Editor’s Note: In line with our recent series about disaster preparedness, we bring back this article from the 2007 magazine archives. Many thanks to “Doc Degnan” for it.
What do you need to be prepared for an emergency? The answer falls into two categories; 1) knowledge and skills and 2) equipment. To answer the question of what do I take with me today, or on this trip, is going to be change depending on your knowledge and skills, expected or potential injuries, ability to carry, cost and availability of equipment. To further complicate this, is that what you need is going to constantly vary, depending on activity, available resources, and limitations imposed by practical considerations. I cannot give you recommendations for what you need in an emergency and I cannot evaluate your knowledge and skills. I can however review equipment that can used in common emergencies that the average person, without advanced training can provide potential life or limb saving skills. My intention is to discuss equipment options, reviewing costs, risks, benefits, considerations in using.
It is not intended to be a complete list of everything available, instructions in use, just some of the common, available equipment and evaluation of them. I admit that what works for one person may not be best for another person or situation. The first topic to be considered is traumatic bleeding, in particular from the extremities (arms and legs). I chose this because bleeding is the second leading cause of death in civilian trauma, accounting for about 40% of traumatic deaths. It is common and results from knives, bullets, accidents, chainsaws, glass and many others. It is extremely life and limb threatening very quickly; but, with few exceptions, can be controlled by most people with minimal training and /or equipment. Bleeding involving the chest, abdomen, head and neck is beyond the intended scope of this article with the possible exception of two products mentioned later that can be of great benefit if used properly.
The first step in dealing with a bleeding arm or leg is to ensure that you and the victim are safe and secondly that their airway, breathing, and circulation are stable. Next is to evaluate the wound and amount of bleeding, keeping in mind that not all bleeding may be visible and always keeping in mind the entire condition of the injured person. If there is any question of significant bleeding, one needs to expose the area in order to evaluate it; if it can be done safely. This is almost always done by cutting off the clothing in order to avoid further trauma to the injury. If there is no question of a fracture (broken bone) or a crush injury (a heavy object impacting the arm or leg), then direct pressure on the wound is preferred, using sterile technique if available or as clean as possible cloth. Elevation of the limb should be considered also.
Please note that the precautions about a broken bone or crush injury concern the potential for creating further damage to the nearby artery, vein and nerves with direct pressure. If there is a penetrating object such as a knife or any other object, it is best to leave it alone, in place and have it removed in the hospital.
If the bleeding stops or slows down enough, continue with pressure on the site. If direct pressure does not work, if there is a penetrating object, a fracture or severe crush injury, then one must consider stopping the bleeding by other means; this can be direct pressure on the site over the main blood vessel of the extremity where it joins the body, a tourniquet if trained, or using one of the excellent products available such as QuikClot or HemCon. My intention is not to provide instruction in the use of these, but to review each product and considerations with regard to it’s use.
HemCon and QuikClot are commercial products available to help control severe bleeding. There are others but these two are the most common. They both work well and have advantages and disadvantages. Both have been used by our Military overseas with excellent results. Complications are rare and with the newest product developments should be less. They both act to help stop bleeding when applied directly to the site bleeding with pressure. They require the addition of more product until bleeding stops and they need continued pressure. HemCon comes as a stiff bandage which is applied.
Potential difficulty can occur when trying to place it in an small entry wound given the size and stiffness. They report a smaller roll which is flexible but this was unavailable to evaluated by me. Other considerations are it costs more, has a shorter shelf life. QuikClot has changed it’s product and given it’s advantages I will focus on this since I feel the new one should be used given it’s advantages for those with and without training. Although available in several different versions, they have a box of (5), 25 gram bags which are applied directly to the injury, using as many as required. These bags may also be opened up and the product spread over an area similar to the original version. Importantly, the new version does NOT produce significant heat and will NOT result in thermal damage.
The price of QuikClot is less than half of HemCon, is easier to use, has a much greater shelf life. Although both excellent products, I vote for QuikClot for the reasons of much less cost, much longer shelf life, increased ease of use.
The last item I will mention as a means of controlling bleeding is the Tourniquet. Our recent experience in treating traumatic limb war injuries has completely changed thinking about the use of tourniquets. In battle they are a first line treatment which has resulted in saving many lives and limbs. Please keep in mind that tourniquets have evolved significantly recently. It has been shown that many of the old and improvised ones were ineffective.
Importantly, some are able to be self applied and all are highly effective and safe when used properly. They sell for about 30-40 dollars or less. If trained, they are an excellent option, light, effective, inexpensive and easy to carry. One last consideration is to remember to protect yourself as best possible against body fluid exposure.
God Bless, ejd
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