOUND HAVING THE BEST PERFORM ANCEa"$ i! is s!ro"gl- s&gges!e$ i" emerge"#- $e)ar!me"!s
< MORE SURFACE PRESSURE LESS TISSUE DAMAGE
< THE INFLATABLE RUBBER CUFF MA' DETERIORATE= )rolo"ge$ !ime i" !he iel$= e,)ose$ !o high lo( !em)era!&res
= e,)ose$ !o shra)"el s!ries
< MORE E6PENSIVE
< LARGER PAC/AGE SIE
53
Emerge"#- a"$ Mili!ar-
To&r"i%&e! +EMT.
UNCLASSIFIED
NATO To&r"i%&e! OOM
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UNCLASSIFIED
NATO To&r"i%&e! OOM
5$
UNCLASSIFIED
NATO To&r"i%&e! OOM
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UNCLASSIFIED55
< LESS COMPONENTS
< EFFECTIVE UNDER ALL 0EATHER CONDITIONS
< MORE DURABLE
< HARDER TO USE IN SELF;AID +ARM.
< LESS SURFACE PRESSUREMORE TISSUE DAMAGE s!ra) is
!hi""er a"$ #o&l$ )i"#h !he si" or 2e#ame s!ri"g;lie (hile
!(is!i"g
< NOT 'ET APPROVED
< NO TAG 0HERE TO 0RITE TIME OF APPLICATION
NATO To&r"i%&e! OOM
UNCLASSIFIED
Com2a! A))li#a!io" To&r"i%&e!
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UNCLASSIFIED
Com2a! A))li#a!io" To&r"i%&e!
+CAT.
56
UNCLASSIFIED
S)e#ial O)era!io"s For#es
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UNCLASSIFIED
S)e#ial O)era!io"s For#es
Ta#!i#al To&r"i%&e! +SOFTT.
57
UNCLASSIFIED
0IDER IS BETTER +SOFTT 0.
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UNCLASSIFIED
0IDER IS BETTER +SOFTT0.
58
UNCLASSIFIED
IMPROVISED To&r"i%&e!
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UNCLASSIFIED
IMPROVISED To&r"i%&e!
A )re*e"!a2le $ea!h i" >??
This #as&al!- (as (o&"$e$ 2- a" RPG e,)losio" a"$
s&s!ai"e$ a !ra&ma!i# am)&!a!io" o !he righ! arm a"$ a
righ! leg (o&"$8 He 2le$ !o $ea!h rom his leg (o&"$
$es)i!e !he )la#eme"! o !hree iel$;e,)e$ie"! !o&r"i%&e!s
!he s!ri"gs #&! si" a"$ m&s#les (i!ho&! o##l&$i"g !he ar!erial lo(59
UNCLASSIFIED
IMPROVISED To&r"i%&e!
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UNCLASSIFIED
IMPROVISED To&r"i%&e!
60
This #as&al!- (as (o&"$e$ 2- a" IED8 The )rom)!a))li#a!io" o iel$;e,)e$ie"! !o&r"i%&e!s +T;shir!s a"$
2ra"#hes. sa*e$ his lie8 The irs! res)o"$er "e( (ha! !o$o +(as he )ro)erl- !rai"e$ i" ho( !o $o i!.
T5s (ere )la#e$ )ro,imall-4 "o! !igh!e"e$ or se#&re$ e"o&gh
The s!&m)s (ere "o! $resse$ a! all
UNCLASSIFIED
APPL'ING a" im)ro*ise$ !o&r"i%&e! 9
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UNCLASSIFIED
APPL'ING a" im)ro*ise$ !o&r"i%&e! 9
GATHER MATERIALS3
rigi$ o2e#! +0INDLASS. sh as a s!ro"g s!i#
!o&r"i%&e! 2a"$ +CRAVAT. AT LEAST > 0IDE
SECURING MATERIAL +CRAVAT.
61
UNCLASSIFIED
APPL'ING a" im)ro*ise$ !o&r"i%&e! >
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UNCLASSIFIED
98 A))l- 2a"$ ma!erial aro&"$ !he groi" arm)i!
a2o*e (o&"$ am)&!a!io"
>8 Tie 2a"$ (i!h a hal;"o!
8 Pla#e (i"$lass ro$ o" !o) o "o!
:8 Tie a &ll "o! +s%&are "o!. o*er (i"$lass
62
APPL'ING a" im)ro*ise$ !o&r"i%&e! >
UNCLASSIFIED
APPL'ING a" im)ro*ise$ !o&r"i%&e!
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UNCLASSIFIED
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UNCLASSIFIED
J&"#!io"al i"&ries
Are 2e#omi"g more re%&e"!
Are &s&all- more se*ere
Their rele*a"#e amo"g !he #a&ses o 2lee$i"g
is gro(i"g si"#e !o&r"i%&e!s 2e#ame ee#!i*ei" s!o))i"g !he 2lee$i"g rom !he e,!remi!ies
Resear#hes $e*elo)me"! i"#rease$
De*i#es ee#!i*e"ess has 2ee" !es!e$
TCCC g&i$eli"es #&rre"!l- re#omme"$ CRoC
6$
UNCLASSIFIED
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UNCLASSIFIED 65
UNCLASSIFIED
JUNCTIONAL HEMORRHAGE
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UNCLASSIFIED
JUNCTIONAL HEMORRHAGE
Com2a! Rea$- Clam) +CRoC.
66
UNCLASSIFIED
CRoC i"s!r!ors a"$ s!&$e"!s
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UNCLASSIFIED
CRoC i"s!r!ors a"$ s!&$e"!s
COMMENT
< It or'!& e((ecti,e i !toppi% /ctioal he#orrha%e
< It i! the oly oe a,ailale "o>""" appro,ed
< ea,y (or the #edic?! a%
< @,e a(ter traii%) it ta'e! ti#e to a!!e#le it
< Ai((iclt to a!!e#le he et dirty
< @a!ily di!lod%ed hile hadli% the ca!alty
UNCLASSIFIED
JUNCTIONAL HEMORRHAGE
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UNCLASSIFIED 68
JUNCTIONAL HEMORRHAGEJ&"#!io"al Emerge"#- Trea!me"! Tool +JETT.
UNCLASSIFIED
JUNCTIONAL HEMORRHAGE
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UNCLASSIFIED
JUNCTIONAL HEMORRHAGEJ&"#!io"al Emerge"#- Trea!me"! Tool +JETT.
69
UNCLASSIFIED
JUNCTIONAL HEMORRHAGE
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UNCLASSIFIED 70
JUNCTIONAL HEMORRHAGEJ&"#!io"al Emerge"#- Trea!me"! Tool +JETT.
UNCLASSIFIED
JUNCTIONAL HEMORRHAGE
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UNCLASSIFIED
JUNCTIONAL HEMORRHAGEJ&"#!io"al Emerge"#- Ta#!i#al To&r"i%&e!
JETT
71
Bel!;ee#!
pel,ic !li%
i(re4et di!lod%#et
> me#ha"i#al &"#!io"al !o&r"i%&e!s
pre!!re applicale o ri%ht le(t oth !ide!
at the !a#e ti#e
cp! #odeled %roi tria%lar-!hape
UNCLASSIFIED
HEMOSTATIC FORCEPS
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UNCLASSIFIED
NOT 'OUR FIRST CHOICE OF ACTION
ONL' 0HEN THE BLEEDING IS3
LOCAL
VISIBLE-o& #a" easil- lo#a!e +see. !he r&)!&re$ 2loo$ *essel
SUPERFICIAL
72
HEMOSTATIC FORCEPS
UNCLASSIFIED
MASSIVE E6TERNAL BLEEDING MANAGEMENT
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UNCLASSIFIED
SUMMAR'
FOCUS"ee$e$ !o &"$ers!a"$ ho( !o $eal (i!h hemorrhage
BU' SOME TIME !o rea#! 2- ra)i$l- a))l-i"g goo$ $ire#!
)ress&re or o" )ress&re )oi"!s
DEVISE COMMUNICATE A PLAN
NO HESITATIONo"#e a #o&rse o a#!io" is i"i!ia!e$
ACHIEVE CONTROLo si!&a!io" %&i#l-3 T54 CRoC4 )a#i"g
0OR/ TOGETHER!o(ar$ a" im)ro*eme"!
(or UNTIL 'OU ARE SATISFIED-o& a#hie*e$ !he o2e#!i*e
B' MINIMIING BLOOD FLO0!he (o&"$ si!e #a" 2e ma"age$
FURTHERING MANAGEMENT(i!h )ress&re $ressi"g
REMEMBER THE BASICS1
Basi# !rea!me"!s $o"e (ell (ill mae !he 2igges! $iere"#e
73
UNCLASSIFIED
INTERNAL HEMORRHAGE
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UNCLASSIFIED
CHEC/ ENTIRE BOD'4 ALL ORIFICES INCLUDED
CHEC/ CAVITIES+!hora#i#4 a2$omi"al4 )el*i#.
!he- #a" hi$e large *ol&mes o 2loo$
CHEC/ FOR SIGNS OF SHOC/ +#om)e"sa!e$ la!e"!.!he ass&m)!io" !ha! #as&al!ies (ho loo goo$ are "o!
2lee$i"g i"!er"all- is re%&e"!l- *er- (ro"g
Co"!i"&e$ REASSESSMENTo !ra&ma )a!ie"!s is
esse"!ial
7$
INTERNAL HEMORRHAGE
UNCLASSIFIED
INTERNAL HEMORRHAGE
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UNCLASSIFIED
SIGNS OF SHOC/
E6TERNAL BLEEDING THROUGH A NATURAL OPENING 2loo$ i" !he STOOL +a))ears 2la#4 maroo"4 or 2righ! re$.
2loo$ i" !he URETHRAL MEATUS OR IN THE URINE +a))ears re$4
)i"4 or !ea;#olore$.
VAGINAL 2lee$i"g +hea*ier !ha" &s&al or a!er me"o)a&se.
2loo$ i" !he VOMIT +loos 2righ! re$4 or 2ro(" lie #oee;gro&"$s.
PAIN
TENSION
S0OLLEN AREA +a2$ome"4 )el*is4 #hes!.
75
INTERNAL HEMORRHAGE
SIGNS S'MPTOMS
UNCLASSIFIED
INTERNAL HEMORRHAGE
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UNCLASSIFIED
INSPECTION+e8g8 2r&isi"g.
AUSCULTATION +e8g8 2o(el so&"$s re$e$ .
PERCUSSION +e8g8 $&ll"ess.
PALPATION+$e!e#! a"- !e"$er"ess4 resis!a"#e4 rea#!io"4 )ai"
a"$ s(elli"g. VITAL SIGNS;SHOC/ SIGNS
Diag"os!i# )eri!o"eal la*age
Ul!raso&"$FAST +Fo#&se$ A2$omi"al Ul!raso&"$ or Tra&ma.
76
INTERNAL HEMORRHAGE
E6AMINATION
'OUR JOB IS TO SUSPECT IT AND TO SUSTAIN THE CIRCULATION
INTERNAL BLEEDING NEEDS SURGICAL TREATMENT11
UNCLASSIFIED
ABDOMINAL 0OUNDS
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UNCLASSIFIED
A))l- *er- ge"!le )ress&re !o s!o) !he e,!er"al 2lee$i"g
A"- )e"e!ra!i"g a2$omi"al (o&"$ "ee$s URGENTSURGICAL TREATMENT
E*is#era!io"
$o "o! !r- !o )&sh 2o(elsorga"s 2a# i"!o !hea2$ome"4 &"less !he- sli$e 2a# i" 2- li!i"g !he(o&"$ e$ges
#o*er !he i"&r- (i!h a mois!e"e$ #lo!h or 2a"$age
I sig"s o hemorrhagi# sho# a!er !ra&ma (i!ho&!e,!er"al 2lee$i"g !he" s&s)e#! !he )ossi2ili!- o se*erei"!er"al 2lee$i"g
77
ABDOMINAL 0OUNDS
UNCLASSIFIED
A2$omi"al 2l&"! !ra&ma The s)lee"
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UNCLASSIFIED
The s)lee" is a l-m)h "o$e+imm&"e s-s!em.4 i! has
me#ha"i#al &"#!io"s as (ell3 reser*oir o )la!ele!s4re!e"!io" a"$ remo*al o ol$ a2"ormal RBCs
R&)!&re o !he s)lee" is res)o"si2le or :? oi"!er"al a2$omi"al 2lee$i"g a!er 2l&"! !ra&ma
+r&)!&re o !he li*er >?4 r&)!&re o 2o(el
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UNCLASSIFIED
,ailale #id-pril 2012 >he tar%et o( the co#pre!!io i! the AORTIC BIFURCATION
at the ado#ial-pel,ic /ctio to occlde lood (lo i the
i%ial arterie!
It i! a circ#(eretial de,ice applied to the #id-ado#e)ti%hteed ad i(lated
May re#ai o (or p to a hor !a(ely
79
The A2$omi"al Aor!i# To&r"i%&e!
AAT
UNCLASSIFIED
0ha! or(ar$ sol&!io"
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UNCLASSIFIED
FOAM ; o"goi"g resear#h +s!ar!e$ o" >??=.
T(o $iere"! li%&i$ #om)o"e"!s are i"e#!e$ a! !he same !ime i"!o
!he INTAPERITONEAL SPACE4 !he- rea#! (i!h a mil$ e,o!hermal
#hemi#al rea#!io" +ma- 2e 2e"ei#ial. ge"era!i"g a Styro(oa#-li'e
hydrophoic (oa# that epad! %eerate! pre!!re: ad !olidi(ie! i"
less !ha" 7?se# i a co(or#al cotact ith ti!!e! ithot adherece
re#o,ale i oe piece ri%ht a(ter laparoto#y:
Does"! s!o) !he 2lee$i"g 2&! slo(s i! $o(" so !ha! more ho&rs are
a*aila2le 2eore s&rger-
Pro!o!-)e 3 )e"$i"g %&es!io"s
Ho( mh4 ae#!s res)ira!io" )ress&re agai"s! $ia)hragm#o"!rai"$i#a!e$ i" hea$ i"&r- +h-)o#ar2i#.4 re!ai"e$ oam )ar!i#les4
migra!io" i"!o !he )le&ral s)a#e i" #ase o $ia)hragm la#era!io"s
+more !ha" > #m (i$e.4 leai"g o&! rom holes (o&"$s +seal !hem.4
s&i!a2le or re!ro)eri!o"eal hemorrhage
80
0ha! or(ar$ sol&!io"
UNCLASSIFIED
COMING SOON
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UNCLASSIFIED
COMING SOON
SAFE APPROACH
ELEVATE THE E6TREMIT' +LIMBS.
DIRECT MANUAL PRESSURE
PRESSURE POINTS
TOURNI5UET
COMBAT READ' CLAMP +CROC.
PRESSURE DRESSING
PAC/ING DRESSING
HEMOSTATS
T6A
81
UNCLASSIFIED
0OUND HEMORRHAGE CONTROL
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UNCLASSIFIED
0OUND HEMORRHAGE CONTROLPAC/ING +AMPUTATIONS CAVITIES.
82
UNCLASSIFIED
0OUND HEMORRHAGE CONTROL
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UNCLASSIFIED
OU O G CO OPAC/ING +AMPUTATIONS CAVITIES.
83
UNCLASSIFIED
Me$i#s ra!i"g
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UNCLASSIFIED
g
8$
UNCLASSIFIED
SUMMAR' STOP THE BLEEDING
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UNCLASSIFIED
SAFE APPROACH3 se#&re area a"$ -o&rsel
INITIAL ASSESSMENT M8A8R8 Ele*a!e !he e,!remi!- +lim2s.
A))l- $ire#! ma"&al )ress&re
A))l- )ress&re !o )ress&re )oi"!s
To&r"i%&e! +#o"*er! !o )ress&re 2a"$age (he"
i"$i#a!e$.
J&"#!io"al !o&r"i%&e!s CRoC JETT
Hemos!a!i# ga&es Pa#i"g $ressi"g
Press&re $ressi"g
a! !he same !ime4 #alm a"$ reass&re !he *i#!im4!he sigh! o 2loo$ #a" 2e *er- righ!e"i"g
85
UNCLASSIFIED
SUMMAR' PRESERVE THE CLOT
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UNCLASSIFIED
DO NOTha"$le !he #as&al!- (i!ho&! e,!reme )re#a&!io"
DO NOT&"$er es!ima!e !he ee#! o h-)o!hermia
+h-)o!hermia 2a$l- ae#!s !he #lo!!i"g )ro#ess.
DO NOT)&sh I8V8 l&i$s i a ra$ial )&lse is )rese"!
DO NOTorge! !o im)ro*e !he #lo! (i!h T6A
DO NOT$is!&r2 !he (o&"$
+remo*e !he ga&e4 )ee a! !he (o&"$4 #lea" !he (o&"$.
86
UNCLASSIFIED
DONT CAUSE E6TRA INJURIES
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UNCLASSIFIED
DO NOT)ro2e a (o&"$ or )&ll o&! a"- em2e$$e$o2e#! rom a (o&"$W !his (ill &s&all- #a&se more2lee$i"g a"$ harm
DO NOT!r- !o #lea" a large (o&"$W !his #a" #a&sehea*ier 2lee$i"g
DO NOTremo*e !he irs! $ressi"g i i! 2e#omessoae$ (i!h 2loo$ +&"less i i! is a haemos!a!i#ga&e.W a$$ a "e( o"e o" !o)
DO NOT)ee a! a (o&"$ !o see i !he 2lee$i"g iss!o))i"gW !he less a (o&"$ is $is!&r2e$4 !he moreliel- i! is !ha! -o&Xll 2e a2le !o #o"!rol !he 2lee$i"g
DO NOT!r- !o #lea" a (o&"$ a!er -o& ge! !he2lee$i"g &"$er #o"!rolW ge! me$i#al hel)
RE;BLEEDING
87
UNCLASSIFIED
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