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Stop The Bleed


May is ‘Stop The Bleed’ month... 

So with the month nearly over, let’s first get some background about haemorrhage control, then shut down some bleeding control myths and follow up with a few life saving techniques.

Uncontrolled haemorrhage remains one of the leading causes of preventable deaths worldwide, with some studies suggesting it causes up to 40% of trauma related deaths. As a result of these grim statistics, campaigns such as ‘Stop The Bleed’ were developed. The need for public understanding in this area grew markedly, following a number of mass shootings in the USA – which again, illustrated the significant morbidity of uncontrolled bleeding.

The gold standard for rapid and definitive bleeding control on limbs is the arterial tourniquet. First documented to be used in the American Civil War, there has been a bit of a love/hate relationship with the tourniquet right up until the turn of the century, where tourniquets were readily accepted for use in the military. In fact, it wasn’t until a few years into the Iraq and Afghanistan conflicts that tourniquets became widely accepted, with reports showing a substantial number of deaths that occurred due to significant blood loss could have been avoided with rapid application of a tourniquet. The life saving benefits of these simple devices and other techniques are now spilling over into the civilian world – however it is still frustratingly slow.

A number of bleeding control myths are still thrown around in first aid courses and in people’s general knowledge.
Let’s address a few of them here…

Tourniquets are used as a last resort – FALSE

Whilst some guidelines still state this, it must be emphasised that the tourniquet can, and in some cases SHOULD, be used as your initial treatment. With correct training (even watching a couple of YouTube videos will help), a rapidly and correctly applied tourniquet can stop deadly arterial bleeding. If the wound is smaller and not spurting blood, then by all means use direct pressure first. However, if this doesn’t work, definitely resort to a tourniquet.

Tourniquets should be placed on the upper limbs where there is only one bone – FALSE

A tourniquet can be placed approximately 10cm above the wound, no matter where on the limb it is, so long as that tourniquet isn’t placed on a joint (alternately, high and tight is acceptable, we’ll discuss that further on). The tourniquet does not compress the artery against the bone. It is the circumferential pressure of the flesh that compresses down on the artery. Consequently, where there are two bones in the limb (lower leg, forearm), the circumferential pressure compresses the artery between the bones, thus stopping the bleed.

Tourniquets cause more damage, so I shouldn’t use them – TRUE AND FALSE

TRUE – the tourniquet can potentially cause tissue or nerve damage, especially if left on long term.

FALSE – you should definitely use them!!! A person can live without a limb (although there is little to no evidence suggesting that a person has lost a limb due to long term tourniquet use), they can’t live if they have exsanguinated (a cool word meaning you’ve bled to death).

You shouldn’t put anything into a wound – FALSE

Some deep wounds with arterial bleeds can’t be controlled by a tourniquet, such as wounds in the groin or armpit. As such, a technique to attempt bleeding control here is called wound packing. This will be discussed a little further on.

Improvised tourniquets, like a belt, will work fine – FALSE

Well, mostly false. Improvised tourniquets aren’t great. Sometimes they work, most times they actually make the situation worse by occluding the venous return. What this means is that if arterial blood can get through, the returning venous blood (which comes back at a lower pressure) is cut off with the improvised tourniquet, basically causing a ‘dam’ in the vein. The blood backs up and flows out of the hole you’re trying to stop blood coming out of. Best to get a commercially made (and TCCC approved) tourniquet.

So with some of those myths dispelled and explained, let’s have a look at how to control bleeding, and in particular, dangerous arterial bleeding.

Sustained Direct Pressure

As the term suggests, pressure is applied directly on to the wound with whatever you have at hand (yes, even if it is just your hand). What you are trying to achieve is a clot in the wound, which acts as a plug to stop the blood coming out. Difficulties arise when a person is on anti-platelet and/or anti-coagulation medication (commonly and collectively called ‘blood thinners’). So, some simple techniques can include: 

– Applying a Gauze Pad and simple roller bandage

– Emergency (aka Israeli) Bandage or OLAES bandage

 

 

There are some great videos on YouTube demonstrating correct application of these.
Or… Book in a first aid course with us and we’ll show you in person!

Tourniquets

 Several reputable companies make tourniquets, a significant number of dodgy companies also make them and sell them on Amazon or eBay.
Do yourself a favour, spend the money. You don’t want them breaking (and all reports suggest that the cheap ones do) when you need them the most (i.e. potentially saving your life, or that of a loved one).

As of 2023, the Committee on Tactical Combat Casualty Care (CoTCCC) have recommended the following tourniquets:   

  •  Combat Application Tourniquet (CAT) gen 6 and 7
  • SAM Extremity Tourniquet (SAM-XT)
  • SOF Tactical Tourniquet – Wide (SOFTT-W)
  • Ratcheting Medical Tourniquet – Tactical (RMT-T)
  • TX2” and TX3” (TX2 and TX3)
  • Emergency and Military Tourniquet (EMT)
  • Tactical Pneumatic Tourniquet 2” (TPT2)
 
 


 

 

Apply the tourniquet approx. 5 – 7cm above the wound and tighten according to manufacturers instructions. Tourniquet should ideally be placed on bare skin, however if unable to, ensure pockets are empty beforehand. The tourniquet should be placed horizontally above the wound (i.e. not on an angle) and the windlass should be outermost on the limb to facilitate easier winding. If you are unable to place it directly above the wound (time constraints, low light, long pants/ sleeves, etc), then ‘high and tight’ is acceptable. Place the tourniquet as high as you can on the limb and tighten as mentioned before.

NOTE – Always record the time of application! If bleeding doesn’t stop with one tourniquet, a second one can be placed above the first (i.e. closer to the heart). 


Wound Packing

Some bleeds can NOT be stopped with tourniquets or standard direct pressure. Such as when the source of bleeding is too high on limb for tourniquet application in areas such as the neck, armpit, and groin.

In this case, wound packing with either simple gauze or with special gauze impregnated with clotting agents can be used.

To do this, place a finger inside the wound to determine where the bleeding is coming from. DO NOT blindly pack a wound. Make an effort to locate the source of bleeding and immediately apply direct pressure with a finger then start feeding in the gauze. It is important to maintain pressure on the bleeding point throughout. Keep packing the gauze in until the wound is filled with gauze. Remaining gauze is bunched on top and manual pressure is held with the hand for at least five minutes. Replace your hand with a suitable bandage and the bleeding should have stopped. If using impregnated gauze, DO NOT REMOVE IT!!! Ensure paramedics or hospital staff are made aware.

Clotting agents can include chitosan (a product made from crustacean shells) or kaolin (a clay earth mineral). Both have agents in them that help form clots in the wound. A hot tip – if you have a surface wound that just won’t stop bleeding, try using an impregnated dressing as your ‘pad’, then bandage it up.

So that just about covers the basics of stopping the bleed. As always, the best way to get hands on experience is by booking a first aid course where our awesome trainers can give you all the skills and knowledge in person.

Hope you enjoyed the read!

 

Picture of Craig Middleton
Craig Middleton

Registered Paramedic - Brisbane, QLD