In a column last year, i touched on the importance of integrating more drills on bleeding control for mild, moderate and severe incidents. This is a fundamental skill right up there with providing ventilations, CPR, or making a rescue.
Once your lifeguards have demonstrated their proficiency in applying the skill, as the in-service trainer, you should provide opportunities for your lifeguards to practice their skills within a practical scenario or drill.
How do we do this? Instead of having the skill of bleeding control be the main topic of your in-service, it becomes a necessary task for the drill to move forward. Here are some examples:
- Providing bleeding control before ventilations or CPR
- Discovering that bleeding control must be done while performing CPR, and controlling the victim’s bleeding must occur before CPR resumes
- Bleeding control must occur before the victim is moved to a safe area (victim is dragged or extricated in either a conscious or unconscious state)
- The rescuer must perform bleeding control on themself before providing care to the victim
- The victim is pulled from the water, and it is found that bleeding control is needed
- The victim has sustained an injury with severe bleeding from the torso where a tourniquet cannot be applied
THE DRILLS
Before progressing with your in-service, ensure you have the necessary supplies and equipment: Gauze, pressure bandages, and gloves. If trained to do so, then the additional equipment should include: tourniquets, chest seals, and hemostatic dressings.
MULTI-RESCUER VENTILATIONS: Lifeguards form three-person teams (two will be rescuers, one the victim). A manikin and a BVM are present, as are tourniquet and bleeding-control supplies. The instructor will identify the limb or body area that has severe bleeding.
Objective: Lifeguards arrive on the scene to an unconscious adult. During the primary assessment, it is determined the victim is not breathing, has a pulse, and has severe bleeding. Lifeguards need to stop the bleeding before performing ventilations. Once the bleeding is controlled, Lifeguards will provide one minute of ventilations.
Timing Goal: 2 minutes.
Lifeguards should demonstrate proficiency in:
Hemostatic dressing (if trained for it)
Direct pressure and pressure bandage
Tourniquet (if trained for it)
Chest seal (if trained for it)
MULTI-RESCUER CPR: Lifeguards form three-person teams (two as the rescuers, one the victim). A manikin and AED are present, as are tourniquet and bleeding control supplies. The instructor will identify the limb or body area with severe bleeding.
Objective: The lifeguards arrive on scene to an unconscious adult. It is determined that the victim is not breathing, has no pulse, and has severe bleeding. Lifeguards need to stop the bleeding before performing CPR. Once the bleeding is controlled, lifeguards provide three minutes of CPR.
Timing Goal: 4 minutes.
Lifeguards should be able to demonstrate proficiency in:
Hemostatic dressing (if trained to do so)
Direct pressure and pressure bandage
Tourniquet (if trained to do so)
Chest seal (if trained to do so)
SELF-APPLICATION: Lifeguards are paired up (one will be the rescuer/victim, one the proctor). Bleeding control and tourniquet supplies are available. The proctor will identify the limb or area that has severe bleeding.
Objective: Stop the bleeding.
Timing Goal: 20-30 seconds.
Lifeguards should demonstrate proficiency in:
Chest seal (if trained for it)
•Hemostatic dressing (if trained for it)
Direct pressure and pressure bandage
Tourniquet (if trained for it)
SELF-APPLICATION, MULTI-RESCUER VENTILATIONS: The instructor identifies the limb or body area with severe bleeding.
Objective: Lifeguards are on scene with an unconscious adult. During the primary assessment, it is determined that the victim is not breathing, and has a pulse. However, both lifeguards have sustained injuries that result in severe bleeding. The lifeguards must stop the bleeding for themselves, then the victim before performing ventilations. Once the bleeding has been controlled, the lifeguards will provide one minute of ventilations.
Timing Goal: 3 minutes.
Lifeguards should demonstrate proficiency in:
Hemostatic dressing (if trained to do so)
Direct pressure and pressure bandage
Tourniquet (if trained to do so)
Chest seal (if trained to do so)
EXTRICATION, SELF-APPLICATION: Lifeguards are paired up (one will be the rescuer/victim, one the proctor). Bleeding control and tourniquet supplies are available. The proctor will identify the limb or area with severe bleeding.
Objective: Stop the bleeding. Once the bleeding is controlled, you realize the scene has become unsafe, and lifeguards need to move to a safe location.
Timing Goal: 60 seconds.
Lifeguards should demonstrate proficiency in:
- Direct pressure and pressure bandage
- Tourniquet (if trained to do so)
- Chest seal (if trained to do so)
- Hemostatic dressing (if trained to do so)
EXTRICATION, MULTI-RESCUER: Lifeguards form three-person teams (two will be the rescuers, one the victim). Tourniquet and controlled bleeding supplies are available. The instructor will identify the limb or body area that has severe bleeding.
Objective: Lifeguards arrive on the scene to a conscious adult with severe bleeding. They need to stop the bleeding prior to performing extrication. Once the bleeding has been controlled, the lifeguards determine that the scene has become unsafe. They will assist the victim to a safe location. NOTE: The victim can walk with assist.
Timing Goal: 90 seconds.
Lifeguards should demonstrate proficiency in:
- Direct pressure and pressure bandage
- Tourniquet (if trained to do so)
- Chest seal (if trained to do so)
- Hemostatic dressing (if trained to do so)
Once lifeguards have demonstrated proficiency, move to these variations: - Scenario takes place at night when it’s difficult to see the victim and environment
- The lifeguards and victim must be quiet when providing care and extricating the victim
MISTAKES TO LOOK FOR
As the trainer, your critical eye is needed so participants don’t make mistakes that could delay or compromise care. Here are some errors you might see:
• The lifeguard doesn’t provide effective direct pressure
• The lifeguard doesn’t tighten the tourniquet enough to stop the bleeding
• The lifeguard delays in providing care for severe bleeding
• The lifeguard compromises their own safety
As the trainer, remind your team that death from uncontrolled severe bleeding can happen in under 60 seconds. Remember, less talk and more skill repetition.
Good luck and keep training.