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EMS 80810 Clinically Related Operations: Bleeding Chris Weinzapfel, FF, NREMTP(T) Firefighter/Paramedic/SWAT Medic Rowlett Fire Rescue Rowlett, Texas.

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Presentation on theme: "EMS 80810 Clinically Related Operations: Bleeding Chris Weinzapfel, FF, NREMTP(T) Firefighter/Paramedic/SWAT Medic Rowlett Fire Rescue Rowlett, Texas."— Presentation transcript:

1 EMS Clinically Related Operations: Bleeding Chris Weinzapfel, FF, NREMTP(T) Firefighter/Paramedic/SWAT Medic Rowlett Fire Rescue Rowlett, Texas

2 EMS Objectives 1.Recognize role of history in prehospital hemorrhage treatment.

3 EMS Objectives 2.Identify methods/ techniques in prehospital bleeding control.

4 EMS Objectives 3.Indicate common issues associated with prehospital bleeding control.

5 In the United States

6 Military Medical Corps – 1862

7 In the United States Military Medical Corps – 1862 –integrated medical treatment

8 In the United States Military Medical Corps – 1862 –integrated medical treatment –evacuation of personnel

9 US Special Forces Combat Medics First Assignments ************ US Army “Special Forces Units” “Green Beret’s” Dual Role Operators and Medics President John F Kennedy

10 90% of combat deaths occur on the battlefield before the casualty ever reaches a medical treatment facility. - Col. Ron Bellamy

11 The hemorrhage that takes place when a main artery is divided is usually so rapid and so copious that the wounded man dies before help can reach him. - Col. H.M. Gray, 1919

12 The overwhelming cause of preventable combat death continues to be extremity hemorrhage

13 The American College of Surgeons and the Prehospital Trauma Life Support Guidelines no longer recommend elevation and pressure points for severe bleeding.

14 Figure 1

15 National Registry of Emergency Medical Technicians (NREMT) – February 2009

16 Figure 2

17

18 Internal Hemorrhage

19 External Hemorrhage

20 Types of Bleeding to Consider

21

22

23

24 Bleeding from an arm or leg can usually be controlled by:

25 –trauma dressing

26 Bleeding from an arm or leg can usually be controlled by: –trauma dressing –emergency trauma dressing

27 Bleeding from an arm or leg can usually be controlled by: –manual direct pressure and elevation

28 Bleeding from an arm or leg can usually be controlled by: –manual direct pressure and elevation –tourniquet (last resort?)

29 In some situations, a tourniquet is applied first – since other methods will not be adequate to control the bleeding

30 Hemorrhage and Shock

31 What happens when you start to bleed?

32 Hemorrhage and Shock What happens when you start to bleed? – it depends on how much blood you lose

33 Normal Adult Blood Volume 5 Liters Blood Volume

34 Recognizing Shock

35 Most useful in tactical combat casualty care (TCCC)

36 Recognizing Shock –mental status –radial pulse –heart rate (HR) –blood pressure (BP) –respiratory rate (RR) –likelihood of death

37 Recognizing Shock May be difficult to judge blood loss in combat except by mental status and radial pulse

38 Recognizing Shock Heart rate and respiratory rate may be affected by exertion and combat stress as well as shock

39 500 cc Blood Loss 4.5 Liters Blood Volume

40 Mental state – alert Radial pulse – full Heart rate – normal or somewhat increased Systolic blood pressure – normal 500 cc Blood Loss

41 Respiratory Rate – normal Is he going to die from this? NO 500 cc Blood Loss

42 1000cc Blood Loss 4.0 Liters Blood Volume

43 Mental state – alert 1000cc Blood Loss

44 Mental state – alert Radial pulse – full 1000cc Blood Loss

45 Mental state – alert Radial pulse – full Heart rate – cc Blood Loss

46 Systolic blood pressure – normal lying down Respiratory rate – may be normal Is he going to die from this? NO 1000cc Blood Loss

47 1500cc Blood Loss 3.5 Liters Blood Volume

48 Mental state – alert but anxious Radial pulse – may be weak Heart rate – cc Blood Loss

49 Systolic blood pressure – may be decreased 1500cc Blood Loss

50 Systolic blood pressure – may be decreased Respiratory rate – cc Blood Loss

51 Systolic blood pressure – may be decreased Respiratory rate – 30 Is he going to die from this? PROBABLY NOT 1500cc Blood Loss

52 2000cc Blood Loss 3.0 Liters Blood Volume

53 Mental state – confused/lethargic Radial pulse – weak Heart Rate – cc Blood Loss

54 Systolic blood pressure – decreased Respiratory rate – >35 Is he going to die from this? MAYBE 2000cc Blood Loss

55 2.5 Liters Blood Volume 2500cc Blood Loss

56 Mental state – unconscious Radial pulse – absent Heart rate – cc Blood Loss

57 Systolic blood pressure – markedly decreased Respiratory rate – over 35 Is he going to die from this? PROBABLY 2500cc Blood Loss

58 Expose the Wound

59 Push or cut away loose clothing

60 Expose the Wound Push or cut away loose clothing DO NOT remove clothing that is stuck to the wound

61 Expose the Wound DO NOT attempt to clean the wound

62 Expose the Wound DO NOT attempt to clean the wound DO NOT probe the wound in order to remove an object from the wound

63 Expose the Wound

64 Apply a Bandage or Combined Trauma Bandage

65 Israeli bandage/pressure dressing

66

67 Apply an Emergency Trauma Dressing

68

69 Apply Pressure Dressing Over First Aid Dressing

70 When blood continues to seep from the field first aid dressing

71 Apply an Agent to a Wound

72 ChitoFlex™ Hemostatic Bandage

73 Chitosan (ki’ to san) Dressing

74

75

76

77 Addition to Chitosan Dressing

78 Apply manual pressure

79 Addition to Chitosan Dressing Apply manual pressure A bandage may be applied to the chitosan dressing to prevent it from being dislodged

80 Wound Stat

81 Civilian Accessible Agents

82 QuikClot ®

83 CELOX™

84

85 Figure 3

86 Apply Digital Pressure

87 Uses pressure from the fingers, thumbs, or the heel of the hand applied to an artery supplying the wound Apply Digital Pressure

88 Temporal Carotid Brachial Radial Femoral Posterior/anterior tibialis Apply Digital Pressure

89

90 Tourniquet

91 A constricting band placed around an extremity to stop arterial bleeding

92 Tourniquet A constricting band placed around an extremity to stop arterial bleeding Only used on an arm, forearm, thigh, or leg

93 Tourniquet Used when there is no time to control bleeding Used on an amputation of the arm, forearm, thigh, or leg

94 Applying a Combat Application Tourniquet (CAT)

95 Applying a CAT

96 Marking the Casualty T

97 Dressing an Amputation

98 Place a dressing (soft/absorbent) over the end of the stump Secure the dressing with bandages

99 Dressing an Amputation Prevents contamination Protects from additional injury

100 Applying an Improvised Tourniquet

101 Gather materials Applying an Improvised Tourniquet

102 Rigid object (windlass) such as a strong stick Applying an Improvised Tourniquet

103 Rigid object (windlass) such as a strong stick Tourniquet band (cravat) at least two inches wide Applying an Improvised Tourniquet

104 Rigid object (windlass) such as a strong stick Tourniquet band (cravat) at least two inches wide Securing material (cravat) Applying an Improvised Tourniquet

105 Twist windlass until bright red bleeding has stopped Wrap second cravat around limb Applying an Improvised Tourniquet

106 Wrap tails around end of windlass so the tourniquet will not unwind Tie tails in a non-slip knot Applying an Improvised Tourniquet

107

108 Ranger Ratchet Tourniquet

109 The Special Operations Forces Tactical Tourniquet (SOFT)

110 Are any of the pre-fabbed tourniquets available outside the military?

111 Have you ever used a blood BP cuff as a tourniquet?

112 Wound Packing

113

114

115 Slow the bleeding first with point pressure or tourniquet, depending on the location of the insult Wound Packing

116 Pack and pack and pack until there is no more room, filling all the voids you can Wound Packing

117 Using a gauze with a blood stopping agent will make the pack more effective Wound Packing

118 Using a gauze with a blood stopping agent will make the pack more effective Check and recheck during transport or with movement Wound Packing

119

120 Wound packing with a clotting agent can be helpful Wound Packing

121 Summing It All Up

122 NREMT skill change

123 Summing It All Up NREMT skill change Civilian accessible hemostatic agents

124 Summing It All Up Techniques and equipment used in management of major bleeding

125 Questions

126 Are the blood clotting agents better for a trauma surgeon or emergency room doctor than they used to be – no more concrete clots?

127 Will the clotting agents help control femoral artery bleed?

128 Have the heat effects of some clotting agents improved?

129 Is there any push-back from surgeons?

130 Do these clotting agents have FDA (Food and Drug Administration) approval?

131 Can you put Celox™ in the wound, bandage it, and release the patient?

132 Conclusion

133 Clinically Related Operations: Bleeding If you have any questions about the program you have just watched, you may call us at: (800) or fax (806) Direct your inquiries to Customer Service. Be sure to include the program number, title and speaker. EMS 80810

134 Release Date: 04/01/2010 EMS The accreditation for this program can be found by signing in to

135 This continuing education activity is approved by the Continuing Education Coordinating Board for Emergency Medical Services for 1.5 advanced CEH. You have participated in a continuing education program that has received CECBEMS approval for continuing education credit. If you have any comments regarding the quality of this program and/or your satisfaction with it, please contact CECBEMS at: CECBEMS Ford Road, Suite 478 Dallas, TX Phone: EMS 80810


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