Hemorrhaging: How does P.A.C.E. methodology apply?


The P.A.C.E. methodology for applying a tourniquet or stopping hemorrhaging is based on problem solving in a tactical emergency. In our Tactical Emergency Casualty Care courses we realize that applying any kind of first aid in a tactical emergency situation can pose many different kinds of obstacles and various problems may present themselves. These are not your ideal situations and if certain plans are failing we must move to another plan quickly and safely. Applying tourniquets is a task oriented procedure used for hemorrhage control. So what is the acronym P.A.C.E.?


Primary: Tourniquets are applied when there is hemorrhaging to an extremity that is life threatening. So our primary goal is to go to our tourniquets. Usually they are commercially made and approved. They have been researched and this tells us that they are likely the most successful to get from the point of injury to a medical facility. Any of these tourniquets should be quick to apply in an emergency. This is your "primary" way of dealing with the given problem. Research, training, product development, the complexity of the situation will likely affect the way we go about and why we have chosen the tourniquet as a primary route.

Alternate: This is Murphy's Law, "Anything that can go wrong will go wrong." This usually happens at the worst time. So what happens if the tourniquet isn't working? This could be for various reasons. Perhaps we didn't tighten the tourniquet tight enough, this happens frequently because we don't want to cause undue pain to the victim. Having a tourniquet applied hurts. Or the injury is so bad that the hemorrhaging continues and we need now add our wound packing with some form of hemostatic dressing. Hemostatic dressing, simply put, shortens the clotting time of blood.

Contingent: Well we should always have a contingency plan. What if there is too many victims and not enough supplies. As of late we are likely to run into this situation at a mass casualty event. Clearly, there could be a triage of the environment. Who needs what the most. So if you are out of hemorrhaging gauze and tourniquets what other products can stop the bleeding whether it's a regular gauze or some form of material. Something to stop or slow down the bleeding till the victim has been taken to a medical facility or until more supplies and help arrive. Since we now have less options we also have less time to be choosy.


Emergent: Well the proverbial "poop has just hit the fan." Hemorrhaging is profuse and bleeding needs to stop now, at least while you retrieve the appropriate gear. Or even worse, We are still in the middle of a tactical situation and the victim needs help NOW! This is where we may kneel on the injury using our weight to stop the bleeding while we search for our tourniquet. We can also still observe the environment from this position as well. This buys time while implementing the proper hemorrhaging gear. This is not the best effort but when it seems the world is colliding around us it's our best option.


The PACE methodology is not only used in hemorrhaging situations or tactical emergencies but is used in most first aid or hospital environments as well. This is really all about planning we just need to expand our minds.


Jaguar Executive Services provides First Aid and Tactical Emergency Casualty Care Training to first responders and organizations looking to enhance their skill base. The last couple of years workplace violence is on the rise and knowing how to save lives is a must for anybody.



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