Stop the Bleed: 8 pitfalls to avoid in hemorrhage control

Stop the Bleed, the national campaign initiated by the White House in response to the many recent active shooter incidents in the U.S., has garnered significant attention and support over the past two years. Active shooter situations, coupled with research that has come out of the conflicts in Iraq and Afghanistan, have helped us clarify that the greatest cause of preventable death after trauma is uncontrolled hemorrhage, whether internal or external. In the treatment of myocardial infarction, it has long been said that “time is muscle.” Similarly in trauma, we now have a greater understanding that time is red blood cells and every RBC counts toward the ultimate survival of the trauma patient.To get more news about quick clot combat gauze, you can visit rusuntacmed.com official website.

As a direct result of this realization, several neglected hemorrhage control techniques have become major components of civilian medical educational programs designed to train citizen responders, public safety personnel and medical care providers of all levels. These include techniques that were once performed only within the confines of the OR — such as packing a bleeding blood vessel — and interventions that were long frowned upon — namely, tourniquet application.

While these hemorrhage control techniques are not particularly difficult to learn and master, there are a number of pitfalls related to performing these interventions that can negatively affect the ultimate outcome of the trauma victim.
For many decades the traditional teaching has been that the application of a tourniquet was the procedure of last choice when it came to controlling bleeding from an arm or a leg. Only if all other hemorrhage control efforts failed was a tourniquet to be considered. Even then, it was used with great reluctance and caution out of concern for causing the subsequent amputation of the injured limb.

The experience gained over the past 15 years of combat has clearly demonstrated that recommended, commercially available tourniquets can, in fact, be used safely. Data from the U.S. military have shown that survival for trauma victims who have a tourniquet applied before they bleed into shock is 9 times greater than for victims who receive a tourniquet after they go into shock. In addition, the data show that tourniquets can be safely applied to an extremity for a period of up to 2 hours with no concern about amputation. In fact, there have been no amputations in the U.S. military as a direct result of tourniquet application in patients with an application time of 2 hours or less.

This time period falls well within the timeframe of care of most trauma patients treated in urban and suburban areas of the U.S. That means trained individuals should no longer have any hesitation to apply a tourniquet to an extremity for life-threatening external hemorrhage. The tourniquet should no longer be the last choice for hemorrhage control — it should be the first choice.
Not making a tourniquet tight enough to obliterate the distal pulse
Whenever a tourniquet is applied to an extremity for hemorrhage control, it should be made tight enough to completely obliterate the distal pulse. This is to ensure that no blood is getting past the tourniquet and into the extremity.

There are two important reasons for this. First, if blood is able to get beyond the tourniquet, the patient will continue to bleed, thus defeating the purpose of applying it in the first place. Second, if the tourniquet is not tight enough to act as an obstruction to arterial blood in-flow, it will more than likely serve as an obstruction to venous outflow. This increases the likelihood of developing compartment syndrome in the extremity, potentially resulting in muscle and nerve damage.

3. Not using a second tourniquet
In the majority of cases, the application of a single tourniquet will control the hemorrhage. There are instances, however, when one tourniquet has been placed and tightened as much as possible but it is still inadequate to control the bleeding. These situations typically occur when the wound is located on the lower extremity and the tourniquet has been applied to the thigh.

Experience shows that a single tourniquet may not be able to control hemorrhage — or obliterate the distal pulse — in trauma victims with large, very muscular thighs or those who are obese. In these cases, there should be no hesitation to apply a second tourniquet. Place the second tourniquet directly above and adjacent to the first tourniquet and tighten it as necessary until the bleeding stops.