Saturday, May 14, 2016

Traumatic Injury Motorcycle Course Lesson 1 Massive Bleeding

The following information is for education purposes only.  You should seek professional training.  Please comment with any concerns, or ideas for additions, deletions, or corrections.  I am not a medical professional but have been a first responded for 25 years.

Even though it is a constant in the back of our our minds, nobody wants to talk about it until it happens.  The reality is that riding a motorcycle is one of the most dangerous things for one basic reason.  You are moving at speed without any structure to stop you from coming in contact with the road and other fixed objects.  The slightest crash can leave you with road rash and broken bones.  So if there is a crash and we need to take care of ourselves or another rider, what do we need to know and what do we need to have with us?  That the the focus of this article series.

First about the human body.  There are three ways to cause trauma to the human body; cut it (anything that penetrates your body or erodes your skin), crush (blunt force trauma), and burn (for our cases, when heat is applied the skin.

There are two things that can kill you, illness or injury.  Trauma is obviously injury.  Ironically, the more serious the trauma, the less the first responded can do, but the more more important what they do is.

In the US after a 911 call the average response time is 11 minutes.  The first people on the scene are usually the police since they are patrolling the streets.  Response time for EMS can be much longer in some cases.  All police reciieve basic first aid training and carry limited gear.  The problem is that in case of trauma, what you do in the first few minuets can mean life or death.

Rule #1-  access the scene, chances are you will be riding in front of behind the person who crashes.  The firs thing you need to do is to take a deep breath and carefully move towards or turn around to get to them.  At this point tunnel vision will set in and you may become blind to secondary threats to your own safety.  If you are in a group the others will be freaking out.  Give them something to do by calling 911 or directing traffic.  You need to seperate them from the patient because panic is worthless.  Leave the person in place unless their is a very obvious reason not to do so, such as laying in the middle of a four lane highway that cannot be controlled.  If you have to move them, you need to do your best protect the C-Spine (cervical collar and back).  My advice for doing this is to grab them under the arms, hold them their back up against you around your waist, and drag them very slowly.   This will provide a little traction from the dragging feet to keep the them straight.  Again, avoid moving them if at all possible.

We are going to cover the types trauma here based not on what is the most likely cause of permanent injury or death, but rather the trauma that you will have the ability to treat with limited training and gear.  For instance the #1 cause of permanent injury or death is a head injury.  But we are going to cover massive hemorrhage first because it is not only the first thing you need to check for after an accident but it is also the thing that you are able to treat with minimal training and tools.

Here is the deal, blood goes round and round.  Our circulatory is pressurized like your cars cooling system..  If anything penetrates any part of the system the fluid (blood) will leave the penetration point instead of passing through the system.  The larger the hole and the bigger the hose, the faster they loose blood.  This is how people bleed out.  Realistically during a motorcycle crash I can see two types of injury causing massive bleeding; fractures and impalements.

Due to the mechinisim of injury from a MC accident you are likely to encounter are displaced and open fractures.  The danger in both of these is that the bones are broke and jagged which means they could easily damage a matter artery that runs close to them.  This will most likley occurr in the legs since 30% of all MC injuries are to the legs.  The only real difference between the displaced and open fracture ans implied by the name of the latter is that one is broken and jagged and has come through the skin and the other is still inside the skin.

Displaced (closed) fracture\

Open Fracture

Now matter how big or how small the bleed you basically have to options to stop it, direct pressure which basically covers the hole and keeps blood in until they can begin to repair it at the hospital.  The second is a tounequit which turns off blood flow just above the injury.  

Now remember, on the side of the road we are in less than a sterile environment.  That said one of the scariest things is not being able to see the source of the blood because of how much blood there is.   If you cannot see where the blood is coming from flush it with whatever water you have on hand.   My basic rule of thumb is that if it is squirting you are dealing with an arterial bleed and the only thing you can used to stop it is a tourequit.  Here is the problem though, once a tournequet is in place massive nerve damage is likely and loss of the limb below it, or at least use will be effected.  My point is that by the time you figure out that is what needs to be done and get your tournquit off your bike, you will hopefully be hearing sirens.  If that is the case I would just continue to apply direct pressure and the the police or EMS place it.  Most police are issued and trained in there use these days.  But here is a cautionary tale.

I had a buddy stabbed in the femoral artery in the parking lot of a bar.  You could have thrown a baseball and it RT 95 with it.  The fire station that the ambulance ran out of was a mile away....but they were out on another call.  Another buddy of mine improvised a tournequit and saved his life.  Just because you are "in town" does not guarantee a quick response.

Back to fractures.  In the case of the open fracture, like I said, if blood is squirting all over only a tournequit will stop it.  You will need to decide whether it needs to be placed right away or you are better off with direct pressure.  Just understand that unless the victim is unconscious, the placing of the tourniquet may be nore painful than the injury and they are going to scream in pain.

Now the displaced fracture, the easiest way to identify it even if they have jeans on is to run your hands up and down their limbs.  You will feel the deformity.  If you do feel it cut the clothing off as soon as possible (careful not to cut them).  If using a knife be sure the blade is facing up and away from there skin.  the reason you need to see the bare skin is because if the skin starts swelling like a water balloon they have an internal arterial bleed.  I would hold off placing a tourequit on this because it will be like a twist in a balloon animal and just build pressure.

OK, so now we have gone over the worst bleeds you could possible encounter, let just talk about your plain jane heavy bleeding.  Bleeding that can usually be stopped with direct pressure.  Whenever you go hands on with someone and their is a chance of getting blood on you you are going to want to wear nitrile gloves.  I carry thee pairs rolled up in a little baggie in my pocket.  Two pair for me so I can double glove, and one for whoever I can talk into helping me.  In a pinch you can use a Wal Mart bag between your hand and what you are using to apply direct pressue.  Gloves are however preffered of course.

The truth is that you will probably only have time to locate a t-shirt or towel to use for direct pressure before the cops and EMS show us.  That said once you being to apply direct pressure to a heavy bleed don't remove something when it becomes blood soaked.  Just add something to it.  The smallest and best blood stopper you and buy and carry is the Israeli Bandage.  Click here to learn how to use one.  I put a pin hold in mine and squeeze out the air, it is not sterile anymore but takes up much less room.  The Israili Bandage and CAT tournquit are what troops and contractors carry into combat.  It is miimalist and can save a life in the worst possible circumstances.

Lastly I will cover impalements because there is a good possibility it could happen when flying off a bike or even on one of the huge spikes that seem to be all the range in bike accessories.

Poor fella here got a street sign pole through is thigh.  You can see a tournquet placed above it.  As is protocal, the sign was left in place for transport.  NEVER pull anything  out that is stuck in the body. You never know what it is holding pressure against 

Now you have been given all the nightmare scenarios.  Prepare for the worst, hope for the best.  We have a very limited ammout of blood in our bodies.  Failure to contol a bleed after an accident and before EMS arrives is the most likley thing to cause death, and as I said earlier it is the eassist thing to equip and train to prepare for.  Next up- Airway Management.

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