What Everyone Should Know to Stop Bleeding After an Injury
THE HARTFORD CONSENSUS The Joint Committee to Increase Survival from Active Shooter and Intentional Mass Casualty Events was convened by the American College of Surgeons in response to the growing number and severity of these events. The committee met in Hartford Connecticut and has produced a number of documents with recommendations.
SAVE A LIFE: What Everyone Should Know to Stop Bleeding After an Injury Authors: Peter T. Pons, MD, FACEP Lenworth Jacobs, MD, MPH, FACS Acknowledgements: The authors acknowledge the contributions of Michael Cohen and James “Brooks” Hart, CMI to the design of this manual. Some images adapted from Adam Wehrle, EMT-P and NAEMT.
CONTENTS SECTION 1 ■ ■ 3 Introduction Primary Principles of Trauma Care Response ■ The ABCs of Bleeding SECTION 2 ■ 5 Ensure Your Own Safety SECTION 3 ■ 6 A – Alert – call 9-1-1 SECTION 4 ■ 7 B – Bleeding – find the bleeding injury SECTION 5 9 ■ C – Compress – apply pressure to stop the bleeding by: ■ Covering the wound with a clean cloth and applying pressure by pushing directly on it with both hands, OR ■ Using a tourniquet, OR ■ Packing (stuff) the wound with gauze or a clean cloth an
SECTION 1: INTRODUCTION Welcome to the Stop the Bleed: Bleeding Control for the Injured information booklet. Injury results from a wide variety of causes, including accidents or intentional harm, and in a wide variety of locations, such as your home or workplace. It is important that as many people as possible survive their injuries if they sustain trauma. Uncontrolled bleeding is the number one cause of preventable death from trauma.
PRIMARY PRINCIPLES OF TRAUMA CARE RESPONSE ■ Ensure your own safety ■ The ABCs of Bleeding ■ A – Alert – call 9-1-1 ■ B – Bleeding – find the bleeding injury ■ C – Compress – apply pressure to stop the bleeding by: 1. Covering the wound with a clean cloth and applying pressure by pushing directly on it with both hands, OR 2. Using a tourniquet, OR 3. Packing (stuffing) the wound with gauze or a clean cloth and then applying pressure with both hands.
SECTION 2: ENSURE YOUR OWN SAFETY ■ Before you offer any help, you must ensure your own safety! ■ If you become injured, you will not be able to help the victim ■ Provide care to the injured person if the scene is safe for you to do so ■ If, at any time, your safety is threatened, attempt to remove yourself (and the victim if possible) from danger and find a safe location ■ Protect yourself from blood-borne infections by wearing gloves, if available 5
SECTION 3: A ALERT – CALL 9-1-1 A ■ Get help ■ Call 9-1-1 yourself, OR ■ Tell someone to call 9-1-1 ■ This will notify emergency medical responders and, depending on the situation, police officers to respond to the scene 6
A SECTION 4: B BLEEDING ■ Find the source of bleeding B ■ Open or remove the clothing over the wound so you can clearly see it ■ Look for and identify “life-threatening” bleeding y removing B clothing, you will be able to see injuries that may have been hidden or covered.
What is “life-threatening” bleeding? Blood that is spurting out of the wound.
SECTION 5: C COMPRESS C KEY POINT: There are a number of methods that can be used to stop bleeding and they all have one thing in common – compressing a bleeding blood vessel in order to stop the bleeding.
DIRECT PRESSURE ON A WOUND 1. Take any clean cloth (e.g. shirt) and cover the wound 2. the wound is If large and deep, try to “stuff” the cloth down into the wound 3. Apply continuous pressure with both hands directly on top of the bleeding wound 10 4. Push down as hard as you can 5. Hold pressure to stop bleeding.
APPLYING A TOURNIQUET If you do have a trauma first aid kit: For life-threatening bleeding from an arm or leg and a tourniquet is available: ■ Apply the tourniquet 1. Wrap the tourniquet around the bleeding arm or leg about 2 to 3 inches above the bleeding site (be sure NOT to place the tourniquet onto a joint – go above the joint if necessary) 2. Pull the free end of the tourniquet to make it as tight as possible and secure the free end 3. Twist or wind the windlass until bleeding stops 4.
WOUND PACKING AND DIRECT PRESSURE If you do have a trauma first aid kit: For life-threatening bleeding from an arm or leg and a tourniquet is NOT available OR For life-threatening bleeding from the neck, shoulder or groin: ■ Pack (stuff) the wound with bleeding control gauze (also called hemostatic gauze), plain gauze, or a clean cloth and then apply pressure with both hands. 1. Open the clothing over the bleeding wound 2. Wipe away any pooled blood 3.
SECTION 6: SUMMARY Assure your safety Look for Life-Threatening Bleeding Is a Trauma First Aid Kit available ? NO ■ Use any clean cloth ■ Apply steady direct pressure directly on the wound YES Where is the wound? Arm or leg neck, shoulder, groin Is tourniquet available? YES ■ Apply above the bleeding site ■ Tighten until the bleeding stops NO ■ Pack the wound with bleeding control (hemostatic) gauze (preferred), any gauze, or clean cloth ■ Apply steady direct pressure 13
The only thing more tragic than a death from bleeding… IS A DEATH THAT COULD HAVE BEEN PREVENTED. The ‘Stop the Bleed’ campaign was initiated by a federal interagency workgroup convened by the National Security Council Staff, The White House. The purpose of the campaign is to build national resilience by better preparing the public to save lives by raising awareness of basic actions to stop life threatening bleeding following everyday emergencies and man-made and natural disasters.