“Under the Gun,” by Paige Williams. The New Yorker, 4/8/2019.
Times have changed. Just a few years ago (well, maybe more than a few), and for several years after, I was a Red Cross First Aid, CPR, and AED instructor trainer, which was as high as a volunteer could go in the Red Cross (Lifeguarding, my real specialty, had become an elaboration of an early step in first aid, as it should be: moving the victim to safety. Their Lifeguarding course evolved year-by-year to become fully half first aid and half CPR. I could teach it all, lifeguarding, CPR, and first aid, even as separate courses, except the AED was so simple, it couldn’t fill a course of its own.)
But today, with modern assault weapons and attacks on schools and other public places, controlling traumatic bleeding has gained importance in the public’s mind. Such attacks are called, “Intentional Mass Causality Events.” The informal movement to educate the population to be the First Responders in those critical first minutes until the professional EMS personal can arrive is called “Stop the Bleed,” usually presented as a short seminar.
In trauma care, the primary cause of preventable death is hemorrhage. The basic treatment is, “Keep the blood in the body.” (By any means available.)
Professional responders to the Boston Marathon bombing were surprised how so many ordinary citizens stepped up to care for the most horrific wounds on complete strangers, and even did the right thing with no training. Of more than 200 injuries, only 3 died. The New England Journal of Medicine credited this, in large part, to “courageous civilians.” In Boston and elsewhere, people would instantly help one another in a crisis, even when the injuries were almost unbearable to see, much less to touch.
One teacher, while treating a stabbed schoolboy, told him, “Sometimes when stuff happens, you go into a different state of mind. You surprise yourself at how you can handle things.”
Many attacks are done with AR-15 assault rifles that shoot bullets at extremely high velocity. The force can shatter a bone merely by grazing it, and the casualties look like combat causalities. Organs are in shreds with nothing left to repair.
At the Columbine massacre, rescuers didn’t reach some victims for hours, unable to determine if the killers were dead or hiding.
Standard “Stop the Bleed” presentations often include gross graphics. Experts feel this helps desensitize the trainees to their natural revulsion to large amounts of blood that may be mixed with tissue, teeth, and bone. We can easily be sickened in seeing large amounts of blood outside of the body. It is slippery and messy, and has a strong metallic smell.
Our tendency is to cover up blood, but, as one expert put it, “to stop bleeding you need to see the bleeding.” Victims have to be made “trauma naked,” moving any clothing aside to pinpoint the source of the hemorrhage.
But now a word about tourniquets. In my day, tourniquets were nor recommended except in the most extreme cases. Tourniquets lost favor after the Civil War because of their association with gangrene and amputation, but a modern patient could usually be quickly evacuated to a hospital. They are back in favor. You can now buy on Amazon a CAT tourniquet (Combat Action Tourniquet) of aluminum and Kevlar ready to use with a built-in windlass.
The tourniquet must be placed above the wound, between the heart and the wound. You can’t go wrong by placing it up near the armpit or groin. But be aware that the tourniquet has to be tight—tight enough to cause the victim pain, who may protest loudly, and you, as kindly as you are, may let up. The longer a tourniquet is in place, the more dangerous it is. Only a doctor in an emergency room should remove a tourniquet, but you hope this is only a few minutes away. And, as one trauma expert said, ” I can’t do anything if the patient is dead.”
Obviously, a tourniquet can only be used on an arm or leg. Bleeding elsewhere has to be controlled with pressure, considerable pressure. It will be all one rescuer can do and should be their sole job. Place the victim on a hard surface, cover the wound with paper towels, or whatever you can find, interlace your fingers, and press down with as much force as you can. If the paper soaks through, leave the old paper in place and pile more paper on top.
Puncture wounds, like bullet wounds can be quite deep. Roll up gauze and push it down the hole, kaolin impregnated, if you have it. Kaolin (clay) helps stop the bleeding.
But, remember I have neither expertise nor training in this, and new procedures are yet to be developed. I am only telling you of informal procedures being used. Use your common sense. Even if you innocently do something wrong, Good Samaritan Laws in many states will protect you from liability. The important thing is to try your best. Who would sue a passerby trying to help?
At one time, the Red Cross was making their CPR training so precise, people were afraid to start, afraid they would do some little thing wrong, like doing 14 compressions between breaths instead of 15. So they would freeze and do nothing. The Red Cross then emphasized the initial step of “Alert others,” even if that is all you do. That alone could be a big help.