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STOP THE BLEED® Course�American College of Surgeons

STOPTHEBLEED.ORG

BLEEDINGCONTROL.ORG

Version 2

STOP THE BLEED® is a registered trademark of the U.S. Department of Defense

SAVE A LIFE

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The American

College of Surgeons Committee on Trauma

The Committee on Tactical Combat Casualty Care

The National Association of

Emergency Medical Technicians

The American

College of Emergency Physicians

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Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

Some of the images shown during this presentation may be disturbing to some people.

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Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

Why Do I Need This Training?

The #1 cause of preventable death � after injury is bleeding.

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Where Can I Use This Training?

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

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Goals

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

1. Identify

Recognize

life-threatening bleeding

Stop the Bleed

�Take steps to

STOP THE BLEEDING

Pressure

✓ Packing

✓ Tourniquets

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Personal Safety

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

YOUR safety is YOUR first priority

If you are injured, you cannot help others
Help others only when it’s safe to do so
If the situation changes or becomes unsafe:

✓ Stop

✓ Move to safety

✓ If you can, take the victim with you

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Personal Safety

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

YOUR safety is YOUR first priority

Wear gloves if you can
If you get blood on you, be sure to clean any part of your body that the blood has touched
Tell a health care provider that you got blood on you, and follow his or her direction

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Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

ABCs of Bleeding Control

A Alert 911

B Bleeding

C Compress

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Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

ABCs of Bleeding Control

A Alert 911

B Bleeding

C Compress

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

A Alert 911

Call 911
Know your location
Follow instructions provided by 911 operator

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Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

ABCs of Bleeding Control

A Alert 911

B Bleeding

C Compress

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

B Bleeding

Find source of bleeding
Look for:

Continuous bleeding
Large-volume bleeding
Pooling of blood

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

B Bleeding

There may be multiple places the victim is bleeding
Clothing may also hide

life-threatening bleeding

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

B Bleeding

Arms and legs

Neck, armpits, �and groin

Body

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

A Alert 911 B Bleeding

C Compress - Pressure

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

C Compress - Pressure

Apply direct pressure to wound
Focus on the location of the bleeding
Use just enough gauze or cloth to cover injury
If pressure stops the bleeding, keep pressure on wound until help arrives

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

C Compress - Packing

For large wounds, superficial �pressure is not effective
If bleeding is from a deep wound, pack gauze tightly into the wound until it stops the bleeding; hold pressure until help arrives
A bleeding control kit may contain hemostatic gauze (gauze that is coated with material that helps the blood clot). Both types of gauze can be used to pack the wound in the same fashion.

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

C Compress - Packing

Arms and legs

Neck, armpits, �and groin

Body

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

C Compress - Tourniquet

Apply 2 to 3 inches above wound
Do not place over the elbow or knee
Tighten tourniquet until bleeding stops
Do NOT remove the tourniquet

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

C Compress - Tourniquet

Can apply to others or on yourself
Can be applied over clothes
Tourniquets HURT
A second tourniquet may be required to stop the bleeding

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

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ABCs of Bleeding Control

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

CAT

RMT

TX3

SAM-XT

TMT

CAT

SOFT-TT

Several tourniquet models are commercially available. The Committee on Tactical Combat Casualty Care also known as CoTCCC or TCCC is the resource the Committee on Trauma Stop the Bleed Program utilizes for direction regarding equipment.

This slide depicts tourniquets that are approved and listed on the TCCC’s adjunct formulary, however not every version of the approved tourniquet is shown. The next slide, Slide 26, provides a by name list of tourniquets approved through TCCC.

Our course teaches the use of a Windlass rod type tourniquet.

Instructors should discuss the mechanisms of the types of tourniquets and differentiate between windlass rod types and ratcheting types. In addition, the instructor should advise participants they may see any of these tourniquets in the field and should familiarize themselves with the tourniquet and how it works. The students in the school class should be taught to use the tourniquets available in their bleeding control kit.

It is important to stress that improvised tourniquets are difficult to make and to apply correctly, and may in fact increase the bleeding by compressing the venous structures. Their utility has not been scientifically proven and therefore caution should be used when considering their use.

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CoTCCC Recommended STB Tourniquets

Recommended Non-Pneumatic Limb Tourniquets

Combat Application Tourniquet Gen 6 (CAT-6)
Combat Application Tourniquet Gen 7 (CAT-7)
Ratcheting Medical Tourniquet (RMT) Tactical
SAM Extremity Tourniquet (SAM-XT)
SOF Tactical Tourniquet–Wide (SOFTT-Wide)
Tactical Mechanical Tourniquet (TMT)
TX2 Tourniquet (TX2)
TX3 Tourniquet (TX3)�

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

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CoTCCC Recommended STB Tourniquets

Recommended Pneumatic Limb Tourniquets

Delphi EMT (EMT)

Tactical Pneumatic Tourniquet 2” (TPT2)��

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

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Bleeding control in children

In all but the extremely young child, the same tourniquet used for adults can be used in children.

For the infant or very small child (tourniquet too big), direct pressure on the wound as described previously will work in virtually all cases.

For large, deep wounds, wound packing can be performed in children just as in adults using the same technique as described previously.

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

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Texas School Bleeding Control Kit: Other Supplies

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

In addition to bleeding control equipment your school bleeding control kit may have:

a thermal blanket
a chest seal kit (ideally for medically trained responders)

The thermal blanket is designed to keep victims warm
The chest seal is designed to temporarily assist with certain types of chest wounds

Adhesive chest seal

The Texas School Stop the Bleed legislation (HB496) signed into law requires certain materials in a bleeding control kit. The language in the law is noted below. We recommend school personnel be aware and familiar with the materials and equipment in their kit.

Wording from the legislation:

“(4)(d) A bleeding control station required under this section must contain all of the following required supplies in quantities determined appropriate by the superintendent of the district or the director of the school:

(1) tourniquets approved for use in battlefield trauma care by the armed forces of the United States;

(2) chest seals;

(3) compression bandages;

(4) bleeding control bandages;

(5) space emergency blankets;

(6) latex-free gloves;

(7) markers;

(8) scissors; and

(9) instructional documents developed by the American College of Surgeons or the United States Department of Homeland Security detailing methods to prevent blood loss following a traumatic event.

(e) In addition to the items listed under Subsection (d), a school district or open-enrollment charter school may also include in a bleeding control station any medical material or equipment that:

(1) may be readily stored in a bleeding control station;

(2) may be used to adequately treat an injury involving traumatic blood loss; and

(3) is approved by local law enforcement or emergency medical services personnel.”

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Avoiding Hypothermia: Thermal Blankets

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

Patients can lose body heat rapidly after an injury
This can lead to impaired bodily functions and even death
Life threatening heat loss can even occur on a hot summer day
Once the bleeding has been stopped, do what you can to prevent heat loss

Remove wet clothing
Cover with a warm blanket or clothing
Shelter from the elements

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Instructions Chest Seal: For Medically Trained Responder

Clean and dry skin around wound

Grasp the plastic tab

Peel backing away from seal

Apply on wound adhesive side down, centering the vent over the wound

Repeat for other chest wounds

Evaluate the patient for improvement

If the patient condition worsens, remove chest seal

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FAQs

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

Impaled objects?
Improvised tourniquets?
Loss of arm or leg?
Pain?
Other questions?

These are common concerns. Take the time to review these carefully with your students.

Impaled objects should be left in place and not removed. The immediate responder could apply a tourniquet above the object. Professional medical personnel, Fire and EMS, are trained to treat impaled objects.

Improvised tourniquets – notes from slide 25 should be reiterated

Loss of arm or leg is referring to the fear that a tourniquet could result in the victim losing their arm or leg if the immediate responder places a tourniquet on the victim. Reassure them that placing a tourniquet on a victim will save their life and far outweighs the loss of an extremity. There are studies available regarding length of time of tourniquet placement.

Victims will experience pain with direct pressure, wound packing, and tourniquet application. It is important to manage their expectations regarding all three techniques for controlling bleeding.

Other questions can and will be asked, please note questions and send to unique questions or questions that you cannot answer to STB staff to provide a response for you and for future course updates.

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For more information:

Stop the Bleed Course v. 2.0

STOPTHEBLEED.ORG

BLEEDINGCONTROL.ORG

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Summary

Stop the Bleed Course v. 2.0

Introduction | A-Alert | B-Bleeding | C-Compression |

Personal safety A Alert 911

B Find bleeding C Compress with

pressure and/or packing

C Compress with a tourniquet

Wait for help to arrive

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The only thing more tragic than a death… is a death that could have been prevented.

Stop the Bleed Course v. 2.0

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Small Groups for skill training and education�Wound packing and direct pressure�Tourniquet application �

Stop the Bleed Course v. 2.0