Stop the Bleed

By Anna Fox, MD

Fall and winter sports are approaching fast. For many, our outdoor hobbies are largely the reason to live in Idaho. These pastimes, however, are often paired with unfortunate results that dominate conversations this time of year, in the form of ‘hunting accidents, ‘ATV accidents,’ and ‘skiing accidents.’ Should the risk of injury keep us from taking advantage of the incredible place in which we live? Of course not. But we can mitigate the impact injury has on our lives and the lives of others by acquiring knowledge applicable to our activities and being prepared to respond, should the undesirable occur.

Compiled below are some basics to consider.  These would be best paired with some basic hands-on training in appropriately adapting these responses to the situation at hand.

Initial reaction:

Assess the risk of the environment and do your best to remove yourself or the

injured person from immediate harm’s way in order to prevent additional unnecessary injury.

Spinal cord protection:

If a person has injured their neck or back, it may be unsafe to move them. If they are in

a place that is safe to help or rescue them, you should help them where they are,

getting them situated while you send someone – or go yourself – for help.

Hemostasis (stopping the bleed):

Pressure: If a person has an open wound and is bleeding externally, pressure should be applied specifically to the site of bleeding. If you can see a bleeding blood vessel, that is exactly where you should apply pressure. You can take clean gauze or even special clot-inducing gauze, such as QuikClot, with you for this purpose. You can learn how to apply a pressure bandage, which can be as simple as: a thick wad of gauze, applied to the desired location, then wrapped/bound in gauze or other material to keep it there (freeing your hands for other tasks). Remember, a person can bleed internally, so his or her condition may require just as much urgency without external bleeding, especially if the following are present: pale skin, heart racing, and/or reduced consciousness.

Tourniquet: A tourniquet is effective in stopping bleeding from an arm or leg, but can

also cause injury to that limb by compressing not only the bleeding blood vessel, but also other blood vessels and nerves. It should be used only when direct pressure is not

effective and the person’s life is threatened. In those circumstances, however, it should absolutely be used. It should be placed just above the site of bleeding, and it should be tight; it should STOP the bleed. Remember, “life over limb.”

The Combat Application Tourniquet, known as the C-A-T, (North American Rescue Products, Inc.) and the Special Operations Forces Tactical Tourniquet, known as SOFTT (Tactical Medical Solutions, LLC) both demonstrated 100% efficacy in self-application studies. Studies in 2009 and 2011 showed that early tourniquet use before shock demonstrated approximately 93% survival, with only about 7% survival if applied after shock onset.

Elevation: Elevate the bleeding limb. This uses gravity to your favor, so that less blood is

pulled into the injured, bleeding limb and therefore lost from the body’s circulation.

Splinting: Splinting of broken limbs may be required before transporting an injured person.

Splints may be makeshift, from items such as hiking or ski poles, or sleeping pads, and should include immobilization of joints above and below the injury.

Supportive measures:

Keep the head and heart low. If the body doesn’t have enough blood supply for its entirety, it is important to continue perfusing, or maintaining blood supply, to the brain and heart to avoid more injury to either vital organ due to lack of oxygen.

Lifting the legs to approximately 45 degrees increases blood return to the chest and heart,

allowing the heart to function more appropriately. This can substantially improve heart

function.

Keep the body warm. Cold body temperature can cause coagulopathy, or abnormal blood

clotting, meaning the body is not responding well to after major injury: a blood clot at the site of injury. Major bleeding and the shock state make it difficult for a person to maintain body temperature and a trauma victim needs support to keep warm.

 

If you frequent the wilderness, lead others into the great outdoors, or participate in high-risk activities, consider enrolling in a short course for wilderness safety or trauma

management such as Stop the Bleed or Tactical Emergency Casualty Care. Hopefully you will never need to apply the skills gained, but having a tourniquet in your pocket and

knowing how to use it could make the difference between losing a friend and saving a life.

 

Resources:

https://wms.org/magazine/1267/M-A-R-C-H_Tourniquet_Optimization_and_Conversion

https://viaaerearcp.files.wordpress.com/2018/02/atls-2018.pdf

Walters TJ, Wenke JC, Kauvar DS, et al. Effectiveness of Self-Applied Tourniquets in Human

Volunteers. Prehosp Emerg Care. 2005;9:416–422.

Kragh JF, Dubick MA. Bleeding Control with Limb Tourniquet Use in the Wilderness Setting:

Review of Science. Wilderness & Environ Med (Special Edition). 2017;28:S25-S32.

Kragh JF Jr, Dubick MA, Aden JK 3rd, McKeague AL, Rasmussen TE, Baer DG, Blackbourne LH.

U.S. Military Experience From 2001 to 2010 With Extremity Fasciotomy in War Surgery. Mil

Med. 2016 May;181(5):463-8.

 

Kragh JF, Swan KG, Smith DC, et al. Historical Review of Emergency