Bleeding Control: Stop the Bleed – “You are the Help Until Help Arrives”

By Sarah V. Gillen, President, Emergency Skills. Inc.

According to the National Trauma Institute, trauma alone is the leading cause of death for individuals aged 1-44, and accounts for 30% of all lives lost in the U.S. Responders to a severe bleeding emergency must take action quickly, often within 5 minutes, to save a life.

While it is human nature to want to help during any emergency, without knowledge, equipment and practice, most people unfortunately hesitate, wasting valuable minutes. In order to save lives, immediate bystander care has been proven to be critical.

Following the devastating shooting at Sandy Hook Elementary School in Connecticut, a committee of healthcare and government leaders convened in Hartford, CT to discuss the issues and make recommendations for emergency response. The strategies released following the meeting are known as the Hartford Consensus and their main recommendation dealt with making prompt bleeding control a priority. “Unfortunately, uncontrolled hemorrhage remains the single most preventable cause of death after both military and civilian injuries. One of the most important lessons learned in the last 14 years of war is that using tourniquets and hemostatic dressings as soon as possible after injury is absolutely lifesaving.”

In order to provide bleeding control, The Hartford Consensus recommended ensuring that lay rescuers would have quick access to bleeding control tools. These tools include pressure bandages, safe and effective hemostatic dressings, effective tourniquets, and personal protective gloves. Here is a summary of how you would use each of these items would be used and how they fit into your emergency response steps:

Steps to follow in a bleeding emergency:

Call 911: In all emergencies, alert 911 of your status and location. If this is an active shooter emergency remain quiet to avoid alerting shooter of your location. Turn the sound off of your phone keys and text someone to call 911 for you, if needed.

Personal protective gloves: All First Aid kits must contain gloves. Protect yourself first. A bleeding victim may be able to assist with applying pressure until rescuer’s gloves are applied properly.

Tourniquets: For serious bleeding on a limb, use a tourniquet. Severe bleeding is defined as continuously flowing and possible squirting and a large amount of blood loss i.e. 6oz (1/2 can of soda) or more. Tourniquets are commercially available but may also be created in the field. The commercially available ones are more effective. If you are making a tourniquet during an emergency, find a long piece of fabric such as a necktie and use a stick (or pencil) as a windless. Follow these steps to use a tourniquet:

• Apply the tourniquet – High and Tight
• Slide tourniquet at least 2-3 inches above the injury (High).
• Do not apply over a joint. Move the tourniquet higher to avoid the elbow or knee.
• Tighten tourniquet by pulling the strap as tightly as possible (Tight).
• Turn the windless to tighten the tourniquet further. Turn until the bleeding has stopped. Note: this will be painful to the victim but necessary to save their life.
• Lock or tie the windless in place.
• If bleeding has not stopped apply a second tourniquet.
• Make a note of the time of application on the tourniquet itself or write on victim’s skin. Write “T” on victim’s forehead.
• Monitor the injury to ensure the tourniquet continues to be effective.

Hemostatic dressings: Hemostatic dressings contain a clotting agent to improve clotting. These dressings may be used in conjunction with a tourniquet but are especially helpful for severe bleeding in parts of the body other than the limbs. For example, injuries to the torso, groin or armpit area. If the victim is bleeding from an injury in the shoulder, for example, following these steps:

• Using your fingers, stuff the dressing into the wound as deeply as possible
• Apply direct pressure to the injury for at least three minutes.
• Use your fingers to focus pressure
• Apply pressure bandage covering the wound and hemostatic dressing.

Hemostatic bandage proper application.

Pressure Bandages: A pressure bandage is a thick pad of gauze placed over a wound and attached firmly, so that it will exert pressure. A pressure bandage may be used in conjunction with gauze or a hemostatic dressing.

Monitor Victim: Ensure bleeding has stopped. Watch for signs of shock. Shock is the failure of the circulatory system to provide an adequate blood supply, especially to the heart, brain, and kidneys. Rigorous pumping of the heart, an infection, or loss of body fluid may cause shock. Severe bleeding will cause shock. Be SHARP to PREVENT SHOCK. Warning signs of shock include:

CLUES (SHARP)

Skin: Pale, cold, clammy

Head: Dizzy, dazed, unconscious

Abdomen: Nauseous

Respiration: Shallow, rapid

Pulse: Weak, rapid

EMERGENCY ACTION (PREVENT)

Protection: Apply Barrier Protection for example gloves

Reassure: Calm them

Elevate: Raise legs, approximately 12 inches with victim lying on his/her back

Very: Gentle handling

Exception: Do not raise legs if there are head, spinal or abdominal injuries or breathing difficulty

Nothing: Give nothing by mouth

Temp: Maintain normal body temperature. Cover, if chilled

There are several ways to prepare your workplace for major bleeding emergencies.

• Review your First Aid supplies
• Upgrade your bleeding control supplies. Gauze and gauze rolls have been the mainstay for decades, consider adding tourniquets and Quick Clot, a hemostatic bandage.
• Make sure your supplies are easily accessible. Do you have one large first aid kit in the kitchen? Consider placing smaller ones around the office.
• Mobilize Public Access Station, for example, includes 4 individual kits with tourniquet, quick clot, gloves, mylar blanket and more
• Add signage, so that kits are easy to locate.
• Train your staff
• Offer First aid and Stop the Bleed programs
• Web-based programs are available.
• Ensure that first aid instruction info or app is available with the supplies
• Mobilize Public Access Kit includes unlimited downloads of their proprietary app with step by step first aid instructions.
• Keep a First Aid manual with the response kits.

Communication:

• Communicate with your building office and local police precinct in advance of an emergency.
• Share your floor plan, so that emergency responders are familiar with layout.
• Review emergency plan with your employees periodically.

Additional Resources:

Hemorrhage control devices: Tourniquets and hemostatic dressings

https://www.bleedingcontrol.org/~/media/bleedingcontrol/files/compendiumhemorrhagecontrol.ashx

Harford Consensus

https://stopthebleedingcoalition.org/index.php/hartford-consensus/

Infographic from Department of Homeland Security

https://www.dhs.gov/sites/default/files/images/oha/16_1011_stopthebleed_infographic_full.jpg