🚧 Under construction — VoTechWorks is being built. A free tech program — complimentary, as our commitment to get America working.
voTechWorksGrade 13 · a vocational technology learning center, by urbanicity
newSchoolWorks.com › VoTechWorks › Agriculture, Environment & Public Service › Firefighting / Public Safety › Emergency Medical Technician – Basic (EMT-B) › Lesson 8
AGR-FIRE51-06 · Lesson 8 · 12 clock hours · practice

Trauma: Hemorrhage Control and Shock Management

Objective. Students will apply direct pressure, wound packing, and commercial tourniquets to control hemorrhage and recognize and manage hypovolemic shock using current Stop the Bleed and TCCC-adapted BLS principles.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed professional in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it as instructions for work on a job site or on live equipment. Always follow your instructor, your supervising professional, and current official references and regulations.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

Hemorrhage Control and Shock Management

Controlling life-threatening bleeding is one of the highest-priority skills an EMT performs. Uncontrolled hemorrhage is a leading cause of preventable death in both civilian trauma and tactical settings. The Stop the Bleed initiative and TCCC-adapted BLS principles guide the modern approach: find the bleed, stop it fast, and recognize when the body is losing the battle.

Direct Pressure

Direct pressure is the first intervention for most external bleeding. Apply firm, continuous pressure directly over the wound using a gloved hand and a clean dressing. Do not remove the dressing to check the wound — if blood soaks through, add more dressing on top and maintain pressure. Elevate the limb if no fracture or spinal concern is present. Hold pressure for a minimum of several minutes before reassessing. Most venous and many arterial bleeds respond to direct pressure alone.

Safety note: Always don gloves and eye protection before contact with any patient. Blood and body fluids are a splash hazard. Standard Precautions apply to every patient, every time.

Wound Packing

Wound packing is indicated for deep, cavity-type wounds where direct pressure alone cannot reach the source — commonly junctional wounds to the groin, axilla, or neck, and deep puncture or blast injuries to the torso. The technique:

1. Expose the wound fully.

2. Feed gauze into the deepest point of the wound cavity — do not simply pile gauze on top.

3. Pack tightly, layer by layer, until the cavity is full.

4. Apply firm, continuous manual pressure over the packed wound for at least three minutes (or per your medical director's protocol).

5. Maintain pressure during packaging and transport if the wound is not otherwise secured.

Hemostatic gauze (e.g., Combat Gauze) is preferred in tactical and some civilian systems; plain gauze works when hemostatic agents are unavailable. Verbalize every step: packing without communicating leaves your partner and receiving team uninformed.

Tourniquet Application

A commercial tourniquet — the CAT (Combat Application Tourniquet) or SOFTT-W (Special Operations Forces Tactical Tourniquet-Wide) — is indicated for:

Placement: Apply 2–3 inches proximal to the wound edge on the extremity. Do not place over a joint. Route the strap, tighten the strap snugly, then twist the windlass rod until bleeding stops and the distal pulse is absent. Lock the windlass, secure the clip, and mark the time of application on the tourniquet tab or the patient's forehead with a marker. Document application time in your patient care report.

Key safety points:

Recognizing and Managing Hypovolemic Shock

Hypovolemic shock occurs when blood loss reduces circulating volume enough to impair tissue perfusion. The body moves through two recognizable stages:

Compensated shock: The body's compensatory mechanisms — vasoconstriction, increased heart rate, increased respiratory rate — maintain near-normal blood pressure. Signs include anxiety/restlessness, pale/cool/diaphoretic skin, mild tachycardia, and normal or slightly low blood pressure. The patient may appear "not that sick" — this is deceptive.

Decompensated shock: Compensatory mechanisms fail. Blood pressure drops noticeably, the patient becomes confused or unconscious, skin is severely pale or mottled, and pulse is weak and rapid. This stage is immediately life-threatening.

BLS Management of Hypovolemic Shock:

1. Control hemorrhage first — all methods above apply.

2. Position: Supine; elevate legs if no contraindication (spinal, pelvic, or respiratory compromise). This is a temporary measure to improve venous return.

3. Oxygen: Apply high-flow oxygen via non-rebreather mask or BVM as indicated by mental status and respiratory effort.

4. Warmth: Prevent hypothermia — cover the patient; cold worsens coagulopathy.

5. Rapid transport: BLS cannot replace lost blood volume. Definitive care (surgery, blood products) is in-hospital. Every minute of delay worsens outcome. Contact medical control early.

6. Reassess frequently: Obtain baseline vitals, repeat every 5 minutes for unstable patients, and document trends.

Communication and Documentation

Verbalize your findings and every intervention to your partner and to the receiving team. Your radio report should include mechanism, mental status, approximate blood loss, hemorrhage control measures applied (tourniquet with time), current vitals, and your transport destination. The receiving team needs this information before you arrive.

Safety Summary

Key terms9

Hypovolemic shockA state of inadequate tissue perfusion caused by loss of circulating blood or fluid volume; hemorrhagic shock is the most common traumatic form.
Compensated shockEarly stage of shock in which the body's compensatory mechanisms (tachycardia, vasoconstriction) maintain near-normal blood pressure despite reduced volume.
Decompensated shockLate stage of shock in which compensatory mechanisms fail, resulting in falling blood pressure, altered mental status, and imminent cardiovascular collapse.
Junctional woundA wound located at the junction of the torso and an extremity (groin, axilla, or neck) where a tourniquet cannot be placed.
Wound packingThe technique of tightly filling a deep wound cavity with gauze to apply internal pressure directly against a bleeding source.
Tourniquet (commercial)A device applied to an extremity proximal to a hemorrhage and tightened — via windlass or ratchet mechanism — until arterial blood flow is occluded, stopping limb bleeding.
Arterial occlusionComplete cessation of arterial blood flow distal to the tourniquet, confirmed by absence of a distal pulse; the endpoint of correct tourniquet application.
Stop the BleedA national public and first-responder awareness campaign that promotes three core hemorrhage-control skills: apply pressure, pack the wound, and apply a tourniquet.
Standard PrecautionsInfection control practices — including gloves and eye protection — applied to every patient encounter, treating all blood and body fluids as potentially infectious.
In class: Tourniquet application speed drill: students apply a commercial tourniquet (CAT or SOFTT-W trainer) to both upper and lower extremities on a training limb trainer, targeting application within one minute and noting time-of-application marking; instructor evaluates tightness and placement. · Wound-packing station: using synthetic wound models and gauze, students pack a simulated junctional wound applying continuous pressure, maintaining pressure for a timed period, and verbalizing the rationale for each step. · Shock recognition and management scenario: manikin patient presents with mechanism of injury and progressing vital signs indicating compensated then decompensated hemorrhagic shock; students identify shock stage, intervene (hemorrhage control, positioning, oxygen, rapid transport decision), and verbalize findings to a receiving team.
Materials: Commercial tourniquet trainers (CAT/SOFTT-W), wound-packing models, gauze rolls (training), synthetic blood/moulage supplies, trauma manikin, PPE (gloves, eye protection), Stop the Bleed reference cards, Brady textbook
Check: Tourniquet application skill sheet: correct placement, tightened to arterial occlusion, time noted, zero critical failures required; wound-packing checklist: all critical steps completed; shock scenario: student must correctly identify shock stage and verbalize all priority interventions — instructor pass/fail sign-off.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Trauma / Hemorrhage Control
1. You arrive at a scene where a construction worker has a deep laceration to the medial thigh with bright red, spurting blood. Direct pressure has not controlled the bleeding after 2 minutes. What is your next priority intervention?
Trauma / Hemorrhage Control
2. After applying a CAT tourniquet to a patient's upper arm, which action is essential before moving the patient?
Trauma / Shock Assessment
3. A patient presents with pale, cool, diaphoretic skin, a heart rate of 118 bpm, a respiratory rate of 22 breaths per minute, and a blood pressure of 102/78 mmHg following a motor vehicle collision. This presentation is MOST consistent with which condition?
Trauma / Hemorrhage Control
4. When packing a deep junctional wound to the groin, where should you place the first handful of gauze?
Trauma / Shock Management
5. A trauma patient becomes confused, has a blood pressure of 74/50 mmHg, a weak and rapid pulse, and mottled skin. Hemorrhage is controlled. What is the MOST appropriate next BLS intervention?
Trauma / Hemorrhage Control
6. Which tourniquet placement is INCORRECT and must be corrected before transport?
Trauma / Hemorrhage Control
7. During a shock management scenario, after controlling hemorrhage your partner asks whether to remove the blood-soaked dressing to reassess the wound. Your BEST response is:
Trauma / Shock Assessment
8. Which combination of findings BEST indicates that a patient is transitioning from compensated to decompensated hemorrhagic shock?
Record this lesson on my transcript. Sign in with your key and enrollment email to record lessons (enroll free if you have no key). This page stays open to read and practise.
← Previous lessonProgram planNext lesson →