Bleeding Control for the Injured: For EMS and trainers

Bleeding Control for the Injured: For EMS and trainers Bleeding Control The focus of this training is to control lifethreatening bleeding. Bleeding patients can die in minutes. Bystanders and law enforcement may be the first to respond to an injured person, before EMS arrive. This training will demonstrate the actions that anyone can take to save a life before professional rescuers arrive. 1

Objectives Demonstrate and teach how to stop bleeding by: Apply direct pressure to a bleeding site Place a tourniquet on an arm or leg Pack a wound and apply pressure Explain the need for victims with these injuries to be transported immediately to an appropriate hospital Why Do I Need This Training? Bombings Home injuries Motor vehicle crashes Work-related injuries Mass Shootings 2

Fundamental Concepts of Hartford Consensus There must be a continuum of care that begins with the initial responders and continues to definitive care. Provide a seamless integration of bleeding control interventions General public Responding officer EMS/fire/rescue Definitive trauma care EMS/fire/rescue must be involved earlier in the care of the victims Fundamental Concept of Hartford Consensus No one should die from uncontrolled bleeding. 3

T-H-R-E-A-T Threat suppression Hemorrhage control Rapid Extrication to safety Assessment by medical providers Transport to definitive care Importance of the First Responder While EMS usually responds quickly Delays can occur. Long delays are possible in some circumstances. First responders may include: Bystanders Police Fire fighters Mike Groll/AP Images 4

Hartford Consensus Call to Action Include the citizen bystander-as-responder concept into training and planning Ensure that first-responding law enforcement officers have training and proficiency in bleeding control Integrate fire/rescue/ems early into the response continuum Key Principles 1. Ensure your own safety 2. Call 9-1-1 3. Identify the injury 4. Stop the bleeding 5

Safety Before you offer any help, you must ensure your own safety! Direct someone to call 9-1-1, or call yourself Protect yourself from bloodborne infections by wearing gloves. Identify Expose the Wound Remove or cut the victim s clothes to expose the wound. By removing clothing, you will be able to see injuries that may have been hidden. 6

Causes of Bleeding Deaths External bleeding: Wounds to the arms and legs Torso junctional wounds: Groin Shoulder and armpit Neck Internal bleeding (bleeding inside the chest or abdomen) Bleeding from Arms and Legs Can be controlled by direct pressure and/or a tourniquet. 7

Courtesy of Norman McSwain, MD, FACS, NREMT-P. 8

Courtesy Louis Alarcon, MD, FACS Improvised tourniquets in Boston Marathon bombing 9

Junctional Bleeding The neck, shoulder, and groin. Bleeding can be controlled by direct pressure and/or wound packing. Junctional Location Bleeding Courtesy of John Holcomb, MD. 10

Junctional Location Wounds Pack the wound with a hemostatic dressing or a plain gauze roll and apply pressure. Hemostatic dressings are materials that will help cause blood to clot. QuikClot Combat Gauze Celox-A Chitosan emily2k/shutterstock, Inc. Courtesy of Z-Medica. Internal Bleeding Injuries to the chest and abdomen may cause bleeding inside the body Cannot be managed outside the hospital Important to recognize these wounds and call 9-1-1 immediately 11

Bulger, PEC 2014 Stop the Bleeding A victim who is bleeding from an artery can die in 3 minutes. Serious bleeding from an extremity is the most frequent cause of preventable death from injury. Life-threatening bleeding needs immediate intervention that anyone can provide 12

The Tourniquet If applied correctly, a tourniquet stops arterial blood flow into the extremity and from the wound. Limiting blood loss may prevent the patient from going into shock. Courtesy Norman McSwain, MD, FACS, NREMT-P. Tourniquet Application Apply immediately if life-threatening bleeding is seen on an arm or a leg You do not need to remove clothing Place above the bleeding site: high and tight Tighten until bleeding stops Properly applied tourniquets cause pain If bleeding is not controlled by applying the initial tourniquet, apply a second one just above the first 13

Tourniquets Courtesy of Peter T. Pons, MD, FACEP. Combat Application Tourniquet (C-A-T) Courtesy of Delfi Medical Innovations, Inc. Emergency and Military Tourniquet (EMT ) Courtesy of Peter T. Pons, MD, FACEP. Courtesy of Peter T. Pons, MD, FACEP. 1 st Generation 2 nd Generation SOF Tactical Tourniquet (SOFTT) Parts of a Tourniquet Composite Resources Inc. 14

How to apply a tourniquet video 15

One-Handed Application to an Arm Courtesy of Peter T. Pons, MD, FACEP. Tourniquet Removal NEVER REMOVE A TOURNIQUET Only a physician or EMS under physician instruction should loosen or remove tourniquet 16

Common Mistakes (1 of 2) Not using a tourniquet for lifethreatening bleeding Waiting too long to apply a tourniquet Using a tourniquet for minor bleeding Common Mistakes (2 of 2) Removing the tourniquet before arrival to the hospital Periodically loosening the tourniquet to allow blood flow to the injured extremity Causes unacceptable additional blood loss Not making the tourniquet tight enough to stop the bleeding Not using a second tourniquet if needed 17

Junctional Wounds Groin, shoulder/armpit, or neck Cannot use a tourniquet Apply direct pressure Pack with hemostatic dressing or plain gauze roll This technique can control bleeding that might otherwise prove fatal Wound Packing Open clothing around the wound. Locate the source of the most active bleeding. Pack hemostatic dressing or gauze roll tightly into wound and directly onto the source of bleeding Compress firmly Jones & Bartlett Learning. Photographed by Darren Stahlman. Jones & Bartlett Learning. Photographed by Darren Stahlman. 18

Wound Packing Wound Packing Quickly apply and hold direct pressure for 3 min if using a hemostatic dressing and 10 min if using plain gauze. Reassess to ensure bleeding is controlled. If initial packing fails to stop bleeding, pack a second gauze on top of the first and reapply pressure. Jones & Bartlett Learning. Photographed by Darren Stahlman. 19

Wound Packing video Jones & Bartlett Learning. Photographed by Darren Stahlman. Jones & Bartlett Learning. Photographed by Darren Stahlman. 20

Internal Bleeding Bleeding inside the chest or abdomen that results from wounds that penetrate those areas Cannot be controlled outside of a hospital Victim needs to be transported immediately to trauma center Identify these patients to EMS providers when they arrive Keep the Victim Warm Patients who are bleeding should be kept warm. Keeping the patient warm is just as important as stopping blood loss. Hypothermia (decrease in body temperature) is much easier to prevent than to treat! 21

Summary Stop the bleed: Direct pressure and packing Use a tourniquet on arms and legs. Ensure EMS has been called for rapid transport for internal hemorrhage Anyone can save a life Questions? 22

Acknowledgements Slides modified from: Bleeding Control (B-Con) Course National Association of Emergency Medical Technicians (NAEMT) American College of Surgeons (ACS) 23