Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Hemorrhage Control in the Backcountry

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This is the next post based upon a presentation given at the Wilderness Medical Society Annual Meeting held in Snowmass, Colorado from July 24-29, 2009. The presentation was entitled “Hemorrhage Control in the Backcountry: Military Lessons Learned.” It was delivered by Brad L. Bennett, PhD, who is a Fellow of the Academy of Wilderness Medicine, US Navy Captain (retired), and a member of the Committee on Tactical Combat Casualty Care.

Brad is a fabulous speaker. The objective of his presentation was to use military lessons to offer a greater understanding of hemostatic (stop bleeding) agents and tourniquets as they might be used by wilderness medical providers. Wilderness medicine may need to be practiced in a hostile environment, with limited resources, delay to evacuation of victims, and limited or no medical providers. He made the point early on that bleeding ranks high on the list of causes of death in all situations of injury, both civilian and military.

Tourniquets, which occlude arterial blood flow and thereby stop bleeding, are still viewed with trepidation by many individuals, because of the adage that they are a last resort, to be used in a situation where it may be necessary to risk sacrificing a limb in order to safe a life.

With hemostatic agents (HA) and tourniquets (TQ), the answer to the question, “Should we use them,” is not yes or no, but what product, when, where, why and how. Interestingly, the epidemiology of wilderness injuries seems to indicate that hemorrhage is mostly an affliction of hunters.

TQ design criteria focus upon self application, for the purpose of an individual being able to control his or her own bleeding. TQ that make the grade in this regard are the Combat Application Tourniquet (C-A-T), SOF-Tactical (SOF-T) and Emergency Military Tourniquet (EMT). Field data on TQ use indicate that these devices can definitely save lives.

The six common mistakes made when using tourniquets are not using one when one should, using one when one shouldn’t, applying the device too far away (towards the heart) from the injury, not removing a tourniquet when it is no longer necessary, removing it too early, and not applying the tourniquet tightly enough. Obviously, these problems are “judgment calls” that can only be lessened or mitigated by proper training and experience in TQ use.

Hemostatic agents come in a variety of forms and brands, including Celox, HemCon, Chitoflex, QuikClot Combat Gauze, InstaClot, ACS+, and others. A good field HA is not expensive, is FDA approved, will stop severe bleeding, does not have adverse effects, is easily stored, has a long shelf life, is easy (ready) to use, requires minimal training for its use, can be used in the field, is lightweight, and is biodegradable and absorbable. These agents can be lifesaving in situations of brisk bleeding, particularly if the bleeding is from a location that cannot be controlled by direct pressure or with a tourniquet. In the next post, I will offer some information from Dr. Bennett about the application of some of these products (TQ and HA).

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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