Primary Survey (Casualty with Catastrophic bleed)

Doctor ABC:

Danger make the area safe for you, your casualty and any bystander.

Response Check for response by using the AVPU scale

The change in priorities when dealing with a catastrophic bleed. 

The catastrophic bleeding must be under control before dealing with any other condition or injury, including cardiac arrest. 

Therefore deal with the catastrophic bleed before the traditional “Airway, Breathing, Circulation”

You must try Direct Pressure before moving onto any other procedures:

You must try Direct Pressure before moving onto any other procedures:

Direct pressure; 

Placing pressure on the wound will constrict the blood vessels manually, helping to stem any blood flow. When applying pressure, the type and direction of the wound may have an effect, for instance, a cut lengthways on the hand would be opened up by closing the hand into a fist, whilst a cut across the hand would be sealed by making a fist. 

A casualty can apply pressure directly to their own wound, if their responsiveness level allows. Ideally a barrier, such as sterile, low-adherent gauze should be used between the pressure supplier and the wound, to help reduce chances of infection and help the wound to seal. 

Third parties assisting a casualty are always advised to use protective latex or nitrile medical gloves to reduce risk of infection or contamination passing either way. Direct pressure can be used with some foreign objects protruding from a wound; padding is applied from each side of the object to push in and seal the wound - objects are never removed.

If direct pressure is not effective a tourniquet maybe used:

There are many tourniquets on the market and they all have their unique features and benefits.

• A windlass is part of a tourniquet that is twisted to tighten it and is then locked or tied in place to secure the tourniquet when

pressure is applied

• A tourniquet should be a minimum of 1.5 inches wide and this is particularly important if you have to improvise and make your own.  A triangle bandage that could be found in your first aid box could be used

• Unpack the manufactured tourniquet and have it ready to use

• Apply directly to the skin and not clothing

• Apply at least 2 inches above the injury

• Make sure you write the time of application on the tourniquet.

Most manufactured ones will have an area designated for this

WARNING: The tourniquet must be easily identified or easily seen. 

WARNING: DO NOT use wire or shoestring for a tourniquet band. 

DO NOT cover the tourniquet--you should leave it in full view. If the limb is 

missing (total amputation), apply a dressing to the stump.

 WARNING: A tourniquet is only used on arm(s) or leg(s) where there is danger of loss of casualty's life. 

CAUTION: DO NOT LOOSEN OR RELEASE THE TOURNIQUET ONCE IT HAS BEEN APPLIED BECAUSE IT COULD ENHANCE THE PROBABILITY OF SHOCK.

ONE Handed Operation

TWO Handed Operation

How to use a Tourniquet, emergency first aid