Stop the Bleeding

Of the approximately 5 milion people who die around the world from trauma every year, at least a third bleed to death. Massive hemorrhage is second only to traumatic brain injury as the cause of death from injury. Not recognizing and failing to respond to hemorrhage is the major preventable cause of death from trauma. Why can't we live without blood? Blood carries oxygen to all our tissues and organs and they cannot function without it. Without an adequate supply of red blood cells we'll quickly die.

Trauma surgeons are starting to reshuffle the deck on priorities in resuscitating trauma patients. For the better part of a half century, stopping bleeding has been the third priority behind airway and breathing problems. Stopping the bleeding is climbing the ranks of priorities particularly in combat where most casualties die within ten minutes of being wounded and usually from exsanguination. 

The military has instituted the MARCH protocol (Massive Hemorrhage, Airway, Respirations, Circulation and Hypethermia) that instructs medics to stop external bleeding before doing anything else. Direct pressure is applied first and if bleeding continues from an extremity a tourniquet is applied above the site of bleeding. The Combat Application Tourniquet (CAT) can be applied by a wounded soldier using just one hand. Applying a tourniquet before a patient goes into shock can improve survival by ninety percent. Tourniquets are becoming part of standard civilian EMS procedure once again and some are suggesting that police carry them also. 

Military surgeons have become experts on stopping the bleeding and lucky for us they have passed that expertise on to the civilian world. More on new ways to stop internal bleeding in Chapter 7 The Color of Blood in Hurt: The Inspiring, Untold Story of Trauma Care.