External hemorrhage;  Extremity hemorrhage

Compressible hemorrhage is hemorrhage that can be seen on external examination of a trauma patient and possibly controlled by direct pressure or a tourniquet. Compressible hemorrhage includes extremity hemorrhage and non-extremity external hemorrhage.

The merits of tourniquet use on the battlefield to control extremity hemorrhage have been debated widely and for centuries. Perhaps as a result, exsanguination from extremity hemorrhage was the most common cause of preventable death in combat during the Vietnam War (Maughon 1970). Because of their effectiveness at controlling extremity hemorrhage and the speed with which they can be applied, tourniquets are the best option for temporary control of life-threatening extremity hemorrhage in the tactical environment. Tourniquets have, therefore, been heavily emphasized in Tactical Combat Casualty Care (Butler et al. 1996, 2007, 2010). Studies by Kragh and Lakstein have confirmed the lifesaving benefit and low incidence of complications from prehospital tourniquet use in combat casualties (Kragh et al. 2008, 2009; Lakstein et al. 2003). Although tourniquet use has been discouraged by civilian EMS systems in the past because of concern about ischemic damage to the extremity, limb loss from tourniquet ischemia has not been found to be a problem when tourniquets have been used appropriately during recent combat operations (Kragh et al. 2009).

Compressible hemorrhage also includes non-extremity external bleeding, which may occur from large vessels in the groin, axilla, or neck. Bleeding in these areas may be addressed either with hemostatic agents or with external pressure devices. The TCCC Guidelines now recommend Combat Gauze™ as the hemostatic agent of choice based on testing at the US Army Institute for Surgical Research (USAISR), which found it to be safe and effective at controlling hemorrhage in a lethal swine model of femoral artery bleeding (Kheirabadi et al. 2009, 2010).

Compressible bleeding in the groin may be successfully addressed with a junctional pressure device such as the Combat Ready Clamp if the bleeding site is not anatomically feasible for tourniquet use and Combat Gauze does not control the hemorrhage (Dubick and Kragh 2012).