IEC-02 Haemostatic Gauze

Where there is a catastrophic bleed that is too high up the limb for a tourniquet, e.g. a high injunctional wound at the groin or armpit, or somewhere other than a limb, or even if you have judged the bleed not to be catastrophic but is still significant, then a haemostatic gauze can be used.

Haemostatic gauzes are gauze bandages that have a substance called chitosan applied/impregnated into them. Chitosan will clot blood, even where the blood’s own clotting factors are reduced due to other wounds being present or are inhibited by drugs such as warfarin or heparin.

Click on the button below for a video demonstrating the Prometheus Chitogauze XR Pro that you will have seen in your training.

The Prometheus Chitogauze XR Pro comes z-folded for ease of use and the gauze is simply packed into the wound. The process of packing the gauze into the wound means that the gauze reaches and helps the blood form clots at the point of bleeding of the blood vessel. Also the packing creates additional pressure at the wound site that also helps stem the flow (which slows bleeding and helps clots form).

Keep the pressure on as each fold is packed into the wound, then apply direct pressure over the top for at least five minutes. (Note – the video says 2 -3 minutes, but five will give you much greater confidence of success and a more robust clot.)

DO NOT use haemostatic gauze for chest cavity or head wounds.

With either tourniquets or haemostatic gauzes, if you’ve used your equipment up already or don’t have any with you, and you still need to control a catastrophic bleed, then you can improvise:

For a tourniquet, a triangular bandage may be sufficient with something strong (like a spanner) as the windlass. The item used as the strap needs to be strong and supple (belts are not very good as they are too stiff to twist).

To pack a wound, the packing from an Olaes bandage can be used, or indeed, any flexible gauze. But remember, there is no clotting agent, so clotting is reliant on the casualty’s own blood to do the work.

IEC-01 Tourniquets

Once scene safety has been considered and managed, then controlling catastrophic bleeding is the highest priority in patient care. A catastrophic bleed will kill a casualty faster than a blocked airway.

Please click on the button below for the Faculty of Pre-Hospital Care (FPHC) Position Statement on the Application of Tourniquets.

From your training, you will be familiar with the Trauma Resus cat’ bleed protocol and the Tourniquet Action Card (TAC) :

As a reminder, the protocol is printed on the TAC :-

Each step is tried and the next step moved to quickly if that isn’t working.

  1. First try one pressure dressing/ direct pressure
  2. Apply a tourniquet close to the wound (4-5 cm above if an amputation)
  3. Apply a second tourniquet above the first
  4. If still uncontrolled, remove the original pressure dressing and pack the wound with haemostatic gauze
  5. Apply pressure dressing/s over the top and direct pressure for 5 minutes 
The tourniquet (TQ) must be applied on a compressible part of the limb, so not on a knee or elbow joint. It may be that the TQ has to be placed above the joint even for a wound that is below the joint, in order to effectively compress the bleeding blood vessel/s.
 
The situation and complexity of the rescue may mean that you need to modify the protocol. For instance, if you are on your own and your casualty is unresponsive, you may have to manage their airway, so going straight to a tourniquet is fine.
 
But the bottom line is, ‘make the bleed stop !’. 
 
Now click on the button below for a video on the management of catastrophic bleeding :

Tourniquets are simple and effective in the rapid control of catastrophic bleeds on limbs, but remember, that is all they are for.

Don’t forget to write the time of application on a TAC and place the TAC on the casualty where it can be clearly seen. Your casualty is now ‘Time Critical’, so inform the rescue operation/emergency services of this, and of course, at handover. 

IEC-03 Choking

The next video is accessed via an external website (Resus Council UK), and may use Flash Video. If you have any problems playing it, please go to Adobe’s Flash Player download page and download the Flash installer.

The video is about how to deal with a choking casualty. Remember the protocol ?

When you reach the Lifesaver website, please take the menu on the bottom line, and complete the “REBECCA” scenario.

IEC-01 Minor Head Injury

Please click on the link to access the NICE guidance on the assessment and early management of head injuries.

You only need to go through Sections 1.1 and 1.2, which relate to pre-hospital assessment and actions.

Now watch this video about the treatment of minor head injuries, and the things to watch out for which might indicate developing problems.

IEC-02 COVID-19 – Emergency Response to a Casualty with Suspected or Confirmed Case

The button below links to a series of short videos, covering the recommended emergency response to a casualty with either a suspected of confirmed case of COVID-19.

There are 4 video clips :-

  1. A practical demonstration of putting on (donning) and taking off (doffing) the PPE for aerosol generating procedures (AGPs)
  2. Approaching the casualty and treatment, using the SCENE approach and a modified Algorithm
  3. How to deal with a casualty who appears to be in cardiac arrest
  4. An overall summary.

To view the video, please click on the link below.

IEC-01 COVID-19 – Positional Statement – Guidance for Advanced First Aiders

Introduction

Some key points to note with relation to COVID-19 are :-

  • There are no specific first aid treatment measures for suspected or confirmed COVID-19 casualties.
  • There are significant risks to a first aider when assessing and treating a casualty with COVID-19.
  • If there is a risk that your team could be assisting casualties from outside of your organisation, then add the following items to your primary and secondary response bags :-
     – Surgical face mask x 2
    – Oxygen filta mask
    – Clear plastic drape
  • If members of your organisation are reporting to work fit and healthy and a first aid incident occurs, then the risk to the first aider is very low.
  • If there is a risk that your team could be assisting casualties from outside of your organisation, then  :-
     – Basic first aiders should follow the Resuscitation Council UKs guidance.
    – Advanced first aiders should follow the positional statement – See link below.

We will continue to update this position as further evidence, guidelines and advice are produced. If you have any queries in the meantime please don’t hesitate to contact us.

Please click the link below to view a positional statement with guidance for advanced first aiders.

IEC-02 Resuscitation Refresher in COVID-19 Context

There are a couple of changes to the Algorithm as mentioned in the video in the previous topic:

Airway and breathing assessments are NOT done by the traditional ‘look listen and feel’ of a rescuer getting their head close to that of the casualty. Instead we rely on sound, and watching (or feeling) for a rise and fall of the chest.

We now know that we need to wear a higher level of PPE for use of a BVM and so, for a patient with breathing difficulty, or for resuscitation, where a BVM is indicated, that additional PPE must be worn. Naturally this means that there may be some delay in delivering breaths to a cardiac arrest casualty, so ‘compressions-only’ CPR is the technique until there is a rescuer present in suitable PPE to carry out breathing support with a BVM. There should be NO mouth-to-mouth, or expired air resuscitation (EAR), delivered to a casualty.

One small additional item of equipment should also be used, namely a HME filter. A HME filter or HMEF – ‘Heat and Moisture Exchanging Filter’ must be placed between the bag/valve and the mask. This ensures that no water-droplets or breath moisture from the casualty pass through into the bag/valve part of the device.

If the patient is not breathing and an i-Gel is indicated, then the HME filter goes between the i-Gel and the bag/valve or between the i-Gel and the flexible extension tube.

Please click below for a link to the manufacturer’s website for some detail on HME Filters. 

Aside from the additional PPE and the changes concerning the use of BVMs; resuscitation, CPR and ‘Pit-Crew’ CPR,  is pretty much the same as before.
 
Click below for a video where treatment is given to a casualty with a breathing rate of less than 10, who then goes into cardiac arrest. The video shows the PPE being worn for resuscitation and the use of a BVM.
 
In the video you’ll see we use the BVM for a while, before switching to the i-Gel. This is for demonstrating the transfer of the HME filter. In practice, for cardiac arrest, we can still go straight to the i-Gel (with the HME filter attached).

This next video shows the insertion of the HME filter between the mask and bag/valve and then being transferred to the i-Gel.