How quickly can we give the most people this critical, life-saving information in the minimum amount of time? Pay attention we are going to proceed as rapidly as possible; covering all the required talking points and required demonstrations.
To ensure the audience is understanding the information we will have knowledge checks during the class, and a practical demonstration. To pass this class, the participant must demonstrate practical competency.
Knowledge check: What is the #1 cause of preventable death after injury? Bleeding.
Look for signs a person is bleeding, that may be
the spurting or pooling of blood,
the presence of bright red blood (arterial blood),
Act immediately - grab the wound or above the wound to cause pressure and slow or stop the flow of blood.
Knowledge check: What is your #1 priority? Your safety.
Knowledge check: What do the A, B, C stand for? Alert 911, Bleeding, Compression.
Yell - "Emergency! We need help!"
Point to someone and say - "You call 911!"
If help is not there you must call 911 yourself quickly.
A great tactic is to dial 911, put the phone on speaker and lay it down beside the patient, so you can both treat the patient and talk to the 911 dispatcher.
Know where you are.
Stay calm, and communicate your location and the situation clearly.
Address the first and most obvious source of bleeding, then methodically search the victim for other places where they may be bleeding.
Look for exit wounds and remove patients clothing if/as necessary.
KNOWLEDGE CHECK: After treating the most immediate bleeding issues what do you do next? Search for other places where the person may be bleeding.
Continuous bleeding or arterial bleeding from the arms down, or legs down are best treated with a tourniquet. When you see massive bleeding, or spurting of bright red blood on the arms/hands, legs/feet, or an amputation; immediately apply a tourniquet.
The fastest and generally best place to put the tourniquet is high up on the arm or leg, above the bicep muscle, or above the thigh. Be careful to remove any obstructions (i.e. pocket items) and avoid capturing the victims genitals with the tourniquet.
If the bleeding is coming from a junctional area, such as the shoulder, neck area, or hip flexors (including the groin, buttocks, etc.); the best treatment is to "Pack the wound" with gauze or cloth (as clean as possible, if possible).
In many situations, just applying direct pressure to the wound with your hands and/or with gauze or any cloth may be sufficient to stop the bleeding. Sometimes just tightly holding with direct pressure on the wound and holding it until emergency medical services arrive will be enough.
If the wound is larger than a finger and/or deep, you will need to "Pack the wound", ideally with gauze. The idea is to put pressure inside the wound with gauze or cloth and keep packing it to stop the flow of blood. Once the wound has been packed completely, then put the remainder of the packing material on top of the packed wound and apply steady pressure.
If it will be some time before medical assistance arrives, or if you must move the patient; you should wrap the wound securely so that steady pressure is applied.
KNOWLEDGE CHECK: For deep or large wounds in junctional areas, what technique is usually best? Wound packing.
A major hemorrhage on the arms/hands, legs/feet is occurring, immediately apply a tourniquet. If the source of the injury is known it may be better to apply the tourniquet 2 or 3 inches above the wound. If the source or extent of the injury is unknown, it is generally best to immediately apply the tourniquet "high and tight" on the upper arm, or upper leg. It may require more than one tourniquet to completely stop the bleed. Tighten the tourniquet until the bleeding stops.
Tourniquets are painful when applied correctly. It helps to tell the patient this is necessary and will save their life; reassure them as possible.
KNOWLEDGE CHECK: Can you apply a tourniquet over clothing? Yes.
KNOWLEDGE CHECK: Can you apply a tourniquet to yourself and/or others? Yes.
There are many approved "ready made" tourniquets available. You can and should use an improvised tourniquet if necessary.
Do not remove impaled objects, just pack bandages around and stabilize as much as possible.
Generally the loss of an extremity will bleed profusely and necessitate a tourniquet.
Massive trauma is often very painful, as is the application of a tourniquet. In combat medical situations, Soldiers are often given pain medication and general antibiotics immediately at the point of first medical treatment; this is outside the scope of this class.
Know several methods of creating and applying improvised bandages and tourniquets.
Punctures to the chest cavity that penetrate into the lungs require an occlusive dressing.
Abdominal wounds can not be packed, the best treatment is to cover the wound with gauze/cloth and get medical treatment as quickly as possible.
Hemostatic agents (wound clotting), particularly those that are impregnated into gauze can be as or more effective in creating a blood clotting effect. But they are expensive, may cause some complications, and expire relatively quickly.
Examples of improvised tourniquets:
Tape - strong duct tape wrapped many times increasingly tightly
Triangular bandages - wrap and twisting technique (learn it)
Strips of cloth (blankets, sheets, etc.)
Pressure bandages - Israeli and many others can become improvised tourniquets
Cordage - improvised, the wider and stronger the better
Some belts* (most pant belts will not work), seat belts, webbing, etc.
Ideally the constriction area is wider than an inch, two or three inches is better
Carry emergency supplies on and about your person.
Have handy at a minimum some compact gauze, and ready made/improvised tourniquets.
Know how and when to treat trauma, and teach others.
Learn several ways to improvise tourniquets and test them on yourself and friends.