Would you know how to deal with a catastrophic bleed?

We live in a very dangerous world, a high percentage of us will never be involved in having to deal with a catastrophic injury. Something to consider is that we all drive cars. In 2017, there were 1,793 people killed on the roads in Britain, the highest annual total since 2011.

In 2017, 24,831 people were seriously injured on the road in Britain. In 2017, England experienced the highest number of road fatalities (1,544), accounting for over three-quarters (83%) of road deaths in the UK. So, there is a possibility we could encounter catastrophic injuries. We might also need to consider our line of work, is it industry or construction? Although health & safety is paramount people still get injured. It is better to have some knowledge that to have no knowledge at all.

What is a catastrophic bleed? It’s a bleed that will have life threatening consequences, if untreated quickly you can bleed to death in as little as 3 to 4 minutes, even quicker in children and babies.

How do I recognise a catastrophic bleed? If it’s arterial it will be spurting from the wound and the blood will be fully oxygenated and bright red. Your casualty will be in a great deal of pain, also showing signs of medical shock. Remember,  if your casualty is not breathing but has a catastrophic bleed then the bleed is categorised as more important than breathing. So, the protocol would be

C-catastrophic bleeding

A-airway

B- Breathing

C- Circulation

ENUSURE SOMEONE HAS CONTACTED THE EMERGENCY SERVICES

You then need to do the following:

1 Find the point of bleeding: this might be inside the wound, mop out any excess blood and add direct pressure to it, to stem the flow of blood.

2 Tightly pack the whole wound with the dressing (fold the dressing in to the wound). Ideally use a haemostatic dressing, here at METT Training we recommend using CELOX.

3 Press on the tightly packed wound for at least 10 minutes, if you are using a haemostatic dressing check packaging, it may say 1 to 3 minutes depending on which agent you’re using.

4 Cover the wound with a sterile dressing, ensure the haemostatic packaging goes to hospital with the casualty.

5 Consider that your casualty will have lost a lot of blood, start treating for medical shock, lay them down with their feet raised, use a chair or whatever you can find. They may look pale and their breathing might be very shallow and rapid. Don’t give them anything to eat or drink (NIL By Mouth protocol). Keep them warm using only one blanket, (you can place as many blankets under the casualty as you see fit) and protect them from the elements.

The safe method of using tourniquets when deal with a CAT bleed

Tourniquets have been around for a very long time. During Alexander the Great’s military campaigns in the fourth century BC, tourniquets were used to stanch the bleeding of wounded soldiers. Romans used them to control bleeding, especially during amputations. These tourniquets were narrow straps made of bronze, using only leather for comfort. In 1718, French surgeon Jean Louis Petit developed a screw device for occluding blood flow in surgical sites. Before this invention, the tourniquet was a simple garrot, tightened by twisting a rod (thus its name tourniquet, from tourner = to turn). In 1785 Sir Gilbert Blane advocated that, in battle, each Royal Navy sailor should carry a tourniquet: “It frequently happens that men bleed to death before assistance can be procured, or lose so much blood as not to be able to go through an operation”. Source Wikipedia

The European Resuscitation Council (ERC) First Aid Guidelines 2015 state that when direct pressure cannot control severe bleeding, tourniquets and haemostatic dressings are now advised. ILCOR (International Liaison Committee on Resuscitation) fully supports this.

They also seem to be in and out of fashion, they are most certainly in fashion. A tourniquet quite simply cuts off the supply of blood to the wound. A tourniquet in simple terms is a band, that is placed around a limb, these can be improvised using things in your first aid kit, such as a triangular bandage and some tuff cut scissors, or you can purchase a Combat Application Tourniquet (CAT). These have been designed with ease of use, these can also be added to your first aid kit.

1 Apply the tourniquet as quickly as possible, directly onto the skin about 5 cm above the wound if possible, avoid placing it over the knee or elbow joints. (note: tourniquets should only be placed over limbs with single bones i.e. the upper arm or thigh, even if the bleed is in the lower arm or leg).

2 Tighten the tourniquet until the bleeding stops, your casualty will be in a lot of pain, this may be a 2-person task.

3 If the wound is still bleeding then the tourniquet is not on tight enough, you can re-tighten it, or place a second one above the first, you might still get slight bleeding through a bone if you are dealing with amputation (consider applying a stump dressing).

4 You may have to consider using a haemostatic agent.

5 Note the time the tourniquet was applied, write this on the tourniquet or on the person (this is vital information) and ensure the emergency services have been called.

6 Immediately evacuate the casualty to hospital.

Note: there is a lot of useful information on YouTube regarding the use of CAT Tourniquets

What is Celox?

Celox is a very effective haemostat granule. It is made of a proprietary composition which contains chitosan. Chitosan is a natural polymer extracted from shrimp shells and highly purified. Celox’s composition is protected by 3 international patent applications.

How does Celox work?

Celox granules are very high surface area flakes. When they come into contact with blood, Celox swells, gels, and sticks together to make a gel like clot, without generating any heat. It works independently of the body’s normal clotting mechanism and can clot hypothermic or even heparinised blood.

Will Celox stop life-threatening bleeding?

Yes, if applied to the bleeding vessel Celox can stop life-threatening bleeding from a severed artery. This has been demonstrated independently in laboratory testing and evidenced in actual battlefield use.

Will Celox clot blood containing anticoagulants such as Heparin?

Yes, Celox has been tested and proven to clot blood containing Heparin and Coumadin (generic name Warfarin).

Will Celox clot hypothermic blood?

Yes, Celox has been tested and proven to clot blood as cool as 15°C.

How long can Celox be left in place in a wound?

Case reports have shown Celox has been left in place for 24 hours where there was no re-bleed or leakage. We recommend leaving Celox in place until the patient is moved to definitive care (source CELOX Medical).

CELOX In action

Jugular injury-“ miracle dressing “ allows patient to transfer to hospital.

An eyewitness has praised emergency staff who saved a tree surgeon’s life after he suffered horrific injuries to his neck. The 21-year-old man was working 25 feet up a tree when he slipped and inflicted deep wounds to his neck and arm with a chain saw. The man had blood spurting from the wound, the paramedics packed his injuries with CELOX- a specialist gauze used to treat troops in Afghanistan who have suffered major injuries. And it was thanks to this miracle dressing that the man was stabilised, the bleeding stopped, and he survived.

Who would benefit from doing one of our catastrophic bleeds or first aid courses?

All first aiders, anyone working in a high-risk environment, anyone working in industry, educational establishments, NHS and private health care settings

METT have integrated CELOX training into their nationally accredited first aid training sessions. Why? Because we really believe that everyone should have this life saving knowledge.

Here at METT Training, we have all been trained by Med Trade, specialist instructors in the use of haemostats and tourniquets, this is why we fully recommend the CELOX product

The courses we deliver:

Catastrophic injury training 3 hours

Level 3 Emergency First Aid at work 6 hours

Level 3 First Aid at work 18 hours

For further information contact [email protected] or visit www.metttraining.co.uk

Train with METT and have a lifesaving experience