Little has changed since my Boy Scout First Aid training in the 1970s about how we stop bleeding. Apply direct pressure. Elevate the wound. Remember the pressure points. But thanks in part to the military, a renewed focus on hemorrhage control is apparent in most trauma journals.
A 2013 article in Military Times states that 25 percent of war deaths are “potentially survivable.” Trauma Surgeon Col. Brian Eastridge with the U.S. Army Institute of Surgical Research states that “uncontrolled blood loss was the leading cause of death in 90 percent of the potentially survivable battlefield cases.”
Aggressive tourniquet use is recommended to reduce deaths due to blood loss from limb injuries. Think of the tourniquet, a small, at times improvised, medical device that has been around since the days of Napoleon and still making a tremendous difference today.
Do we see battlefield injuries in our emergency calls? Data from the National Trauma Institute shows that trauma is the number one cause of death in Americans between one and 46 years old and the number three cause of death overall. Each year, more than 192,000 people die from trauma. If emergency responders control blood loss, we can impact those numbers and reduce deaths in our community.
If hemorrhage control is so basic that a child can learn it, professional responders must be experts, right? Well, maybe not. In January, the University of Minnesota and North Memorial Trauma Services conducted a study measuring blood loss during simulation training.
Ninety-six prehospital paramedics and nurses were tested using a high-fidelity simulation training system which measured the amount of blood loss. The intense scenario used a live screaming actor, dimmed lighting and loud background noise.
The clinicians had to control bleeding from a junctional hemorrhage — bleeding from the armpit or groin where a tourniquet would not be effective -— using internal wound packing techniques. They also had to place a tourniquet on an amputated leg. The average measured blood loss was 1512 ml, with 40 percent of the subjects losing greater than two liters of blood.
Commonly, uncontrolled exsanguination of two liters or more is considered fatal. This raises the question; do our trauma patients succumb to fatal injuries, or do we not fight to keep them alive?
Treating exsanguinating trauma is a high risk, low frequency event. Regardless of previous experience or training, bleeding control techniques need to be taught and practiced with motivation and enthusiasm from the bystander all the way to the hospital. Direct pressure, elevation, pressure points, wound packing, tourniquets and a sense of urgency all make a difference for these patients. Make the bleeding stop!
Rob Pearson is a paramedic with North Air Care.