HEMORRHAGE

CONTROL
EXERCISES
MYTH #5: DIRECT PRESSURE DEVICES CAN BE USED TO
CONTROL BLEEDING IN EVERY REGION OF THE BODY AND ON
EVERY WOUND.

Record your voice with your opinion about this myth

• An absolute contraindication to use of direct pressure devices, such as the iTClamp, is that it can’t be
used on the eyes and will not stop internal bleeding into the chest or abdominal cavities. The clamp
creates a pressure and watertight seal of the skin edges. The resulting wound pocket fills with blood
until pressures equalize and bleeding is tamponaded. The wound must be amenable to forming a
pocket for the clot to form. In order to do that, it requires skin edges be brought together, which
means the device will often be ineffective on large amputations, areas of large skin loss, and
extensive open wounds on mangled extremities. Tourniquets are better options for these types of
wounds.
• OPINION:
MYTH #6: TRAUMA PATIENTS SHOULD BE TREATED USING THE
AIRWAY, BREATHING, CIRCULATION, DISABILITY,
EXPOSURE/EXAMINATION APPROACH.

Record your voice with your opinion about this myth:

• The basis of this approach, which has been adopted by ATLS, PHTLS, ITLS, etc., is based on the idea that airway problems:
• Will cause death in the first few minutes;
• That breathing problems are next; and
• That death from bleeding takes somewhat longer.
• Therefore, the treatment priority has been ABC.
• The concern with this approach is that it doesn’t take into consideration the cause of, nor the length of time it takes to treat,
airway and breathing problems. For example, if the patient has airway and breathing problems because of loss of
consciousness from hemorrhagic shock, it doesn’t make sense to spend five or 10 minutes to intubate and ventilate before
addressing the root cause.
• Now that there are reliable devices for rapid hemorrhage control (45–60 seconds to apply a tourniquet to an amputation, or
five seconds to apply a direct pressure device), it makes more sense to address the root cause first in situations where patients
are experiencing active hemorrhage.
• OPINION
MYTH #7: DURING A MASS CASUALTY INCIDENT, ALL PATIENTS
ARE TRIAGED TO DETERMINE THE ORDER OF TREATMENT.

DISCUSS WITH A PARTNER, DO YOU AGREE OR DISAGREE WITH THIS MYTH? WRITE DOW THE AGREEMENT
YOU GET
• During a mass casualty incident (MCI), all patients are quickly triaged to determine the order of treatment, tagged, and then
treatment is based on priority.
• Most triage systems will only allow for quick treatments of airway (reposition the body, etc.) and uncontrolled bleeding during the
initial assessment phase. Typically only direct pressure from another person or the victim themself is available for rapid control.
• Tourniquets can be placed in 45 seconds by experienced users. Typical approaches to triage take about 20–40 seconds per patient.
• Mass casualt-y or active shooter situations require a modified triage and treatment approach to maximize lives saved. Rapid
hemorrhage control is often the most important intervention, but the ability to establish and maintain direct pressure on multiple
wounds and multiple patients is often beyond the capability of a limited number of responders.
• Tourniquets and direct pressure devices can provide reliable, safe, effective hemorrhage control in less than five seconds. Not only
will this help to stabilize the patient in question but it quickly frees the first responder to complete other lifesaving interventions
and triage all victims for more definitive care and transport.
• The same rationale also applies to tactical situations where every second is critical for carrying out other tasks.
• OPINION
MYTH #8: THE WOUND ISN’T BLEEDING VERY
MUCH. IT DOESN’T REQUIRE TREATMENT.

READ THE FOLLOWING MYTH – WHAT WOULD YOU DO IN THAT CASE?

• Loss of blood volume and shock will result in a significant decrease in active bleeding. This can be
very deceptive—especially in children and athletes who can compensate for even extensive blood
loss. Recognition of the severity of the patients’ condition is vital if they’re to be saved. Persistent
slow bleeding will result in significant blood loss over time, and is more frequent in situations in
which the injured can’t attempt self-care, such as entrapment or tactical scenarios, or those at
extremes of the age spectrum. Also, it may be hard to appreciate the small arterial bleeding coming
from scalp wounds. These may continue to bleed indefinitely and will often only stop upon wound
closure.
• OPINION:
MYTH #9: “STAY AND PLAY” IS ACCEPTABLE
WITH TRAUMA PATIENTS.
ROLE PLAYS – WITH YOUR PARTNER REPRESENT THE FOLLOWING MYHT – CHOOSE FOR THE
BEST DECISION, IF IT IS NECESSARY CHANGE THE LAST FACT.
• When Princess Diana was removed from her severely damaged car in France, she was still conscious and in a state of
severe shock from internal hemorrhage. The physician-staffed ambulance sat on the scene to treat her instead of treating
and moving her to a trauma center/operating room. The ambulance spent nearly an hour doing onsite treatment of a
symptom—falling blood pressure— rather than treating its cause: an internal vascular injury.
• Severe trauma patients require rapid treatment and transport. Delays in either can allow a patient to lapse into
irreversible shock. EMS providers must be conscious of this and get the patient moving to a trauma center ASAP.
• Excessive or unnecessary extrication procedures should be eliminated or reduced when confronted with a dying trauma
patient with suspected internal hemorrhage. Work with rescue crews and command officers to expedite patient removal
and transport when faced with a patient bleeding out internally and in need of trauma center/operating room care.