1. HEMORRHAGE CONTROL RIFLES LIFESAVERS

2. Core SkillsControl Bleeding2 Introduction Review types of injuries Review types of injuries Review Tactical Combat Casualty Care Review Tactical Combat Casualty Care Evaluate and control bleeding Evaluate and control bleeding Take home message: HEMORRHAGE CONTROL SAVES LIVES Take home message: HEMORRHAGE CONTROL SAVES LIVES

3. Core SkillsControl Bleeding3 Facts and Tips Blood volume of the adult human body Blood volume of the adult human body Approximately 5 to 6 liters Approximately 5 to 6 liters Loss of as little as 2 pints may cause shock Loss of as little as 2 pints may cause shock Field blood pressures, when palpable pulse is appreciated Field blood pressures, when palpable pulse is appreciated Carotid: SBP>60 mmHg Carotid: SBP>60 mmHg Femoral: SBP>70 mmHg Femoral: SBP>70 mmHg Radial: SBP>80 mmHg Radial: SBP>80 mmHg

4. Core SkillsControl Bleeding4 Sources of Bleeding Arterial Arterial - Rapid, profuse and pulsating - Bright red in color Venous Venous - Steady flow, nonpulsating - Dark red or maroon in color Capillary Capillary - Slow and oozing - Often clots spontaneously, not dangerous

5. Core SkillsControl Bleeding5 External Bleeding

6. Core SkillsControl Bleeding6 Types of External Bleeding Lacerations Lacerations Abrasions Abrasions Puncture wounds Puncture wounds Amputations Amputations Avulsions Avulsions

7. Core SkillsControl Bleeding7 Laceration

8. Core SkillsControl Bleeding8 Abrasion

9. Core SkillsControl Bleeding9 Puncture Wound

10. Core SkillsControl Bleeding10Amputations

11. Core SkillsControl Bleeding11Avulsion

12. Core SkillsControl Bleeding12 Internal Bleeding Can occur with blunt or penetrating trauma Can occur with blunt or penetrating trauma Suspicion based on mechanism of injury Suspicion based on mechanism of injury Falls Falls Blast injuries Blast injuries Penetrating trauma Penetrating trauma

13. Core SkillsControl Bleeding13 Causes of Internal Bleeding Blunt Trauma Blunt Trauma Auto vs. pedestrian Auto vs. pedestrian Motor vehicle accidents Motor vehicle accidents Falls Falls Blast injuries Blast injuries Etc. Etc. Penetrating injuries Penetrating injuries Gunshot wounds Stab wounds Shrapnel wounds

14. Core SkillsControl Bleeding14 Internal Bleeding Signs and Symptoms Signs and Symptoms Pain, tenderness, swelling, discoloration at injury site Pain, tenderness, swelling, discoloration at injury site Bleeding from any body orifice Bleeding from any body orifice Vomiting blood Vomiting blood Tender, rigid, or distended abdomen Tender, rigid, or distended abdomen

15. Core SkillsControl Bleeding15 Internal Bleeding

16. Core SkillsControl Bleeding16 Injured Internal Organs

17. Core SkillsControl Bleeding17 Internal Bleeding Can result in rapid progression to hypovolemic shock and death Can result in rapid progression to hypovolemic shock and death IV fluids may buy time IV fluids may buy time The scalpel is the cure: The rapidly spiraling patient requires surgical intervention The scalpel is the cure: The rapidly spiraling patient requires surgical intervention Immediate evacuation Immediate evacuation

18. Core SkillsControl Bleeding18 CARE UNDER FIRE “The best medicine on any battlefield is fire superiority” “The best medicine on any battlefield is fire superiority” Control of hemorrhage is essential since injury to a major vessel can result in hypovolemic shock in a short time frame Control of hemorrhage is essential since injury to a major vessel can result in hypovolemic shock in a short time frame 2/3 of all preventable combat deaths are due to hemorrhage from extremities 2/3 of all preventable combat deaths are due to hemorrhage from extremities

19. Core SkillsControl Bleeding19 CARE UNDER FIRE Prompt use of tourniquets to stop the bleeding may be life saving Prompt use of tourniquets to stop the bleeding may be life saving Various types of tourniquets exist Various types of tourniquets exist Combat application tourniquet (CAT) Combat application tourniquet (CAT) Theraband Theraband Cloth and stick Cloth and stick

20. Core SkillsControl Bleeding20 TACTICAL FIELD CARE Evaluation begins with ABCs with attention to priorities Evaluation begins with ABCs with attention to priorities Any bleeding site not previously controlled should be addressed Any bleeding site not previously controlled should be addressed Significant bleeding should be controlled using a tourniquet Significant bleeding should be controlled using a tourniquet Initiate IV fluids Initiate IV fluids Prepare for evacuation Prepare for evacuation

21. Core SkillsControl Bleeding21 STOP THE BLEEDING ! Apply direct pressure with gauze or Israeli dressing Apply direct pressure with gauze or Israeli dressing Elevate the extremity above the heart Elevate the extremity above the heart Apply additional dressings if wound continues to bleed Apply additional dressings if wound continues to bleed Apply pressure to appropriate pressure point if continues to bleed Apply pressure to appropriate pressure point if continues to bleed Immobilize injured extremity with a splint Immobilize injured extremity with a splint Apply tourniquet if continues to bleed Apply tourniquet if continues to bleed Initiate IV fluids and treatment for shock as needed Initiate IV fluids and treatment for shock as needed

22. Core SkillsControl Bleeding22 Pressure Points May be helpful with severe bleeding as an adjunct May be helpful with severe bleeding as an adjunct Apply when bleeding not controlled by direct pressure and elevation Apply when bleeding not controlled by direct pressure and elevation Apply pressure to appropriate pressure point Apply pressure to appropriate pressure point (

23. Core SkillsControl Bleeding23 Important Pressure Points Brachial Brachial Femoral Femoral (

24. Core SkillsControl Bleeding24 Brachial Pressure Point Located in upper arm above the elbow in the groove between muscles Located in upper arm above the elbow in the groove between muscles Apply pressure to the inside of the arm over the bone using the fingers or thumb Apply pressure to the inside of the arm over the bone using the fingers or thumb

25. Core SkillsControl Bleeding25 Brachial Pressure Point

26. Core SkillsControl Bleeding26 Brachial Pressure Point

27. Core SkillsControl Bleeding27 Femoral Pressure Point To control severe bleeding of thigh and lower leg To control severe bleeding of thigh and lower leg Located at front, center part of crease the groin Located at front, center part of crease in the groin

28. Core SkillsControl Bleeding28 Splints Immobilization of the injured extremity is one of the best ways to stop bleeding Immobilization of the injured extremity is one of the best ways to stop bleeding Broken bone fragments may lacerate blood vessels Broken bone fragments may lacerate blood vessels Muscular activity will increase rate of blood flow Muscular activity will increase rate of blood flow

29. Core SkillsControl Bleeding29 Tourniquets Early use of a tourniquet in the setting of forceful arterial bleeding, such as an amputation, may be life-saving Early use of a tourniquet in the setting of forceful arterial bleeding, such as an amputation, may be life-saving STOP THE BLEEDING! STOP THE BLEEDING!

30. Core SkillsControl Bleeding30 Tourniquets Use a commercial tourniquet, such as the Combat Application Tourniquet, if available Use a commercial tourniquet, such as the Combat Application Tourniquet, if available If not available, then use.. If not available, then use.. Cravat Cravat Belt Belt Rope Rope Strap from LBE Strap from LBE Any available material Any available material

31. Core SkillsControl Bleeding31 Combat Application Tourniquet WINDLASS OMNI TAPE BAND WINDLASS STRAP

32. Core SkillsControl Bleeding32 Tourniquet Application Place tourniquet between the heart and wound Place tourniquet between the heart and wound Wrap tourniquet around extremity Wrap tourniquet around extremity Tighten UNTIL BLEEDING STOPS Tighten UNTIL BLEEDING STOPS

33. Core SkillsControl Bleeding33 Tourniquet Application

34. Core SkillsControl Bleeding34 Tourniquet Self-Application

35. Core SkillsControl Bleeding35 Tourniquet Etiquette Never cover a tourniquet with another dressing, etc. Never cover a tourniquet with another dressing, etc. Write “T” on the casualty's forehead with pen or blood Write “T” on the casualty's forehead with pen or blood Never loosen or remove a tourniquet once placed Never loosen or remove a tourniquet once placed

36. Core SkillsControl Bleeding36 Amputation First, STOP THE BLEEDING! First, STOP THE BLEEDING! Use direct pressure, Israeli dressing, or tourniquet as necessary Use direct pressure, Israeli dressing, or tourniquet as necessary Apply dressing to cover end of the stump Apply dressing to cover end of the stump Blood vessels may collapse, retract or curl closed and limit bleeding Blood vessels may collapse, retract or curl closed and limit bleeding

37. Core SkillsControl Bleeding37 Summary Care Under Fire: Stop significant bleeding with tourniquet while returning fire Care Under Fire: Stop significant bleeding with tourniquet while returning fire Tactical Field Care: ABCs with attention to stopping significant bleeding Tactical Field Care: ABCs with attention to stopping significant bleeding Evacuation Care: Treat shock with IV fluids, rapid evacuation to surgical assets Evacuation Care: Treat shock with IV fluids, rapid evacuation to surgical assets This knowledge will save lives in Iraq, maybe your own This knowledge will save lives in Iraq, maybe your own

38. Core SkillsControl Bleeding38 Questions?