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Dealing With Catastrophic Bleeds

Disclaimer.

I am not a medical professional. What follows are my condensed notes from many courses I have been on through. I accept no responsibility if you try anything you read here and it doesn’t work or it makes things worse. If you want practical knowledge on this subject then go on an approved course.

Most of us will have done some form of official first aid training. Most civilian training concentrates on:

Danger

Response

Airway

Breathing

Circulation

However, other courses include an additional stage after Danger and that is Catastrophic Haemorrhage. This could be a bullet wound, stabbing or an industrial accident and knowing how to treat it could save a life in the same way as knowing basic life support.

For the purposes of these notes I’m going to imagine I have encountered a very obvious catastrophic bleed that needs to be dealt with immediately and there is no object in the wound.

What is a Catastrophic Bleed/Haemorrhage?

Any major bleed that is likely to cause fatality.

Or

A lot of blood quickly and freely leaving the body.

As with any emergency or first aid situation our first consideration is our own personal safety, I’m not going to be able to help anybody and I’m going to make the situation worse if I get injured too. If the situation is an industrial accident I need to know that all equipment or power that could be dangerous has been shut off. If the situation is due to a street attack or an active attacker situation then I need to know that I can work on the casualty in safety.

Get Help! Better still pick a specific person and tell them directly to call an ambulance. Do not assume that just because someone is bleeding out in front of them anyone within a crowd of people will actually think to call 999. If you’re by yourself, then call 999 and put your phone on hands free so you can work.

Put gloves on to protect you and the casualty… if you have any.

Expose the wound, you need to see what you’re doing, remove cut or tear casualty’s clothing.

Some organised/prepared people never leave the house without a small first aid kit. Many people carry a first aid kit in their car and all businesses should have a decent sized first aid kit handy. While you’re directing one person to call for an ambulance then direct a second to get you a first aid kit.

While you are waiting for medical supplies and paramedics to arrive you need to get pressure on the wound…lots of it! Putting your hand over the area of the wound may not be that effective because your hand diffuses your pressure over a wide area. What is effective, is direct digital pressure over the source of the bleeding. On limbs you could also use a knee or elbow, whatever it takes to apply a massive amount of pressure directly to the site if the wound. It’s really hard work to apply direct digital pressure to the source of the bleed, fingers get tired within a few minutes.

Trauma kits and first aid kits:- they’re not the same. In a perfect world some bystander will present you with a trauma kit complete with CAT tourniquet, hemostatic gauze, pressure dressing plus a couple of Russell chest seals. The reality is unless you’re in a military environment or around someone who uses chainsaws, this is pretty unlikely. What is far more likely is that you’ll be offered a garden variety first aid kit (used by office workers to treat ouchies and boo boos) which has never been restocked.


Treating limbs.

Tourniquet.




So lets say that while you’re are applying effective direct digital pressure to the source of the wound that by some miracle someone passes you a trauma kit containing a proper medical tourniquet. The tourniquet should be applied directly to the skin, 50-75mm proximal to the wound site (nearer the body). The velcro strap needs to be really tight before you even think about tightening the windless. Twist the windless (rod) until the bleeding stops and no distal pulse can be felt. This will hurt…lots! It might hurt even more than the original injury but it’s necessary. Secure the windless and lock it into place. Write the time of application in 24h clock on the tourniquet and on the casualty somewhere obvious like the face and mark it with a T.

If the wound continues to bleed then tighten the tourniquet more or apply a second tourniquet above the first. If you’re absolutely sure you’ve stopped the bleeding then cover the wound to prevent infection.

Myths and discussions regarding tourniquets:

There is a myth that tourniquets will mean the limb may have to be amputated afterwards, in reality things would have to go badly wrong for a very long time for this to happen.

Improvised tourniquets are not effective don’t waste your time unless you really know exactly what you’re doing.

There is much discussion as to whether tourniquets on the lower limbs are effective because the are two bones running parallel to each other and this will effect how effective the tourniquet is, I have always been told this doesn’t matter and to apply the tourniquet 50mm above the wound site.

Wound packing




What is more likely to happen is you might be given a basic first kit. Just bandaging the wound won’t apply enough pressure to stop the bleed. You will need to pack the wound, tightly! Get the gauze and while applying pressure to stop the bleed pack the gauze as tight as possible. The gauze needs to be in direct contact with the bleeding wound so that the pressure stops the bleeding and the gauze helps a clot to form. I cannot emphasize enough how tightly the gauze needs to be packed. Keep packing the wound and make sure you maintain pressure. When the wound is completely and tightly packed keep the pressure on with your fingers for at least 3 minutes. If you’re 100% sure that you have controlled the bleed then you may can apply a tight pressure dressing over the wound (you may consider immobilizing the injury at this point) and check the casualty for other injuries or deal with other casualties.

In extreme emergencies where there are no medical supplies or personnel are immediately available then you may use any clean absorbent material (it doesn’t have to be sterile) but as before, make sure it’s tight.

Junctional wounds

Groin, armpits, shoulders, buttocks. You can’t use a tourniquet here even if you had one. Here you have to pack the wound as detailed above. However don’t pack a neck wound as it could impair breathing, instead apply direct digital pressure.

Chest wounds

Don’t pack a chest or abdominal wound, the wound site is likely to be far too deep for you to reach it and by trying to pack it you are likely to do more damage. You can bandage the wound, but not tightly.

Sucking chest wounds (not a bleed but still important)

This is a hole in the chest made by a puncture wound, the creates another way for air to enter the chest. This means when you breathe in that air not only enters through your mouth and nose as normal, but through the hole in your chest. This can lead to a collapsed lungs.

Indicators or a sucking chest wound:

A hole in the chest

More than one hole in the chest (in case of gunshot check for entry and exit wound)

Bright pink or red foaming blood around the wound

Sucking or hissing noises when casualty is breathing

Heavy bleeding from wound

Coughing up blood

Treatment of this means stopping air getting in through the extra hole(s) while letting the excess air out.

Put your hand or someone elses hand over the wound.

If someone has a trauma kit you might get a medical chest seal to apply to each wound site…but don’t bank on it.

With some tape and something plastic (credit card or plastic bag) you can make a 3 sided flutter valve. If possible get the casualty to breathe out, then place the plastic over the wound and secure on three sides with tape. This should let air out without letting air in (if after you’ve applied chest seal you notice a build up of air in the chest you may need to take the seal off, it might mean air is leaking into chest via lungs). If you have no resources available lean a conscious casualty against something with injured side downwards.

How to check a casualty to ensure you reveal all injuries:

Start at head and work down in a logical order

Check both hands regularly for blood

If casualty flinches this could indicate an injury

Do chest, back armpits and top of thighs

Do each limb systematically with both hands.

Conclusion

Contact emergency services immediately, apply lots of direct digital pressure to wound site.

Points to consider:-

A) All uncontrolled bleeding is fatal eventually, however the time it takes for this to happens varies enormously, obviously work with all possible haste but don’t believe the old wives tales that if you nick the femoral artery then you’ll be dead in 15 seconds.

B) A catastrophic bleed can be from anywhere, if you see an artery spurting out bright red blood at an alarming rate then you should definitely treat it. However this is the stereotypical Hollywood catastrophic bleed. In reality it can be from a limb, junction or chest and abdomen

C) Not all arterial bleeds are catastrophic, minor ones can be dealt with by direct pressure

D) You can’t estimate the severity of a wound based on how much blood you can see. If you cut your head or get a nose bleed there appears to be lots of blood but in reality you won’t lose much. However if blood is pooling internally or is being soaked up by clothing then you might not see any.

Stay Safe.

Richard Talbot (KMW Instructor)

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