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TOURNIQUET BREAKOUT SESSION

OBJECTIVES

Identify signs of life-threatening bleeding
Describe the principles related to bleeding control until help arrives

HEALTHCARE DISASTER MANAGEMENT TRAINING

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Define “Active Shooter”

“The FBI defines an ‘active shooter’ as one or more individuals actively engaged in killing or attempting to kill people in a populated area.”

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EPIDEMIOLOGY

~ 60,000 people die each year from uncontrolled hemorrhage, 75% due to physical trauma

There have been at least 607 mass shootings through November 22 this year. That’s just short of the 638 mass shootings in the country at this point last year – the worst year on record since the group began tracking them in 2014. There were a total of 690 mass shootings in 2021. The United States is likely to soon surpass the total of 610 mass shootings in 2020, with more than a month left of 2022 to go.

Latif, R.K., Clifford, S.P., Baker, J.A. et al. Traumatic hemorrhage and chain of survival. Scand J Trauma Resusc Emerg Med 31, 25 (2023). https://doi.org/10.1186/s13049-023-01088-8

National Trauma Institute, available at https://www.nattrauma.org/trauma-statistics-facts/. Accessed on 6/29/2023

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FBI 2024 Active Shooter Incidents Snapshot

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www.fbi.gov/file-repository/reports-and-publications/2024-active-shooter-report/view

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STOP THE BLEED PROGRAM

HEALTHCARE DISASTER MANAGEMENT TRAINING

5 million people world-wide die from trauma every year

A victim who is bleeding from an artery can dies in as little as 3 minutes

30-40% of hemorrhage accounts for 30-40% of all deaths for patients injured in the prehospital environment

There have been at least 607 mass shootings through November 22 this year. That’s just short of the 638 mass shootings in the country at this point last year – the worst year on record since the group began tracking them in 2014. There were a total of 690 mass shootings in 2021. The United States is likely to soon surpass the total of 610 mass shootings in 2020, with more than a month left of 2022 to go.

Latif, R.K., Clifford, S.P., Baker, J.A. et al. Traumatic hemorrhage and chain of survival. Scand J Trauma Resusc Emerg Med 31, 25 (2023). https://doi.org/10.1186/s13049-023-01088-8

National Trauma Institute, available at https://www.nattrauma.org/trauma-statistics-facts/. Accessed on 6/29/2023

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STOP THE BLEED

Main Points

Personal Safety
A - Alert 9 1 1
B - Bleeding
C - Control Bleeding (compress/tourniquet)

Identify where the blood is coming from

Wait for help to arrive

HEALTHCARE DISASTER MANAGEMENT TRAINING

Safety YOUR safety is YOUR first priority. If you are injured, you cannot help others. Help others only when safe to do so. If the situation becomes unsafe, stop, move to safety, if possible, that

PPE (transmission extremely low) wear gloves. Wash hands after contact, tell a health care provider you were exposed for follow up

Alert 9 1 1- Call or have someone call 9 1 1. Know your location, follow instructions of medical dispatcher (likely to ask what happened? when did it occur? Location? Number of victims? Ongoing threats to safety?

Bleeding- find source. Make sure to find other sources of bleeding.

Control Bleeding (compress/tourniquet)

Direct pressure, if bleeding stops, continue pressure until 9 1 1 arrives
Tourniquet: Extremity bleeding that doesn’t stop with direct pressure.

Apply 2-3” above wound
DO NOT place over elbow or knee (for groin/joints, TQ will not work-Direct pressure)
Tighten until bleeding stops
DO NOT remove the TQ
If bleeding doesn’t stop, apply a second TQ

PAIN is expected

Wait for help to arrive

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BLEEDING CONTROL

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ABC’S OF BLEEDING CONTROL

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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.

HEALTHCARE DISASTER MANAGEMENT TRAINING

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FAQs

Should you remove impaled objects?
What is the next step after personal safety?
Will the victim lose an arm or leg from a tourniquet?
Are tourniquets painful?
When can you remove the tourniquet?
Other questions?

HEALTHCARE DISASTER MANAGEMENT TRAINING

Review:

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.
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. After checking the scene and ensuring personal safety, what is the next step you should take when helping someone with severe bleeding?