Stop the Bleed: Bleeding Control Training for the Injured
Bryan W. Olson
One of the most common causes of preventable death, is severe, uncontrolled bleeding.
Everyone should know how to recognize life-threatening bleeding and take the appropriate steps to control it while awaiting the arrival of emergency medical services (EMS). Due to years of conflict throughout the world, the United States Military has taught us some simple techniques to use to increase the number of victims we can save from severe bleeding.
Unfortunately, people can be injured in many ways, including, traffic accidents, accidental injuries sustained at home, work, or during an act of violence, such as the mass shootings at Columbine, Virginia Tech, Ft. Hood, the Pulse Nightclub and Boston Marathon bombing. Regardless of the cause of the injuries, all serious bleeding must be controlled as quickly as possible in order to save the victim’s life. Many seriously injured victims will need surgery to survive, but the surgeon’s skill cannot help if the victim does not make it to the hospital alive. It may take medical personnel some time to reach the victims. Bystander and average citizens, can take steps to stabilize victims while waiting for professional responders to arrive. In most situations, EMS responds quickly to the scene. However delays can and do occur from traffic congestion, road closures, inclement weather, and lack of personnel and equipment due to a very busy shift.
Before you offer any help, you need to always ensure your own safety. If you become a victim yourself, you can’t help anyone. Use personal protective equipment such as gloves, masks, and safety glasses.
A victim may have different types of bleeding when injured, but arterial bleeding is what is most serious and life threatening. Arterial bleeding is identified by its bright red color, and spurting or pumping flow from the wound. This pumping action will cause a person to lose more blood faster than other types of bleeding. Venous bleeding, which is described as a darker colored red or maroon, with a steady flow from the wound, can also be serious if a large vein is damaged and not treated.
A victim who is bleeding from an artery can die in as little as 3 minutes. Serious bleeding from an extremity is the most frequent cause of preventable death from injury. With the average EMS response time being 6-8 minutes, one can see how important it is to stop severe bleeding immediately while waiting for EMS to arrive.
A tourniquet is a device that stops the flow of blood to an extremity. If applied correctly, the tourniquet stops arterial blood flow into the extremity and to the wound. Limiting this blood loss may prevent the victim from going into shock and death.
For several years, the use of tourniquets was controversial to say the least. Some believed that the application of a tourniquet would essentially guarantee the loss of that extremity. Actual use in combat has shown that is not true. Tourniquets are often left in place for several hours during surgical procedures. There have been no documented cases of amputations caused by a tourniquet left in place for fewer than 2 hours. If an extremity is lost, it is usually due to the severity of the initial injury, not the tourniquet itself.
While it is better to use a commercial device, if one is not available, tourniquets can be improvised from belts, strips of bed sheets, triangular bandages, t-shirts, and other items. To avoid creating another injury, the material when applied should be approximately I inch wide. A sturdy rod will also be needed to tighten the material around the extremity.
As a side note, when applied correctly and effectively tourniquets do hurt. Considering the immediate circumstance however, it is better than death. Pain does not mean you should remove it. Never remove or loosen a tourniquet once applied. This may cause the blood clots to break loose and the wound to bleed even more severely. Removal will be done by doctors at the hospital where advanced techniques and equipment can be used to control any bleeding that may occur with that injury.
There may be situations where a tourniquet cannot be used for severe bleeding. Wounds to the neck, shoulder, armpit, and groin are known as junctional wounds and severe bleeding in these areas cannot be controlled by a tourniquet. Direct pressure can be attempted, but if arterial bleeding is involved, it may not be enough. Wound packing is technique that can be used for these injuries.
Wound packing involves doing just what the name implies. Taking care not to injure yourself on bone fragments, broken glass, metal fragments, or other sharp objects inside the wound, pack the wound with plain gauze or gauze containing a hemostatic agent to help the blood clot to stop the bleeding. The idea is to put enough pressure on artery to stop the bleeding or at least slow it down enough to clot on its own. Once the wound cavity is fully packed, additional pressure will be applied over the wound to help the blood clot. Never remove the original packing material as this may cause blood clots to break loose and the wound can bleed more severely. Removal of the packing material will be done at the hospital. As with tourniquets, this can be a painful procedure. You should make the victim aware of this before you begin.
In an ongoing effort to spread the word to our community, the Border Regional Advisory Council (RAC) and West Texas Medical Reserve Corps, is offering free, lifesaving training on these skills to you and or your organization. Classes are offered to the general public on Saturday mornings, every other month.
If you are interested in this free, 2 hour class, please contact the BorderRAC at 915 838-3200 or visit www.borderrac.org for more information.
References: National Association of Emergency Medical Technicians, (NAEMT), / Pre Hospital
Trauma Life Support, (PHTLS), 2014.
https://www.dhs.gov/stopthebleed , 2014.