Uncontrolled bleeding is a leading cause of preventable death in trauma cases. Subjects suffering from severe hemorrhages can die in as little as five minutes, far less time than it typically takes for SAR teams to transport them to a hospital. Stop the Bleed training provides SAR professionals with the knowledge to identify and control bleeding effectively, enhancing survival rates dramatically.
In SAR operations, the ability to control bleeding is a critical skill that can make the difference between life and death. Hemorrhage is one of the leading causes of preventable death in trauma cases and understanding Stop the Bleed techniques allows rescuers to provide immediate care to stabilize individuals until advanced medical assistance arrives.
Bleeding can quickly become life-threatening if not controlled, especially in trauma settings such as natural disasters, accidents, or wilderness rescues. Massive bleeding can lead to shock and organ failure within minutes, underscoring the importance of prompt intervention.
This chapter provides an overview of what SAR members need to know. Each member needs to attend Stop the Bleed classes regularly that are taught by a certified instructor.
It is important to use Personal Protective Equipment when using Stop the Bleed techniques. Rember your PPE training!
Types of Bleeding
To effectively address bleeding, it is essential to recognize its types:
- Arterial Bleeding: Bright red blood spurting from a wound, often in rhythm with the heartbeat. It is the most dangerous and requires immediate action.
- Venous Bleeding: Dark red blood that flows steadily. It is less forceful but can still be life-threatening.
- Capillary Bleeding: Oozing blood from small vessels. Though not typically life-threatening, it should still be controlled to prevent infection.
Key Techniques for Stop the Bleed
Apply Direct Pressure
Direct pressure is the first and simplest method for controlling bleeding. Use clean gauze, cloth, or any available material to press firmly on the wound. If the bleeding does not stop, continue applying pressure without lifting to check the wound.
Elevate the Wound
If feasible, elevate the bleeding area above the level of the heart. This technique reduces blood flow to the injury and aids in controlling hemorrhage. However, elevation should not be used if it risks further injury to the patient.
Use a Tourniquet
A tourniquet is a vital tool in stopping arterial bleeding, especially in limbs. To use a tourniquet effectively:
- Place it 2-3 inches above the wound, avoiding joints.
- Ensure it is tightened enough to stop blood flow completely; the bleeding should stop, and the pulse below the tourniquet should no longer be detectable.
- Note the time of application and ensure medical professionals are informed later. Tourniquets should not be left on for extended periods.
Pack the Wound
For deep or penetrating wounds, packing with gauze or a hemostatic agent can be incredibly effective. Push material directly into the wound cavity, ensuring pressure is applied. Hemostatic gauze, infused with clotting agents, can significantly enhance the effectiveness of wound packing.
Pressure Dressings
Once the bleeding has been controlled, apply a pressure dressing to maintain wound care. This stabilizes the injury and allows the patient to be transported without risking further hemorrhage.
Special Considerations for Wilderness and Remote Areas
In remote environments, time is often against rescuers. Here are techniques tailored to such settings:
- Improvised Materials: Use clean clothing, belts, or sturdy materials as substitutes for medical tools.
- Extended Care: Stabilize the patient for prolonged periods by maintaining pressure dressing and monitoring signs of shock.
- Evacuation: Prioritize rapid transportation to advanced medical facilities for definitive care.
Stop the Bleed Kit
A Stop the Bleed kit is a portable medical kit specifically designed to provide the essential equipment needed to control major bleeding. Unlike standard first aid kits, which focus on minor wounds, a Stop the Bleed kit is tailored for rapid response to severe hemorrhage and includes items selected for efficiency, reliability, and ease of use under stress.
Key Components of a Stop the Bleed Kit for SAR
- Tourniquets: Typically, the kit includes one or more high-quality, windlass-style tourniquets (such as the CAT or SOFTT-W) designed for fast, one-handed use.
Note: if you have not had extensive Stop the Bleed training do not carry a Tourniquet. It will only get you in trouble.
- Compressed Gauze: Sterile, compact gauze used for wound packing or direct pressure. They are lightweight yet absorbent.
- Pressure Bandages: Elastic bandages (e.g., Israeli bandage, OLAES) that apply sustained pressure over wounds, vital for controlling bleeding and securing dressings.
- Trauma Shears: Sturdy, blunt-tipped scissors for cutting away clothing or gear to access injuries quickly and safely.
- Gloves: Nitrile or latex gloves to protect both rescuer and subject from bloodborne pathogens.
- Medical Tape: For securing dressings and devices in place, even in challenging environments.
- Marker: For noting the time of tourniquet application directly on the device or the patient.
Optional
- Hemostatic Dressings: Gauze impregnated with agents that accelerate blood clotting (e.g., QuikClot, Celox). These are crucial for packing deep or irregular wounds.
- Emergency Blanket: Compact space blankets to help prevent or treat shock by keeping the injured person warm.
- Instructions/Reference Card: A waterproof quick guide outlining steps for hemorrhage control, especially useful for less experienced responders or bystanders.
- Chest Seals (optional): For SAR teams operating in environments with a risk of penetrating chest trauma, vented chest seals can be crucial additions.
Packing a Stop the Bleed Kit for Search and Rescue
When assembling a kit for SAR, consider the environment, typical mission profile, and number of potential casualties. Kits should be rugged, weather-resistant, and clearly marked. Some teams may opt for individual kits carried on each member’s person (Individual First Aid Kits, or IFAKs), while others may use larger team kits staged in strategic locations.
Choosing the Right Equipment
Quality matters. Use only tourniquets and hemostatic agents that have been proven effective in real-world situations and recommended by agencies such as TCCC (Tactical Combat Casualty Care). Avoid untested or knock-off devices, as their failure can be fatal.
Considerations for SAR Environments
- Waterproofing: Kits should be packed in waterproof pouches or dry bags to withstand wet, muddy, or snowy conditions.
- Visibility: Bright colors or reflective strips make the kit easy to find in low-light or chaotic situations.
- Compactness: Space is at a premium on SAR missions; kits must be lightweight yet complete.
- Accessibility: Supplies should be organized so that the most critical items can be grabbed within seconds.
Training: The Cornerstone of Bleeding Control
The best kit is only as effective as the responder using it. All SAR personnel should undergo bleeding control training, ideally including hands-on practice with tourniquet application, wound packing, and use of pressure bandages. Many organizations, such as the Stop the Bleed campaign and the National Association of Emergency Medical Technicians (NAEMT), offer certified courses.
Regular refresher training ensures that skills remain sharp, equipment is familiar, and muscle memory is maintained – which is crucial under high-stress conditions.
Communicating with Medical Support
Document bleeding control efforts (such as time of tourniquet application) and communicate this information clearly to advanced medical providers when possible, especially upon transfer of care.