Trauma care.

[beastmaster]

I was thinking about getting a product called,'' Quick clot''. They use a similar product in the military.
I have been doing a lot of work far from help if needed and out of cell phone coverage. I replaced a guy who cut himself with a chainsaw in the tree, by the time he made the hospital he lost 3 pts of blood. So all that has got me thinking.
I am the only climber and I work with several inexperience guys. I worry about them, plus I would be on my own if I was injured in a tree.
I see they sell a powder and also a gauze. I would like to have it on my belt and in my first aid kit. Any recommendations? Thanks

 

[Kottonwood]

Quickclot can cause extensive tissue damage and burning. In a situation where you are only hours max from a hospital you are better off using a tourniquet. In a situation where there is significant bleeding and no way to use a tourniquet ie a high femoral artery wound or a gut wound then a much better product is celox, it does not burn like quickclot does. Keep in mind if you use any of these products you are going to make the docs job much harder, they will have to clean all that stuff out of there before they close you up.

-Keith

 

[Scrat]

Patriot
do you know which stuff is in the buckingham kit that is yellow with the green cross? just bought that for myself and my climbing partner. you just raised a very interesting question

 

[Kottonwood]

Tree Stuff - Cederroth Blood Stopper Bandage Pack

It looks like what is in the buckingham kit is a bandage. A bandage that will most likely not stop an arterial bleed no less. Honestly if help is on the way you are usually better off with a tourniquet.

A note about quickclot as well, I havent used it in a few years. I didn't like it when it came out because of the burns, supposedly they have changed their formula since then, it still gets HOT. Either way celox is a great Product. It really stops the bleeding, even if your moving around or trying to crawl to safety etc.

But yeah, back in the day when I used this stuff Docs would be pissed if you used it in a situation where you could have just used a tourniquet, it makes a hell of a mess of a wound, especially the quickclot. Not to say these aren't good tools to have available, as a last resort anything is better than bleeding out.

 

[indiansprings]

I make sure I carry a couple of tampons and a couple of maxi pads in my truck first aid kit, it it non arterial, they'll do a great job of stopping bleeding in puncture wounds, or wear a chain has torn flesh open.

 

[Toddppm]

Tree Stuff - Cederroth Blood Stopper Bandage Pack

It looks like what is in the buckingham kit is a bandage. A bandage that will most likely not stop an arterial bleed no less. Honestly if help is on the way you are usually better off with a tourniquet.

A note about quickclot as well, I havent used it in a few years. I didn't like it when it came out because of the burns, supposedly they have changed their formula since then, it still gets HOT. Either way celox is a great Product. It really stops the bleeding, even if your moving around or trying to crawl to safety etc.

But yeah, back in the day when I used this stuff Docs would be pissed if you used it in a situation where you could have just used a tourniquet, it makes a hell of a mess of a wound, especially the quickclot. Not to say these aren't good tools to have available, as a last resort anything is better than bleeding out.

Are you a paramedic? Was at the motocross track a couple weeks ago and a guy got a hole torn in his thigh about 5" long and inch or 2 wide. Wasn't arterial, so I just wrapped a shirt around it and kept pressure on it and slowed the bleeding alot. My daughter just went through combat medical training and said they now recommend a tourniquet for any kind of heavy bleeding, when I was an emt we were always taught it was a last resort unless arterial. They change this now?

 

[Grace Tree]

We carry Celox on our harnesses and in the truck.
Phil

 

[deeker]

I make sure I carry a couple of tampons and a couple of maxi pads in my truck first aid kit, it it non arterial, they'll do a great job of stopping bleeding in puncture wounds, or wear a chain has torn flesh open.

Those along with an XL BP "Blood pressure" cuff, most leg and arm bleeds will stop with direct pressure. A tourniquet has amputation problems. Most arterial bleeds are controllable with a compression bandage or direct pressure which is not released until the ER Physician's hand takes over.

While I don't have the brass to be a tree monkey, I don't like to further a persons injury.

A former BIL lost his 16yr old bro by not applying direct pressure to the left femoral artery wound inflicted by a .22 rifle. On a long 3 mile trip to the local ER. He said "blood is gross"!

I would like to see more crews have an EMT-Basic on site, costs being the only downside.

Sorry for the rant.

Kevin

 

[deeker]

Are you a paramedic? Was at the motocross track a couple weeks ago and a guy got a hole torn in his thigh about 5" long and inch or 2 wide. Wasn't arterial, so I just wrapped a shirt around it and kept pressure on it and slowed the bleeding alot. My daughter just went through combat medical training and said they now recommend a tourniquet for any kind of heavy bleeding, when I was an emt we were always taught it was a last resort unless arterial. They change this now?

Great post!

Please tell your daughter, Thanks for her service!!

 

[Kottonwood]

I am not a paramedic but I have extensive experience stopping bad bleeders. I have used celox, quickclot, and tourniquets in real world scenarios.

In the training I have received and what I believe is the most up to date information on immediate trauma care is that you can go right to a tourniquet if you you need to. On large wounds that are not arterial or a full amputation a pressure dressing may stop the bleeding at first, but because of the wound and shock, capillaries also close to shut off blood to the area. After a period of time the wound can start bleeding more and a pressure dressing won't suffice.

Limbs can survive a pretty good amount of time with a tourniquet on (I don't know exactly how long but it's definitely measured in hours), it is common practice during surgeries to put a tourniquet around a limb for the duration of the surgery.

A note about tourniquets. If it doesn't hurt, and I mean really hurt...... you're not doing it right.

Another note. Once you put a tourniquet on only a qualified person should remove it. There is a technique to removing a tourniquet properly, also sometimes you require drugs to prevent reactions to acids built up on the wrong side of the tourniquet. Anytime you put on a tourniquet you should record the time that you put it on.

 

[Dalmatian90]

when I was an emt we were always taught it was a last resort unless arterial. They change this now?

I let my EMT expire in '08 after 20 years...I hadn't been active in a few years, and decided so much had changed if I went back active it would be worthwhile to just repeat the whole class...as much of a PITA that would be.

And yes, they emphasize using a tourniquet much more nowadays.

Not that all systems have necessarily updated their protocols yet, but basically if you can get them to a hospital within 2 hours go ahead and use the tourniquet first for any major bleeding from an extremity. Most places, most times you're well within that window.

Tourniquet First! - Major Incidents - @ JEMS.com

The older, last resort recommendations had come out of the WWII experiences where soldiers might have spent hours on a battlefield before evacuation, and even after evacuation the aid station might not have realized there was one in place (covered by blankets, etc).

Of course if you're the only guy who can climb in the area and you're up in a tree you may end up pushing that 2 hour window even if you were trimming trees across the street from a trauma center, because the vast majority if not all fire departments if they can't reach you with a aerial tower they are going to look like a monkey fornicating with a football trying to get you down.

=============
Speaking of Monkey Fornicating Football, as I recall the "back story" this first incident was witnessed by a rescue-trained arborist whose assistance was initially declined -- but he hung around while the hilarity ensued (included bringing a Coast Guard chopper 50 miles inland, and the closest base I know with one is Cape Cod 150 miles away, to try and lower a rescuer into the tree top) until they finally decided he was the best option.

Then they gave him a lesson on the rescue harnesses the rope team had, and he went about his business efficiently to tie off the plane to secure it, put in points to lower the victims from, and get them in harnesses to be lowered to the ground once they climbed out of the airplane.

http://www.masslive.com/news/index.ssf/2008/08/antique_biplane_crashlands_in.html

And three years later with almost the identical situation, they decided they should call him in to help:

http://www.firehouse.com/news/top-headlines/conn-pilot-rescued-aircraft-stuck-tree

 

[flushcut]

Good thread! This should be a sticky.

 

[deevo]

Are you a paramedic? Was at the motocross track a couple weeks ago and a guy got a hole torn in his thigh about 5" long and inch or 2 wide. Wasn't arterial, so I just wrapped a shirt around it and kept pressure on it and slowed the bleeding alot. My daughter just went through combat medical training and said they now recommend a tourniquet for any kind of heavy bleeding, when I was an emt we were always taught it was a last resort unless arterial. They change this now?

Yeah thats what I thought as well? I am on the Volly FD, and they took the tourniquets off the trucks a while back. You could do one as a last resort, but not part of our first aid training anymore. Is that just an Army thing Patriot tree co? Squad 143 what are you guys doing?

 

[deevo]

I am not a paramedic but I have extensive experience stopping bad bleeders. I have used celox, quickclot, and tourniquets in real world scenarios.

In the training I have received and what I believe is the most up to date information on immediate trauma care is that you can go right to a tourniquet if you you need to. On large wounds that are not arterial or a full amputation a pressure dressing may stop the bleeding at first, but because of the wound and shock, capillaries also close to shut off blood to the area. After a period of time the wound can start bleeding more and a pressure dressing won't suffice.

Limbs can survive a pretty good amount of time with a tourniquet on (I don't know exactly how long but it's definitely measured in hours), it is common practice during surgeries to put a tourniquet around a limb for the duration of the surgery.

A note about tourniquets. If it doesn't hurt, and I mean really hurt...... you're not doing it right.

Another note. Once you put a tourniquet on only a qualified person should remove it. There is a technique to removing a tourniquet properly, also sometimes you require drugs to prevent reactions to acids built up on the wrong side of the tourniquet. Anytime you put on a tourniquet you should record the time that you put it on.

Thanks for that explanation! Is the Celox available at any pharmacy or do you have to get it at a special place? I will google it and see if they sell it here in Canada

 

[Grace Tree]

http://www.amazon.com/Celox-Hemostatic-Granules-15g-Packet/dp/B003B76NVO/ref=sr_1_1?ie=UTF8&qid=1323008401&sr=8-1

 

[Toddppm]

I let my EMT expire in '08 after 20 years...I hadn't been active in a few years, and decided so much had changed if I went back active it would be worthwhile to just repeat the whole class...as much of a PITA that would be.

And yes, they emphasize using a tourniquet much more nowadays.

Not that all systems have necessarily updated their protocols yet, but basically if you can get them to a hospital within 2 hours go ahead and use the tourniquet first for any major bleeding from an extremity. Most places, most times you're well within that window.

Tourniquet First! - Major Incidents - @ JEMS.com

That's a good article, I have forgotten a lot of that stuff as it's been at least 13-14 years or so since I was into it.


and the Dr. who commented on the article about the aterial vs. venous injury makes a very good point.

 

[deevo]

Amazon.com: Celox Hemostatic Granules 15g Packet: Health & Personal Care

Great thanks for that!

 

[beastmaster]

Thank you all this has all been very informative. My first aid training was in boy scouts, a long, long time ago. So we don't use the stick method to apply a tourniquet anymore. Maybe its time to take a class. Iv'e seen so many near accidents and almost traumas over the years it's only a matter of time tell someones luck runs out. It would be hard to take if someone died and I could of prevented it.
I jokingly tell my idiot grounds men to always be on guard underneath me when I am in a tree. If I drop a saw or pole pruner on them and kill them, I'll feel really bad, but they'll still be dead. But truth be told I'm like a mother hen with those youngsters. They have developed a lot of bad habits, they think macho is risking danger and taking chances.(Maybe I did 25 years ago too)
Again thank for the information.

 

[Dalmatian90]

This came across another forum today, yeah it's a bit lengthy and over-produced...but kind of gives you a good idea of the monkey fornicating with a football that real-world accidents can become, especially when they're out of the ordinary. It is a wildland firefighter who died after being hit by a falling snag while using a chainsaw.

You get the same injury on the ground in a suburban backyard, OK, no problem the Firefighters & ambulance crew will load you up and get you to the hospital pretty darn quick. That's well within their comfort and experience zone. Some up in a tree, or in this case just a 1/3rd of a mile off road (and I assume steep terrain), and it became a CF.

Googling a bit more background, a tourniquet couldn't be used because the injury was in the pelvis/groin area so there was nothing to wrap on around; though the belief is the newer Quick Clot type treatments like some of the posters above have mentioned would have worked much better then the work and tee shirts they used to try and put pressure on the bleeding.

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Hmmm...embed isn't working, here's a link: http://www.youtube.com/watch?v=TFLgOQqLq_Q&feature=player_embedded

 

[medic2397]

The tourniquet is making a come back for sure. I am a flight paramedic as well as a tactical officer in NY and we have recently been teaching all patrolmen tourniquet first for ALL bleeding in the tactical environment. Theory is "stop the bleeding." Once you have time on your side you can re-assess and remove as necessary. As far as working in the tree goes, I would say the same. If you are bleeding from an extremity, put the tourniquet on. If it turns out to be nothing more than a hangnail, great! If its arterial, then you'll be damn glad you used the tourniquet.

As far as quick clot goes, we are also teaching to use this. Not in the traditional powder form, it now comes as quick clot gauze or combat gauze. It is a gauze impregnated with quick clot. It does not burn like it use to and is designed to be used where a tourniquet cannot be applied (torso, upper leg, groin etc.) If you remember the movie "Blackhawk Down" they showed a scene where they couldn't get a torniquet on and ultimately the soldier died from an arterial bleed. Quick clot was developed for wounds like that.

I wish there was a class designed for stuff that we are doing, not just a regular old "bandaid" class.