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07 May 2019

Bleeding Control - Lets Get The Facts Right

Bleeding Control - Lets Get The Facts Right

Uncontrolled haemorrhage is responsible for over 35% of pre-hospital deaths. With the rate of homicides in the UK reaching their highest point in a decade, increasing awareness of effective bleeding control practise has never been so important.

The debate around proper haemorrhage control in the UK is on-going and it is evident that there are still misconceptions around understanding the different practises for stopping bleeding quickly and the limitations of equipment such as tourniquets or haemostats.

Here are five common myths about bleeding control and what you can do instead to effectively ‘Stop the bleed’...

Myth #1: Palm pressure will stop the bleeding.

Direct pressure is the primary technique recommended for bleeding control. However, just placing an entire palm over the bleeding area may not always be the most effective way to apply pressure to a bleeding wound. Applying pressure directly to the source of bleeding with a finger (digital pressure) reduces the diameter of the surface through which the pressure is being applied, and so increases the rate of applied pressure1.

It is very difficult to apply digital pressure for longer than a few minutes, especially during transport due to the constant movement, therefore other haemorrhage control techniques such as Celox™ Rapid gauze  should be used once the bleeding source has been identified, these help speed up blood clotting to stop the bleed much faster than pressure alone.

 

Myth #2: Adding multiple pressure dressings enhances bleeding control.

If applying a pressure dressing has not been successful in stopping the bleed and so becomes soaked with blood, it is likely that the pressure the dressing is giving isn’t focussed enough on the source of bleeding. Adding further dressings diffuses the pressure even more, resulting in an even more ineffective attempt at haemorrhage control2.

In some cases minor to moderate bleeding on extremities can be controlled by pressure dressings adequately but in more serious injuries or those to the to the head or truncal area, multiple pressure dressing application is unlikely to offer any real benefit. In these cases additional haemorrhage control techniques are required such as haemostatic agents or tourniquets.

 

Myth #3: Application of haemostatic agents alone will stop all bleeding.

Haemostatic agents, whether in powder, granular or gauze form, need to be packed against the source of a bleeding wound with adequate pressure maintained for three to five minutes (or as per the haemostat manufacturers guidance) or until the bleeding stops. Simply pouring a granular agent into a wound will not necessarily provide the right amount of compression needed to stem the bleed3.

Haemostatic agents such as Celox™ Rapid gauze should be used in conjunction with direct digital pressure and tight wound packing to push the haemostatic agent right to the source of bleeding.  Palm pressure should then be applied for the compression duration stated by the manufacturer of the haemostat being used. Once the bleeding has been stopped a dressing can be applied to maintain the pressure and keep everything packed and secured for transportation to the hospital. It is also important that the packaging is conveyed to the hospital with the patient, this can easily be achieved by tucking it in to the top layer of the dressing.

 

Myth #4: All limb bleeding can be controlled by a single tourniquet.

In order to ensure a tourniquet is applied effectively, training in its use should be sought as per the European Resuscitation Council Guidelines (Section 9), untrained users may find it difficult to tighten the tourniquet to the adequate pressure to successfully stop bleeding. A tourniquet should be applied 2 – 3 inches above the injury4. When it comes to larger upper thigh areas a single tourniquet may not be enough to control the bleed. In these cases, a second tourniquet needs to be applied above the first in order to administer the right amount of pressure to stem the bleeding.

Additionally, wounds should be monitored for re-bleeding5 when a patient’s blood pressure returns to normal. In these cases the tourniquet used may potentially need to be tightened even further or additional tourniquets applied.

 

Myth #5: Leather belts make great tourniquets.

Whilst using a belt as a make-shift tourniquet is better than nothing at all, using one in place of a proper commercial tourniquet to attempt to occlude arterial blood flow is more than likely to be unsuccessful. The buckle of a belt is highly unlikely to be strong enough to withstand the amount of pressure required, and attempting to tighten the belt with a DIY windlass is near impossible due to the rigidity.

Commercial tourniquets such as the CitizenAID Tourni-Key offer a much more effective low-cost solution to improvising a tourniquet which works with just a piece of clothing such a scarf or tie.

 

Understanding proper haemorrhage control methods and applying them quickly is the key to reducing unnecessary deaths due to uncontrolled bleeding. In the UK, haemostats can only be used by trained emergency responders, though this can be as simple as a first aid course and a course on how to use haemostats. Lots of  advice and training on haemostats and trauma care can be found at the Celox Academy.

If you would like any more information on training or advice on products such as our bleeding control kits or personal Critical Injury Pack please get in touch with us today by email sales@spservices.co.uk or by phone on 01952 288 999.

 

Sources

https://www.health.harvard.edu/staying-healthy/emergencies-and-first-aid-direct-pressure-to-stop-bleeding
2 https://www.wounds-uk.com/resources/details/effective-compression-therapy
https://www.celoxmedical.com/
4 https://redcrosstourniquet.com/
5 https://watermark.silverchair.com/milmed

 

 

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