Hemorrhage Control

When there is a Catastrophic Bleed taking place a person's mind may be racing trying to figure out "what do I do, what do I do". Well hopefully having the 4D's resting in the back of your mind after today will help Combat that uncertainty. There are basic actions and concepts that must be taken to ensure a severe bleed is managed correctly, as a rule, "the 4 D's of massive Hemorrhage" will help you remember some critical points. When dealing with a trauma resulting in a massive Hemorrhage, you should make every effort to visualize the wound whenever it's possible, and safe, to do so.

  • Give strong consideration to prophylactically applying a tourniquet to the affected limb without tightening in all but the most minor cases of hemorrhage. Situations can change rapidly and being prepared for the unexpected is the safest practice.

REMEMBER the 4 Ds of Massive Hemorrhage Control

  • DETECTing the Bleed makes it to the top of the list because blood travels, and just because you see a dark red area on a casualties clothes does NOT mean that's where the injury is located (Gravity is not your friend). Exposing the wound enables you to know what you're dealing with and manage it accordingly, will direct pressure suffice, or will this need a Tourniquet to effectively occlude blood flow?

  • A wound that is deep, bleeding heavily, or has blood spurting from it (which as we covered yesterday would be caused by bleeding from an artery), may not clot and may not stop bleeding.

  • DIRECT PRESSURE has long been held as the gold standard to address a serious Bleed. Take any clean cloth and cover the wound (provided you don't have emergency medical supplies on hand Such as Gauze). If the wound is large and deep, try to insert the cloth down into the wound (unless there is something clearly protruding, e.g. A piece of metal or foreign object). Apply continuous direct pressure with both hands directly on top of the bleeding wound. When I say firm pressure I mean push down as hard as you can on that wound site. Ideally, this firm direct pressure will stop or significantly reduce the Hemorrhage. So where do you turn if direct pressure has failed to cease the bleeding?

  • DEVICES, such as commercial Tourniquets like North American Rescues Combat Application Tourniquet (CAT TQ), Tac Meds SOFTactical Tourniquet, and to a lesser extent, the compact SWAT T or Esmarch Bandage. Now don't worry, if you don't carry a commercial Tourniquet (TQ) there are many ways to improvise one if need be, and, if you know what you're doing. I however would strongly encourage all of you to carry a commercial TQ, they are fast, proven, and effective in managing severe Hemorrhage. With a serious Bleed every second counts and when an artery is involved you literally have minutes, so every single second counts.

  • The last point I'm going to touch on is more for those of us that have a medical background and will be providing Intravenous Interventions.

  • DON'T DILUTE, with a Massive Hemorrhage taking place IV Fluid replacement ,will be conducted. The "Dilution" is simply referring to providing too much fluid too fast, thus diluting the casualty's clotting factors and possibly dislodging an established clot. If that happens, well, we just created another problem and went ahead with making a bad scenario much worse. There is simply no better fluid/solution than casualty receiving blood, more on that later.

  • So in closing, DETECT the injury, apply DIRECT pressure, utilize DEVICES if need be, and remember DON'T DILUTE.