2026 TCCC指引--01 May 2026
Massive hemorrhage b.
1. 其他止血輔助用品：
Celox 紗布或
Chito 紗布或
XStat（最適用於深部、狹窄的交界處傷口）
iTClamp（可單獨使用，也可與止血敷料或 XStat 聯合使用）
• 止血敷料應至少直接按壓 3 分鐘（XStat 可選擇按壓）。每種敷料的作用機制不同，因此如果一種敷料無法止血，可以將其移除，並更換相同類型或不同類型的敷料。 （注意：XStat 不得在現場移除，但可以在其上覆蓋額外的 XStat、其他止血輔助用品或創傷敷料。）
6. Circulation a. Bleeding 1.下列狀況應懷疑骨盆骨折. 需使用骨盆固定帶
TCCC guideline 有幾個大標題. 下面僅節錄各大標題中出血相關建議
Basic Management Plan for Care Under Fire/Threat
Basic Management Plan for Tactical Field Care-
Principles of Tactical Evacuation Care (TACEVAC)
Basic Management Plan for Tactical Evacuation Care
下面節錄各大標題關於出血部分
Basic Management Plan for Care Under Fire/Threat
-共有七點建議. 僅節錄第六點(第六點下又有三項建議)
-第六點. 在戰術情況許可時. 停止危及生命的外出血
a. 由傷員自行止血
b. 使用 CoTCCC建議的肢體止血帶. 商用止血帶較能符合人體解剖構造
c. 由制服外. 將受傷部位近心端打上止血帶. 若無法確認出血部位. 盡量靠軀幹方向打止血帶. 越接近越好(越高越高).並將傷員轉移到遮蔽處
6. Stop life-threatening external hemorrhage if tactically feasible:
a. Direct casualty to control hemorrhage by self-aid if able.
b. Use a CoTCCC-recommended limb tourniquet for hemorrhage that is anatomically amenable to tourniquet use.
c. Apply the limb tourniquet over the uniform clearly proximal to the bleeding site(s). If the site of the life-threatening bleeding is not readily apparent, place the tourniquet “high and tight” (as proximal as possible) on the injured limb and move the casualty to cover.
Basic Management Plan for Tactical Field Care
-之下有20點. 節錄第3點. 第6點.
-之下有20點. 節錄第3點. 第6點.
1. Establish a security perimeter in accordance with unit tactical standard operating
procedures and/or battle drills. Maintain tactical situational awareness.
2. Triage casualties as required. See Triage Recommendations in Supplement A – Triage in
TCCC.
3. Massive Hemorrhage 大出血
4. Airway Management
5. Respiration/Breathing
6. Circulation 循環
7. Hypothermia Prevention
8. Traumatic Brain Injury:
9. Penetrating Eye Trauma
10. Monitoring
11. Analgesia
12. Antibiotics
13. Inspect and dress known wounds
14. Check for additional wounds.
15. Burns.
16. Splint fractures and re-check pulses.
17. Cardiopulmonary resuscitation (CPR).
18. Communication
19. Documentation of Care.
20. Prepare for Evacuation
3. 大出血 Massive hemorrhage (包含a.b.c.d.四點)
Massive hemorrhage a.
Massive hemorrhage a.
評估是否有未識別的出血，並控制所有出血點。如果尚未進行，請使用 CoTCCC 建議的肢體止血帶控制解剖結構上適合使用止血帶的危及生命的外部出血，或用於任何創傷性截肢。直接將止血帶綁在出血部位上方 2-3 英吋的皮膚上。如果第一個止血帶未能控制出血，則在第一個止血帶旁邊並排綁上第二個止血帶。
a. Assess for unrecognized hemorrhage and control all sources of bleeding. If not
already done, use a CoTCCC-recommended limb tourniquet to control lifethreatening external hemorrhage that is anatomically amenable to tourniquet use or for any traumatic amputation. Apply directly to the skin 2-3 inches above the bleeing site. If bleeding is not controlled with the first tourniquet, apply a second tourniquet side-by-side with the first.
already done, use a CoTCCC-recommended limb tourniquet to control lifethreatening external hemorrhage that is anatomically amenable to tourniquet use or for any traumatic amputation. Apply directly to the skin 2-3 inches above the bleeing site. If bleeding is not controlled with the first tourniquet, apply a second tourniquet side-by-side with the first.
Massive hemorrhage b.
對於無法使用肢體止血帶或作為止血帶移除輔助手段的可壓迫性（外部）出血，首選的戰術戰鬥傷亡救護（CoTCCC）止血敷料是戰鬥紗布。
For compressible (external) hemorrhage not amenable to limb tourniquet use or as an adjunct to tourniquet removal, use Combat Gauze as the CoTCCC hemostatic dressing of choice.
Celox 紗布或
Chito 紗布或
XStat（最適用於深部、狹窄的交界處傷口）
iTClamp（可單獨使用，也可與止血敷料或 XStat 聯合使用）
• 止血敷料應至少直接按壓 3 分鐘（XStat 可選擇按壓）。每種敷料的作用機制不同，因此如果一種敷料無法止血，可以將其移除，並更換相同類型或不同類型的敷料。 （注意：XStat 不得在現場移除，但可以在其上覆蓋額外的 XStat、其他止血輔助用品或創傷敷料。）
Hemostatic dressings should be applied with at least 3 minutes of direct
pressure (optional for XStat). Each dressing works differently, so if one fails
to control bleeding, it may be removed and a fresh dressing of the same type
or a different type applied. (Note: XStat is not to be removed in the field, but
additional XStat, other hemostatic adjuncts, or trauma dressings may be
applied over it.)
• 如果出血部位適合使用交界處止血帶，請立即使用。一旦適合使用，請勿延遲使用交界處止血帶。如果沒有連接止血帶，或在準備使用連接止血帶時，應使用止血敷料進行直接加壓止血。
If the bleeding site is amenable to use of a junctional tourniquet, immediately
apply a junctional tourniquet. Do not delay in the application of the junctional
tourniquet once it is ready for use. Apply hemostatic dressings with direct
pressure if a junctional tourniquet is not available or while the junctional
tourniquet is being readied for use.
Massive hemorrhage c.
Massive hemorrhage c.
對於頭部和頸部外部出血，如果傷口邊緣容易重新對合，則可使用iTClamp作為控制出血的首選方法。如有必要，在應用iTClamp之前，應使用止血敷料或XStat填塞傷口。
** 但頸部及胸腔不建議使用填塞止血, 這裡的填塞應該不是直接用紗布將傷口塞到止血. 而是在傷口內稍微填充止血敷料. 再用 iTClamp夾住外皮. 與腹股溝大出血的填塞止血不同
1. iTClamp 單獨使用或與其他止血輔助手段合併使用時，均無須額外施加直接壓力。
** 可將 iTClamp 想像成手術縫合線. 我縫合傷口時. 會先用紗布加壓順便吸走血水. 紗布放開瞬間趕緊看清楚傷口狀況. 傷口常常不是直線. 有時候需先用手指將兩側表皮拉靠近. 將兩側皮膚左右上下挪移. 傷口兩側皮膚先推到正常解剖位置才下針. 避免下針後出現傷口兩側不對齊的狀況. 在縫合針刺入皮膚的時候. 不會在傷口加壓. 這句話應該是這個意思.
2. 如果將 iTClamp 用在頸部，應頻繁監測氣道，並評估血腫擴大程度是否會壓迫呼吸道。如果發現血腫擴大，應考慮建立確定性氣道。
** 在ACLS說的 definitive airway 是指將管子插入氣管內. 並將管子末端氣囊打飽. 一般都是指氣管內管. 不過氣管內管本來就有不同種類(例如雙腔氣管內管). 所以 laryngeal mask airway 或者 iGel 這些不算是 definitive airway. 若傷患需要空運. 應以蒸餾水取代空氣打入氣管內管氣囊. 避免空中低壓造成氣囊過度膨脹損傷氣管黏膜.
3. 請勿將 iTClamp 用於在眼部或眼瞼附近（距眼眶 1 公分以內）。
For external hemorrhage of the head and neck where the wound edges can be easily
re-approximated, the iTClamp may be used as a primary option for hemorrhage
control. Wounds should be packed with a hemostatic dressing or XStat, if
appropriate, prior to iTClamp application.
1. The iTClamp does not require additional direct pressure, either when used
alone or in combination with other hemostatic adjuncts.
2. If the iTClamp is applied to the neck, perform frequent airway monitoring
and evaluate for an expanding hematoma that may compromise the airway Consider placing a definitive airway if there is evidence of an expanding
hematoma.
3. DO NOT APPLY on or near the eye or eyelid (within 1cm of the orbit)
Massive hemorrhage d.
進行出血性休克的初步評估（頭部無外傷的情況下出現意識狀態改變和/或橈動脈搏動微弱或消失），並考慮立即啟動休克復甦措施。
Perform initial assessment for hemorrhagic shock (altered mental status in the
absence of brain injury and/or weak or absent radial pulse) and consider immediate
initiation of shock resuscitation efforts.
Basic Management Plan for Tactical Field Care
6. Circulation 第六點之下又有 6 個次標題. 僅節錄 a. bleeding 這段.
a. bleeding
b. Assess for hemorrhagic shock (altered mental status in the absence of brain injury
and/or weak or absent radial pulse).
c. IV/IO Access
d. Tranexamic Acid (TXA)
e. Fluid Resuscitation
f. Refractory Shock
a. Bleeding (bleeding 之下又分成四點)
若懷疑骨盆骨折. 需使用骨盆固定帶6. Circulation a. Bleeding 1.下列狀況應懷疑骨盆骨折. 需使用骨盆固定帶
1. 嚴重鈍力或爆炸傷，並伴隨以下一項或多項指徵： 骨盆疼痛 任何嚴重的下肢截肢或接近截肢 身體檢查結果提示骨盆骨折 意識喪失 休克
A pelvic binder should be applied for cases of suspected pelvic fracture:
1. Severe blunt force or blast injury with one or more of the following
indications:
Pelvic pain
Any major lower limb amputation or near amputation
Physical exam findings suggestive of a pelvic fracture
Unconsciousness
Shock
6. Circulation a. Bleeding 2. 重新評估先前的止血帶使用情況。
暴露傷口，確定是否需要止血帶。如有需要，將先前綁在制服外的肢體止血帶重新定位，方法是在出血點上方 2-3 英吋處直接綁上第二個止血帶，然後鬆開第一個止血帶。確保出血已止住。如果沒有創傷性截肢，應檢查遠端脈搏。如果出血持續或遠端脈搏仍然存在，則考慮進一步收緊止血帶，或與第一個止血帶並排使用第二個止血帶，以同時止血並消除遠端脈搏。如果重新評估確定先前的止血帶不需要，則移除止血帶，並在 TCCC 傷亡卡上記錄移除時間。
2. Reassess prior tourniquet application. Expose the wound and determine if a
tourniquet is needed. If it is needed, reposition any limb tourniquet placed
over the uniform by applying a second one directly to the skin 2-3 inches
above the bleeding site, then loosening the first tourniquet. Ensure that
bleeding is stopped. If there is no traumatic amputation, a distal pulse should
be checked. If bleeding persists or a distal pulse is still present, consider
additional tightening of the tourniquet or the use of a second tourniquet sideby-side with the first to eliminate both bleeding and the distal pulse. If the
reassessment determines that the prior tourniquet was not needed, then
remove the tourniquet and note time of removal on the TCCC Casualty
Card.
6. Circulation a. Bleeding 3. 若符合以下三個條件，肢體止血帶和連接處止血帶應盡快更換為止血敷料或加壓敷料：
傷患未處於休克狀態；可以密切監測傷口出血情況；止血帶並非用於控制截肢肢體的出血。如果可以透過其他方法控制出血，應盡一切努力在2小時內更換止血帶。除非有密切監測和實驗室檢測能力，否則不要移除已使用超過6小時的止血帶。
** 若止血帶已經使用超過6小時. 受傷肢體可能已經發生細胞壞死. 貿然移除止血帶. 有可能讓肢體缺氧的血液回流到心臟. 這些缺氧血可能會將壞死組織產生的物質帶到心臟. 例如鉀離子. 可能誘發心律不整造成猝死. 還有一些毒素可能造成其他器官衰竭(例如橫紋肌溶解造成急性腎衰竭)
3. Limb tourniquets and junctional tourniquets should be converted to
hemostatic or pressure dressings as soon as possible if three criteria are met:
the casualty is not in shock; it is possible to monitor the wound closely for
bleeding; and the tourniquet is not being used to control bleeding from an
amputated extremity. Every effort should be made to convert tourniquets in
less than 2 hours if bleeding can be controlled with other means. Do not
remove a tourniquet that has been in place more than 6 hours unless close
monitoring and lab capability are available.
注意：接受過TCCC ASM/CLS訓練的人員，除非得到TCCC CMC/CPP人員或其他高級醫務人員的指示，否則不應在止血帶使用2小時後嘗試更換止血帶。在缺乏醫療監督的情況下，應保持止血帶原位並繼續監測，直到傷者轉入更高等級的醫療機構。
NOTE: TCCC ASM/CLS trained personnel, should not attempt tourniquet
conversion beyond 2 hours post-application unless directed by TCCC
CMC/CPP personnel or other advanced medical personnel. In the absence of
medical oversight, maintain the tourniquet in place and continue monitoring
until the casualty reaches a higher level of care.
4. Expose and clearly mark all tourniquets with the time of tourniquet
application. Note tourniquets applied and time of application; time of reapplication; time of conversion; and time of removal on the TCCC Casualty
Card. Use a permanent marker to mark on the tourniquet and the casualty
card.
6. Circulation a. Bleeding 4. 暴露所有止血帶，並清楚標示止血帶的使用時間。在TCCC傷亡卡上記錄止血帶的使用情況和使用時間、再次使用時間、轉換止血方式的時間以及移除止血帶的時間。使用記號筆在止血帶和傷亡卡上進行標記。
Expose and clearly mark all tourniquets with the time of tourniquet application. Note tourniquets applied and time of application; time of reapplication; time of conversion; and time of removal on the TCCC Casualty Card. Use a permanent marker to mark on the tourniquet and the casualty card.
