London attacks - First aid and Hemorrhage control
Last week we witnessed another “Lone Wolf” style attack on a European Capital, this time London, firstly we send our condolences to the family’s of the victims, and secondly we send thanks to the emergency services, as always they acted selflessly and professionally. It’s too early make an in depth analysis of the events, and more importantly, an analysis of the events leading up to the attack itself, but as the investigation unfolds It will be interesting to note any opportunities to have Broken the Attack Cycle prior to the Attack phase.
The simplistic nature of this incident, illustrates once more just how easy it is to bring a city to standstill, Any person, with the inclination, a car, a couple of kitchen knives and an unsophisticated plan can cause a major incident.
So, we thought rather than try to unravel the events at an early stage we would write a brief post regarding the benefits of learning first aid, more specifically hemorrhage control as it would appear, stabbing and slashing at the general public has become a terrorist Modus operandi, so lets have a think about what we, as the public can do do preserve life in the aftermath of an attack.
Thankfully, nowadays, more and more of the general public are learning First Aid, each work place must have a designated First-Aider and a box of First Aid equipment, this is a great start. This uptake of learning, along with the public placement of Automated External Defibrillators (AED’s) and education regarding their use has seen victim survivability increase dramatically in those suffering a Heart Attack. But with regards to bleed control / mass hemorrhage the basic level public training has improved little.
Depending on your age and when and where you may have completed your training you may remember different mnemonics from your First Aid course….ABC – DRABC – DRSABC – CAB - MARCH, you may have different ideas about amount of compressions / ratios to breaths, some people may think it’s wise to immediately put the casualty into a recovery position and some may not! It’s a topic with much confusion for some, But one thing most will not have covered extensively on a basic course is advanced control of bleeding. At best there will be some talk of indirect / direct pressure, the application of bandages and elevation of the wound.
Before continuing onto the subject of bleed control, we would however recommend that if you haven’t studied first aid in a while or are confused about the items above / confused about the correct and current procedures for CPR / Defib then after reading this article (or even better right now!) Get yourself booked on a basic First Aid course!
In the UK we have organisations such as the Red Cross who provide a good level of First Aid training UK wide, there are also many independent trainers such as friend of CPM’s Danny Hyde, who following a career with the Fire Service is doing great things providing training and raising money for schools to buy defibrillators – His website can be found by clicking here! And then of course over here in Spain we have the counterpart of the Red Cross, La Cruz Roja! Wherever you decide to train, just make sure you do!
So, why does losing blood cause a problem? Well, short answer is that a loss of blood leads your body down a path towards Hypovolemic (Low Volume) shock, this actually occurs pretty rapidly, and at about 20% loss this will become life threatening, as your blood volume decreases the body is unable to ensure that Oxygen / nutrient rich blood reaches the body tissues and organs, as less and less does these organs will begin to shut down.
So, how does one identify hypovolemic shock? Well, a huge amount of visible blood loss is certainly an indicator, it’s safe to say if attending an incident whereby there has been a traumatic amputation, severe stab or gunshot wound then it’s likely that blood loss is going to be a problem, but trauma isn’t always so visible. With blast injuries, blunt force trauma or a fall for example, the bleed may be internal, this is harder to identify.
A patient with an internal bleed will likely have pain radiating from the area of the bleed itself, depending on the area and size of bleed there may or may not be bruising, there may be visible distortion to the area of the body in which the injury has taken place, as the bleed becomes more severe they will likely be confused, cold, clammy, will have a rapid / weak pulse, they may faint / lose consciousness altogether. As a member of the public, there is little one can do to treat someone with a severe Internal bleed, they need immediate emergency care from a medical professional, once you are sure the medical services are on the way you may treat the patient for shock, keep them calm, comfortable, warm and reassure them help is on the way, if they lose consciousness then monitor their HR and breathing, be prepared to carry out CPR if they lose the ability to pump blood or breathe for themselves. For external bleeds there are of course more options.
There are various types of external bleed, Capillary, Venous and Arterial – A Capillary Bleed is the type most people are used to dealing with, Capillaries, whilst tiny have important functions throughout the body, but thankfully despite this, a minor scrape or cut resulting in capillary rupture externally is not going to cause you too many problems, we’ve all been there, little bit of a bleed, apply some pressure, wait a bit and it’ll stop, at most you may want a bandage or a plaster, of course elevating the affected area will also help the blood flow stop if you’re in a rush!
Venous bleeds are generally characterised by a continuous flow of dark red blood, This colour comes from the fact that the veins carry De-oxygenated blood back to the Heart, Hemoglobin is the substance that binds to blood oxygen in Oxygenated blood and gives it the Red colour, since venal blood is lacking oxygen there is lower hemoglobin count, accounting for the darker colour.
A venous bleed can still be dangerous, deep veins if cut can lose blood quickly, but normally a venous bleed can be controlled by exerting direct pressure onto the wound with a bandage (assuming no foreign body within the wound itself) The bleed should be stemmed within a few minutes of pressure, you’re then able to bandage correctly. As with above elevating the limb will help with control, if you can’t get control through direct pressure and bandaging then seek medical attention, it may be the case that the wound needs stitching / gluing anyhow, as always, if in doubt get it checked by a professional.
Arterial bleeds will generally result in a large volume of blood and often in spurts, the blood will be bright red due to the high levels of Oxygen / Hemoglobin, if severe enough an Arterial bleed can cause death within minutes.
The purpose of our writing from here on out is to really explore the severe bleed, Basic First Aid qualifications are great, but, justifiably, they spend more time on CPR and Capillary / Venal bleeding – Severe bleeds are covered, but the detail level is not in depth, on a basic First Aid course we are taught direct pressure, perhaps indirect pressure and the importance of summoning advanced medical care, but as the recent incident any many others have shown, there are times when it’s worth knowing more.
We’d like to use this article just to show some of the kit and equipment used by medical professionals to manage blood loss, at present there is some debate regarding whether it may or may not be useful to provide more training on these items to the public at a basic level – There was once a time when medical bodies wouldn’t have dreamed of handing over AED’s to the general public and now they are saving lives!
Lets look at some of the items in use below and see what you think! Could you see them ever being used by Joe Public? Could they be included in the box alongside an AED? …… We’d love to read your comments, especially from medical professionals themselves.
The Tourniquet has been seen on the battlefield since the Middle Ages, its a simple solution to a major battlefield problem! Someone has a severe bleed, you can’t stop it, lets get something tightly above the wound to tighten and constrict, thus stopping the bleeding!
No doubt it started with rags and sticks, then over time developed and evolved, nowadays there are many different types of medical tourniquet in use for various procedures, but the one that is most prevalent, especially with regards to trauma is the CAT Tourniquet, or one of the many imitations, It’s simple to apply (even one handed) easy to use and does exactly what it’s meant to do.
Over the last decade on the battlefields of both Iraq and Afghanistan these have been applied again and again saving countless lives, these items are now carried on Ambulances by Technicians / Paramedics and by Policemen, is it too much of a stretch of the imagination to think they may be added to AED boxes in public places or the work first Aid box in the future? Take a look at the video below and see what you think!
Quikclot Combat Gauze
This is a 3 inch by 3.5 metre gauze strip, impregnated with a Haemostatic agent, in this case the mineral Kaolin, the gauze comes in a vacuum packed package and lasts for 5 years, it’s small easy to carry and great at doing what it’s meant to do. The Haemostatic agent it contains aids clotting, actually speeding up the time by a factor of 4, it’s great for packing into a deep wound site so as to get to where it’s needed, on hard to access areas where you can’t use a CAT such as the groin, or a large open wound this is ideal, you can pack it out with gauze before bandaging. As with the CAT it’s fairly easy to use and not a great deal of scope for user error.
Celox-A Haemostat Applicator
As with the Quikclot and CAT, this is so simple to use, it works much like the expanding foam used to fill gaps around a window! But rather than preserving your heating bill escalating it’s preserving life, the applicator in is placed into a wound, the plunger is pressed and the Celox granules are dispensed into the wound just where they’re needed. This applicator is particularly good for penetrating wounds, gun shots, stab wounds and wounds with small entry points. Video tutorial below.
Unlikely that administration of I.V Fluids will be something the public will be able to do anytime soon, and rightly so, but with the pace of technology change and Artificial Intelligence, who knows, perhaps the future will see a device similar to that of an AED that automates the process. As noted above, a loss of blood, loss of blood volume leads to hypovolemic shock, various fluids are often administered directly into the veins (IV cannulation) after traumatic blood loss so as to stabilise the patient, there are various bagged solutions and of course donor blood itself, the latter being vital for saving life through restoration of volume and oxygen carrying capacity. Video below is a guide to I.V Fluids (for the Geeks among you)
PYNG Fast Responder – Sternal Intraosseos Device
Ok, so this isn’t technically for directly controlling hemorrhage, instead this is a device, similar to that of an I.V cannula, it’s an access port and allows rapid infusion of fluids into the body, In certain situations, one can appreciate it’s difficult to cannulate a casualty, this device allows you to make connection directly into bone matter in a matter of seconds and infuse fluids as normal, the video below shows just how effective this device is!
So! that wraps up this article for now, as always, we hope it gives you something to discuss and something to think about – How would you deal with a situation? Do you have the skills required to deal with an unconscious casualty or someone with a major bleed? We hope you’ll never have to, but it’s always better to have knowledge and not need it than to need knowledge and not have it!
Perhaps this will spur you into getting some training, then buying a med kit with some haemostatic agents and a CAT! Keep it in the car or in you bag on a night out, imagine how many lives may be saved if everyone did the same, would there be as many victims of teen knife crime? As many grieving parents, we think not, the more education we can deliver the more equipment we are taught to use the more people survive and the more we combat acts of violence, stupidity or terror.