Wow. A lot of good responses here. This is a big help for me figuring out a basic first aid system.

I look forward to reading more.

David

here's one thing ... and I want to get the opinion especially of the paramedics on this forum.

for a case of serious (or critical) bledding from an extremity I am considering the following technique.

1. While one person gets gear ready (bandages, celox dressings, water for irrigation), a second person applies immediate pressure at the site of the wound.

2. when ready to go, someone takes a piece of surgical tubing and wraps it around the uppermost part of the extremity with some tightness. not enough to be a tourniqet, but enough to reduce blood pressure in the extremity.

3. with blood flow temporarily reduced ... wound is uncovered, irrigated to clean out foreign matter, new bandages applied, pressure applied again on new banadages. goal of this step - 60 secs maximum time.

4. surgical tubing is removed and pressure is maintained on the wound site.

the idea of this technique is to temporarily reduce blood flow to allow quick cleaning and better application of proper bandages. the aim is to be smooth and fast, so blood pressure to the extremity is only reduced for a short time.

and by the way, you could essentially do the same thing if you used a blood pressure cuff on the extremity (and pumped it up) to reduce blood flow. just don't pump it to the point where it gets to systolic pressure - allow some blood to keep flowing.

thoughts??

Pete2

Here in OR, their use was recently covered at one of my monthly classes for my First Responder Cert. The class is delivered by a retired FD Lt. at the local Station. It's new material to the class this year.

I'll comment on the wound that isnt bleeding out.

You will be stunned and fearful of treating that wound,but if you have no choice,you have no choice.

I wont go into what to clean with,you will use what you have.Just get it as clean or sterile as you can throughout treatment.

Use common sense to clean wound and keep clean as best you can.

A wet packing,not dripping wet but moist enough that it isnt dripping,and covered with a dry dressing will work in that situation.Change daily.Protect both victim and yourself from wound and infection,that means gloves if you have em.

As long as victim agrees that what you are going to do isnt the optimal,but the best you have,and is willing to accept the risk,then you just buck up and do it.

BTDT one time,dont want to do again,wound healed but......not a good thing to deal with.

Boy, this is a mixed one. First, surgical tubing probably won't be tight enough for a true arterial bleed. Arteries tend to be deep, veins shallow. So, if it's veinous, your tubing is going to make the bleeding worse, because you block the "uphill" flow. Kind of like when you give blood, and they wrap tubing around your bicep to bulge out your elbow veins. A BP cuff would be better, but to truly stop bleeding, you NEED to overcome systolic blood pressure.

Second, I wouldn't ever do this under rare circumstances.

I think most folks reading this are confusing 2 concepts: bleeding control, and infection control. Guess which comes first?

AFTER the bleeding has stopped, THEN start the infection control. Stop the bleeding however you have to - gauze, TQ, celox, finger on a blood vessel ... the hold it for a while. If it's critical bleeding, you might not be able to stop it, in which case the person dies. But, after 10-15 minutes of serious, HARD direct pressure, most bleeding will stop. Wait a while, an hour or 2, before even thinking of infection control. Honestly, if you're within 24 hours of a medical center, I would barely consider going back there. If it's difficult to control once, it's going to be hard to control a second time.

Sometimes, you don't just do something - you stand there.

In my SAR incidents, we always concentrated on stopping the bleeding, first and foremost. The patient was usually within the ER within twenty-four hours. We had the opportunity for good feedback from the receiving hospitals and I don't recall any comments relating to infection.....

If the victim had a pulse and respirations when entering, they eventually walked out of the hospital in reasonably good shape...

i was talking about a constriction proximal to the wound.

what I got out of the responses is that possibly it's not worth the effort - and just better to go with direct hard pressure.

let's set aside the possibility of a constriction band. and we'll just look at a practical situation. suppose you've got someone with arterial bleeding, maybe from a forearm as a result of a slash with a knife. The immediate response (from me or bystanders) would be to get direct pressure on the wound. most likely this could just involve skin against flesh, or possibly some loose clothing pressed against the wound.

it seems as though it would be preferable to actually remove the clothing (used as a bandage) and replace with bandages, or better still bandages impregnated with Celox. Hence if bleeding has not stopped in say a few minutes (3-5 mins) ... maybe try a very fast release of pressure, removal of blood-soaked clothing, and application of new bandages and more pressure.

the issue here is what the first responder does immediately (and this could be the patient themselves), and what the first-aid provider does as soon as they arrive.

Pete2

- IIRC the only granular hemostatic that was shown to cause emboli was WoundStat. WoundStat is a fundamentally different material than the zeolite comprising early QuikClot. Too bad too, 'cuz WoundStat worked incredibly well at achieving fast hemostatis. It formed into a putty-like material that was fantastic for sealing up a torn artery without heat.

- Chitosan hemostatics with shrimp shells are made such that the protein in some seafoods that affects certain people is not present. You will not have a seafood reaction to Chitosan.

- Here in my county where I worked for years at EMS, we now have CAT tourniquets on the trucks. I have old pals who successfully used the CAT on a dialysis pt whose fistula split open. They tried direct pressure first but it didn't work. Recently a deputy sheriff was shot in the thigh with a 40S&W resulting in a bad femoral bleed. His partner used a CAT carried in an ankle holster to save his life.

- Complete amputations are not the most catastrophic injury to cite in an effort to champion direct pressure. A complete amputation is actually LESS serious (in terms of bleeding) than a fat artery that has been torn lengthwise. Completely amputated vessels often clamp off pretty well (at least for a while) on their own as the smooth muscle encasing them spasms in response to the trauma. The effect is greater with a sharp clean cut, less so with a ragged/shredded wound (like a blast injury). This is a 'grace period' that gives you time to get to the hospital, so some EMS providers overlook it and think the 5 minutes of direct pressure they applied did the trick. Not all cases, of course.

I worked a motorcycle wreck where the rider got T-boned by a car. The rider's lower leg was cleanly cut off when it got pinched between the motorcycle and the car's bumper. We were looking right at the exposed bone and flesh. It only oozed, it barely bled. He would have bled a lot more had his popliteal artery been shredded by a rifle round instead.

"we now have CAT tourniquets on the trucks"

Can you explain that a bit more. CAT tourniquet??

tx, Pete2

Sorry Pete, I lapsed into jargon-speak!

Here ya go:

CAT home page

at North American Rescue