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44-Hour Course

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Lesson no. 20

Hemorrhage – Bleeding

A hemorrhage, by definition, is blood fluid exiting from the blood vessels.

The bleeding can be divided into three types:

 

  • Subcutaneous bleeding (blue mark).
  • External bleeding – bleeding (often gushing) from the body. This is the bleeding we will treat. The dangers of external bleeding are massive blood loss, infection, and hypothermia.
  • Internal bleeding – this is bleeding that is out of our control when in the field! That is, it cannot be stopped.

 

Any internal bleeding can develop to a level of medical shock. Internal hemorrhages can be difficult to diagnose. This bleeding should be suspected when there are unexplained signs of shock and external signs on the body (blue marks or bruises). This hemorrhage can be stopped in an operating room.

 

Hemorrhages can be stopped by direct or indirect pressure:

 

  • Direct pressure is pressure applied with a bandage on the injury site to stop the blood from escaping.
Bandage by England flag method
Bandage by Pressure triangle
  • Indirect pressure is stopping all blood supply to the site of injury by blocking the arteries (tourniquet), and in doing so preventing bleeding, but creating necrosis to the same location.

Of course, it is always preferable to use direct pressure over indirect pressure to prevent unnecessary necrosis, but there are a number of cases where indirect pressure should be applied.

 

Let us remember these cases with the help of the acronym Kever Rachel as well as the case where it’s “Tachat Esh” (under fire):

 

The acronym, when translated from Hebrew, is as follows:

  • Partial/full amputation.
  • CPR.
  • Multiple hemorrhage points/large shrapnel that is stuck and bleeding.
  • Multiple wounded at the scene.
  • Darkness, where you cannot be sure of the extent of the bleeding.
  • Direct pressure did not help.
  • Under fire – the causes necessitating a tourniquet are divided into causal (direct pressure did not help) and effectual (dark and cannot see the severity of the bleeding). There are cases where a tourniquet will be applied as a result of an effectual factor and where it now makes sense to convert it to a personal bandage (direct pressure).

 

This operation is only allowed by medics, paramedics, and doctors because once the tourniquet is placed, toxins and blood clots begin to accumulate in the area. Only a skilled responder who knows how to properly convert a tourniquet and how to deal with potential complications can do so.

 

There are also pressure points used in cases where we must place a tourniquet but we cannot do so (there aren’t any tourniquets on hand, or the tourniquet physically cannot be placed at the point of bleeding, for example, an armpit). We will learn about these points in the practical lessons.

Wounds

Wounds are a daily and common injury and can usually be treated independently.

 

Types: Scrape, Rub, Tear, Burn

Treatment

  • First, if there is bleeding – the bleeding should be stopped immediately.
  • If no bleeding is present, rub and scrape wounds can be disinfected using gauze pads soaked in Savi-Or (antimicrobial soap).
  • After disinfection, apply polyidine if available, and bandage. The point of applying a dressing is first and foremost to create a closed encasing.
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