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Why Bleeding Control Training Should be as common as CPR Training

There are numerous medical emergencies that require immediate intervention which simply cannot wait for Emergency Medical Services to get to the scene. Some of the most common are anaphylactic reactions(allergic reaction), choking, opioid overdoses, cardiac arrest, and, of course, uncontrolled bleeding. All of these are conditions that can kill a person very quickly if aid is not rendered in a timely manner. This has led to the creation of various training programs that have been taught around the world to First Responders and the general public alike. The most well known of these programs set a precedent by addressing Cardiac Arrest Intervention and early response by the lay person. It’s known as CPR Training, or Cardio-Pulmonary Resuscitation. The techniques of CPR consist of providing chest compressions to the sternum in the area directly above the heart and Rescue Breaths through the airway and down into the lungs during Cardiac Arrest. This is all done to supply the brain and other areas of the body with oxygenated blood flow. Another aspect of this training is learning how to use an AED, or Automated External Defibrillator, in conjunction with chest compressions and rescue breaths to deliver a measured electrical charge in the hopes that this dose of electricity will interrupt dangerous heart rhythms, kickstarting the patient's heart back into its normal rhythm. Many medical problems can cause cardiac arrest, but in the heat of the moment, the most important thing is that early CPR is performed along with the appropriate application of an AED. Thanks to this training being so widespread, the use of its techniques have saved countless people's lives.

Just as early CPR is important to creating positive outcomes for patients experiencing cardiac arrest, so too is proper bleeding control techniques to those who have experienced a traumatic injury. The strong emphasis that already exists for CPR training regarding lay people could translate into more lives saved if the same type of strong emphasis were applied to Bleeding Control training.

Many First Aid courses mention bleeding control, but it is as a fleeting footnote without actually investing time in proper training of the students. Also, several of the curriculums still maintain older models regarding the most appropriate immediate interventions- placing tourniquet use as the last resort method. Tourniquet use should, in fact, be the first thing someone rendering aid considers. In recent years, the Bleeding Control Program initiated by the National Association of EMT’s (NAEMT) and currently endorsed by the American College of Surgeons as the Stop-the-Bleed Campaign has provided a much needed solution for bleeding control training. This program breaks down the fundamental life-saving knowledge required to render aid during a blood loss emergency.

A lot of people unfamiliar with tourniquets may be wondering how they are actually implemented during an emergency response. Tourniquets are used to control bleeding from arterial wounds to the upper and lower extremities by applying significant pressure to the blood vessels above the site of the injury. This occludes blood flow to the area, allowing the patient's body to retain its vehicle for transporting oxygen throughout. The tourniquet applies pressure through the use of a mechanical advantage often given by a windlass, a metal or plastic rod situated on the device. The Committee on Tactical Combat Casualty Care has provided numerous recommendations on commercially available tourniquets that have shown extremely high success rates in controlling bleeding to arterial extremity injuries. To further illustrate why rapid response is important, we have to take into account how quickly a person can bleed to death from an injury. The human body contains about 5 Litres of blood volume, give or take some depending on the person. Typically, a healthy person can lose up to 1.5 Litres (1500 ml) of blood before they reach a point where positive outcomes are greatly diminished for the patient. This figure relies on the idea that the patient in question is relatively healthy and does not have any pre-existing conditions that would further complicate their bodies ability to compensate for traumatic injuries. The reality of the world we live in, though, is that a lot of people have health problems and take medications that hinder their bodies’ ability to naturally produce a clot that helps stop the bleeding. Another aspect to consider is the amount of time it takes for an individual to bleed out to the point of no return. Through a femoral artery injury, a person could lose their entire blood volume within two and a half minutes, let alone less time for them to reach the previously mentioned 1.5 litres. The best EMS response times in the United States come out of Chicago with an average of 6 minutes. The numbers just aren't on the patients’ side when they're experiencing an uncontrolled hemorrhage, which is why it is important that bleeding control stations and trained individuals are common throughout our communities.

Tourniquets have a long history in emergency medicine with the majority of that history touting that they should be a last resort, but US Military Case Studies on Preventable Battlefield Deaths have shown that proper application of CoTCCC approved commercially available tourniquets can be used for several hours without ill affect to the limb in question, and that even after extended periods of time, the risk can be minimal with proper awareness of the issues that accompany prolonged application. In the years since September 11th, 2001 and the start of the Global War on Terror, these numerous case studies by the US military and countless practical applications in the field have lead to a change of overall mindset regarding the first-line use of tourniquets in the military, and over the last 19 years this change of mindset has slowly trickled into Civilian EMS. The amount of people alive today because of proper tourniquet applications just goes to show their efficacy. Various stateside violent attacks such as The Boston Marathon Bombing, the Active Threat Attack at Sandy Hook Elementary School, and The Pulse Nightclub Shooting all demonstrate the need for early medical response. The Hartford Consensus, which examined the Sandy Hook Elementary School Incident looked at what could be done to decrease the loss of life during active threat attacks and determined that early intervention to uncontrolled bleeding through the use of tourniquets would have significant impact on preventing deaths in otherwise survivable injuries. If Active Threat Attacks are looked at as a whole, many times the injuries sustained by the victims have the potential for positive outcomes if aid is rendered in a timely manner. Most people who have died during said incidents have died because Emergency Services simply could not get to them in time. The published studies of the Hartford Consensus have led to the adoption of tourniquets as the go-to intervention for the majority of Civilian EMS Departments, which is a step in the right direction towards saving lives.

Aside from Tourniquets, hemostatic gauze is being included in bleeding control kits for wound areas that just aren't amedable to a tourniquet, such as junctional wounds to the pelvis(groin), armpit, and the neck. This gauze works by means of a chemical reaction when introduced to blood from the injured area by helping produce a clot, thus occluding blood flow. Direct pressure is applied for a specified amount of time into the wound channel with the hemostatic gauze onto the bleeding vessel. Numerous communities have already embraced Stop The Bleed Training and understand its importance, so much so that right beside AED Stations, Bleeding Control Kits are popping up with all the necessary medical supplies to treat life- threatening injuries.

To a large majority of the general public, much of the information in this article will be new or will shed a new light on the subject of bleeding control and why it and associated training programs are important for medical responders and everyday people alike. According to the Center for Disease Control the leading cause of death for all people under 44 years of age is unintentional injury, which only solidifies the need for more training and awareness of how to deal with traumatic injuries. While active threat attacks are statistically a rare occurrence, having the proper training, medical equipment, and mindset during these situations absolutely saves lives. However, a much more likely scenario involves incidents that occur all around us in our everyday lives, such as falls, car crashes, farm accidents, playground accidents, and injuries related to occupational hazards. The availability of bleeding control stations and Stop The Bleed training will only serve to benefit our communities as a whole.

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