In light of the serious incidents involving knife crime lately here’s our guidance on how to treat catastrophic bleeding & the truth behind tourniquets. And although this advice is written by practising nurses this is no substitute for getting emergency professional medical help.
It’s not just stab wounds that can cause such severe bleeding, as it can happen in the garden, doing DIY at home or in the sports field. Anyone who’s been stabbed or bleeding needs immediate help and helping them is actually pretty straightforward, so just by following these three simple steps could really make a difference between life and death:-
If bleeding is controlled you can dress the wound and then put another second dressing on top. Still bleeding? Apply pressure, remove soaked dressings and start again. Do not remove anything that has knitted to the wound as this has now started to clot and is helping stop the blood.
If there is an object in the wound, don’t remove it as this could make the bleeding a lot worse. Apply pressure around it. The general rule is NEVER remove a knife as if you unplug the hole and then start CPR you are pushing the blood out faster. OR if blade so central that it prevents the body from laying removal of knife is still last resort. Removal could sever a large vessel which is a death sentence.
It’s a judgement call and not an easy one. If the patient does go into cardiac arrest it is likely due to major haemorrage (blood loss) in which case compressions will do nothing due to an empty circulatory system. As a first aider you are stuck in a hard place and calling for help immediately will support your actions.
If a wounded person loses a substantial amount of blood, the body is no longer able to compensate for that amount of blood loss. There simply isn’t enough blood flowing through the body and they will develop hypovolaemic shock. Shock can be life-threatening so if you suspect someone is going into shock do the following:-
Should I use a tourniquet?
Something we’re frequently asked. Tourniquets and haemostatic dressings have been introduced as additional options to treat severe catastrophic bleeding. However, direct pressure remains the main choice of treatment and it will control bleeding in the vast majority of cases. The European Resuscitation Council 2015 guidelines state that haemostatic dressings and tourniquets should be used when direct pressure is either not possible or ineffective.
If someone is bleeding extremely heavily from either a major artery or vein, they can lose a lot of blood very quickly and the bleeding is likely to pulsate in time with the heart. This is more pronounced with an arterial bleed, but happens with internal bleeds too.
Did you know an adult could easily lose 40% of their blood volume in 3-4 minutes and even quicker in a child!
In environments where a catastrophic bleed is likely, tourniquets and haemostatic dressings should be an integral part of the first aid kit and all first aiders should be trained in their use.
Child Matters First Aid Kits now contain a pack of wound plasters in two sizes, larger and more appropriate for child size wounds! So if you’d like one, CONTACT US. Just £20 for this green soft pack.
As a member of the general public you are unlikely to have trained to use a tourniquet. However understanding how to improvise one, and how and when to use one, could save lives if you’re ever involved in a major medical accident or emergency. It is important for the doctor treating the casualty to have a good understanding of how long the tourniquet has been applied for. Write the time the tourniquet was applied onto the tourniquet itself or onto the casualty.
Please remember that although tourniquets can save lives, their use should not be taken lightly. They remain a second-line treatment when direct pressure is not possible or insufficient to control bleeding.
One of the easiest ways to make an improvised tourniquet from the contents of a standard first aid kit is to use a triangular bandage folded into a broad fold bandage and to tighten the tourniquet using scissors as a windlass. A table knife would work even better as otherwise you no longer have your scissors available to use. It will be painful for the person injured but it must be tight enough to entirely stop the bleeding as arteries may be harder to stop as they are less easy to get to.
Please note: A tourniquet should be at least 4cm wide to prevent localised damage to nerve tissues. Here’s how to make it:
If there’s a clean cut through an artery, for example in a deep incised wound, the artery can contract back up the arm or leg. This is why you should place the tourniquet at least 5cm (or 2 inches) above the wound.
You may find other guidance on the positioning of a tourniquet, such as applying the first tourniquet mid-point over a single bone. This advice is also acceptable, so long as the tourniquet is positioned proximal to the wound (closer to the trunk of the body).
NEVER be tempted to loosen or remove a tourniquet. Once applied, tourniquets should only ever be removed by a doctor in a hospital setting.
Please remember that although tourniquets can save lives, their use should not be taken lightly. They remain a second-line treatment when direct pressure is not possible or insufficient to control bleeding.
Alternatively, as a refresher, you can take an online Tourniquets, Haemostatic Dressing course in your own time for 1hr 30mins. 20% off if booked by 31 March 2019!
