advanced wilderness first aid...only ever consider using haemostatic agents on major catastrophic bleeding..life over limb
Flour to stop bleeding??
- Thread starter whitey3192
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advanced wilderness first aid...only ever consider using haemostatic agents on major catastrophic bleeding..life over limb
I don't teach tourniquet or haemostatic use on my first aid courses. Could I? Well yes I could, my insurance as a First Aid provider allows me to do so.
I don't teach it because for general use I don't believe it's needed. I believe that what people need to learn are the basics and the basics for bleeds are pressure, direct or otherwise, and elevation. Bit like in my Mountaineering instruction I'd teach map and compass long before I'd teach GPS.
I said it already in a post on this section of the forum, there appears to be a frightening amount of people who are living in a fantasy land when it comes to either their knowledge base, skill level or training.
Femoral bleeds? I've dealt with two. Both died.
I don't teach it because for general use I don't believe it's needed. I believe that what people need to learn are the basics and the basics for bleeds are pressure, direct or otherwise, and elevation. Bit like in my Mountaineering instruction I'd teach map and compass long before I'd teach GPS.
I said it already in a post on this section of the forum, there appears to be a frightening amount of people who are living in a fantasy land when it comes to either their knowledge base, skill level or training.
Femoral bleeds? I've dealt with two. Both died.
I'm interested to know, were you taught it's use on this course and if so, with which organisation?
covered the use quickclot, celox, tourniquets and direct pressure...but like i said only for major catastrophic bleeding..which I probable would never come across, so I personally would never carry them
the organisation was outdooremergencycare as part of their wilderness first responder course
And if you have received proper training and are confident in their appropriate use then they have a place in your response kit.
I'd echo snipers comments about who taught it and which organisation? I'd also like to know why you think the techniques you've been taught for advanced wilderness first aid translate appropriately for bushcraft first aid? Or any other first aid where an ambulance is a phone call away? I can certainly see why advanced techniques should be taught for wilderness first aid, but for most people camping out in a bit of woodland 3 miles from the M4, practising advanced techniques might be pushing the remit a bit.
Also, do you seriously think that attending a first aid course actually qualifies you to make life over limb decisions? I mean really, honestly have you any concept of what that is actually like? No amount of reading or training is any kind of substitute for real world exposure to a large number of seriously exsanguinating wounds. That kind of experience is pretty much confined to battlefield medicine, A&E, operating theatres and trauma ITU - and even then, it's rare that anyone actually ever gets into a comfort zone with managing those kinds of wounds. Not even paramedics get exposed to that many - which is why paramedics in the UK dont make that call (in all but the most very extreme and rare of circumstances and then usually with radio backup). Femoral bleeds? In 11 years working in trauma ITU, I've managed somewhere between 10 and 20. I didn't keep count. None died (at the time anyway) and I never felt the need for haemostatic agents. Minor arterial bleeds - many hundreds - only ever used pressure and elevation - no problems. Regular old venous bleeds - many thousands, possibly tens of thousands - again, packing, pressure and elevation. It's easy, it's safe, it's cheap and it works, it just takes time and patience - but then I've never had to do it with a dozen Al-Qaeda trying to make Swiss cheese of me with AK-47's.
Eh....yes.
That's a line you perhaps need to re read Martyn. Limbs are no use if you aren't breathing.
See ...there are easy calls ...and not so easy calls. Leg ripped off by a combine harvester - no brainer.
Quick scenario ...
You come across a patient miles from anywhere, with weakly running blood (you think it's pulsatile, but you cant be sure) coming from a single proximodistal laceration approx 5cm in length in the approximate location of the radial artery close to the wrist. There is a blood covered razorblade nearby. Pt is unconscious. You check the fem pulse, it's weak but it's there. You have a mobile phone and a signal and a cat tourniquet, some QuikClot powder and your brain. You know that IF it is a radial artery laceration, then the pt could easily bleed out by the time help arrives. What do you do? The clock is ticking, you need to act now! You have 30 seconds to consider your options before making a decision.
Not so easy?
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Hi Martyn,
I have been taught to use these on a first aid course..would I use them, NO, I would use direct pressure and elevation, that is why i would not even consider carrying them.
Advanced techniques do have a place in wilderness first aid...but I would not dream of using these in a urban environment where people can be in A & E in short order
Please dont make the assumption that I would use any technique that I have not been trainned to use or feel confident to use, a few of the things shown on the course I personnally would not feel competent in doing..I know my limitations...and i would not do or use anything i dont feel happy with, or is not in the best interests of the person concerned. Good basic first aid is all that is needed in the vast majority of cases..and hopefully I will never ever need to use more than that
I have been taught to use these on a first aid course..would I use them, NO, I would use direct pressure and elevation, that is why i would not even consider carrying them.
Advanced techniques do have a place in wilderness first aid...but I would not dream of using these in a urban environment where people can be in A & E in short order
Please dont make the assumption that I would use any technique that I have not been trainned to use or feel confident to use, a few of the things shown on the course I personnally would not feel competent in doing..I know my limitations...and i would not do or use anything i dont feel happy with, or is not in the best interests of the person concerned. Good basic first aid is all that is needed in the vast majority of cases..and hopefully I will never ever need to use more than that
Martyn
I've dealt with more life or death decisions than I care to remember and in situations that I care never to repeat so, as to your scenario,.....know your audience.
Your use of proximodistal and pulsatile terms (yes I know what they mean) doesn't impress me although I'm sure it may some.
Life over limb everytime Martyn. Losing a limb may be tragic but death is final. That's a basic priority of a first aider.
Fair enough. You going to have a punt at my scenario? I'd have thought an attempted suicide was pretty real world?
If that's not to your liking, here's another.
You are out in the woods, miles from anywhere and you hear some screams. You follow the noise and you find a young lady at the bottom of a steep enbankment. It's summer, she's only wearing a skirt and you can tell from the shape of her leg that it's broken. She's howling in pain. She doesnt appear to have any other injuries. You have a mobile phone, a cat tourniquet and a simple first aid kit with some bandages. There is no broken skin, but you can tell from the lump in her thigh muscle that he femur is broken, possibly in more than one place and there is extensive bruising around the whole area of he groin to mid thigh. Because you are a gentleman and because she is awake, you opt to check her carotid pulse and it is strong. Because you are clever, you also check her dorsalis pedis and a pulse is present. What do you do?
I was just trying to be accurate mate, not clever. My point ....that you cannot replace real experience with a training course. If you are exposed to trauma and the abnormal human condition on a regular basis, there are a bazillion factors that register with you simply because you have seen them so many times. Training courses are what they are - broad, nasty, quick and dirty solutions designed to be field expedient, better than nothing protocols. They defintely do not equip you with the knowledge and skills to make the best medical decision possible - which is why I would argue that no first aider should be making life over limb decisions when they are anywhere other than a long, long, long way from help - unless it's a no-brainer. Unfortunately, few of them are that simple.
I would have treated the pt by direct pressure on the bleed and elevation. You can occlude the pulse in your radial artery with light pressure from your thumb alone (try it). Or you could apply direct pressure with a stick or the torsion bar from your CAT, directly over the wound if you prefer (bit of t-shirt will act as a swab). Either method will stop the bleeding completely and leave the ulna artery unobstructed to perfuse the hand (this is why I was so specific about the location and direction of the wound). Whether the bleed is venous or arterial doesnt matter - your intention is to stop it either way. If the pt lived from the blood they had already lost, they would stand a very good chance of keeping their hand too.
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Guys, I don't want to jump into the middle of the argument, but I would make the point that I as a relatively untrained first aider carry quick-clot for one eventuality. IF I get a HUGE bleed in the middle of nowhere and I can't stop it conventionally I am shoving that **** on there. As someone who likes the wilderness I am above average risk for this, and I prepare for that. I have the quick-clot to stop the bleeding long enough that I can get help...
Dave
Dave
You can do what you like to yourself Dave - it's what people do to others ...or what others might do to you with your kit that is the worry.
You can do what you like to yourself Dave - it's what people do to others ...or what others might do to you with your kit that is the worry.
That's completely true Martyn, btw what's the answer to the second one. My first instinct would be to not move her (for fear of initiating an arterial bleed) and keep monitoring her pulse at the extremities, call the pros and wait for them to arrive. I might also prepare a tourniquet in case I detected internal bleeding, which may be what the bruising is from, but I don't know enough to know if that's right.
Dave
EDIT
Does the pulse in the foot indicate a lack of internal bleed?
10/10 Absolutely spot on mate. The pulse in her foot indicates she has supply, though it doesnt prove she doesnt have an internal femoral bleed, it's likely that if she did, she'd loose the pulse in her foot (she could loose it for other reasons too - shock etc). The bruise in her thigh is typical for a broken femur, but could also be from an internal femoral bleed - in which case it would worsen rapidly, extending into her abdomen and down to her knee more than likely. Her strong carotid pulse and awake state also suggests she's not in hypovolemic shock - again suggesting her femoral artery is intact and she is not actively haemorrhaging. She should not be moved for fear of exacerbating a potential spinal injury, which cant be excluded and no attempt should be made to splint her leg for fear of the broken femur rupturing the femoral artery. As you say, phone an ambulance, do not tourniquet, calm her as best you can and observe her pulses, conciousness and bruising. If she looses conciousness and her bruising worsens and she looses the pulse in her foot - then you have a tough decision to make. You still cannot be sure it's a femoral bleed - if it's just a general worsening of capillary bruising and passing out from the pain, then a tourniquet could unnecessarily tear her femoral artery and kill her) and even if it is a femoral bleed, you are not sure where it is (a tourniquet below the bleed would be pointless), but you could feed that info back via your phone and ask for medical advice.
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Thanks Martyn, I'm glad I got it right. I need to get round to doing another CPR+ course as mine expired in 2006 and I think I'd like to do wilderness first aid too, but who has the time?
Dave
BOD
Bushcrafter (boy, I've got a lot to say!)
The point with these scenarios was not to be a smart ****, it was to illustrate how hard it can be to make good decisions. In the first one, you could save the life and the hand without using a tourniquet and there is absolutely no need for clotting agents. It could be that using a tourniquet - which would be very tempting if you had one - would unnecessarily cost the guy his hand. As has been said before, 99.9% of all bleeds can be stopped with packing, pressure and elevation. In the second one, the wrong use of a tourniquet may cost the girl her life. It would be a very difficult call even for an experienced professional. Tourniquets and haemostatic agents are useful tools for a small number of very rare and specific situations, which takes a great deal of knowledge, skill and experience to properly identify - but even then, particularly in civilian medicine, they can be complex and difficult calls. In the hands of someone inexperienced, untrained and unskilled, they are a liability. A temptation that shouldn't be there.
For the battlefield, it's entirely different. The number and type of wounds that indicate their use are very much higher, being mostly gunshot wounds and traumatic amputations from IED's. On top of that, the medics are under a very real risk from incoming fire, making a quick and effective solution all the more pressing. But even military medical protocols change almost by the week. Sometimes it's yes to tourniquets, sometimes, no. Sometimes timed release, sometimes constant on. They are not trying to do the right thing for each individual, they are playing the percentages. That is acceptable in a battlefield, it's not acceptable in a wood 3 miles off the M4.
For the battlefield, it's entirely different. The number and type of wounds that indicate their use are very much higher, being mostly gunshot wounds and traumatic amputations from IED's. On top of that, the medics are under a very real risk from incoming fire, making a quick and effective solution all the more pressing. But even military medical protocols change almost by the week. Sometimes it's yes to tourniquets, sometimes, no. Sometimes timed release, sometimes constant on. They are not trying to do the right thing for each individual, they are playing the percentages. That is acceptable in a battlefield, it's not acceptable in a wood 3 miles off the M4.
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