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Rapid Response Week: Controlling Bleeding


>>What is the most unconventional way you’ve ever seen someone
take care of a wound?>>Objection, leading the witness! You clearly have an example ready to go.>>I saw a friend our ours, whom you know, crash through some drywall after riding an ironing board down the stairs. When he stood up he had
a compound fracture, the bone coming out of his hand, he pops it back into place, wraps it in duct tape, keeps going. ♪ [upbeat guitar] ♪ ♪ ♪ ♪ [music swells] ♪ [diagetic sound bleeds in]>>robot voice: Part one, Bleeding Control.>>All right we’re here
with Daniel and Jenna, our EMT friends. You’re just going to live here now, right?>>Sure!
>>Absolutely I really like it!>>Because we can’t trusted.>>Maybe we can fix all this
up first and then make it safe?>>Until it’s safe, we
definitely need them.>>So you guys are both EMTs, right?>>Yes sir.>>But not paramedics, and
I guess there’s a difference between the two.
>>Clear it up please. What is the difference?>>Well there’s the two types. There’s your EMT basic
which is what we are, and then there’s a paramedic. There’s an intermediate level
but no one uses that anymore. Basics are more for wound care. They can do basic drugs like albuterol for asthma attacks and stuff. Paramedics is when you get into the IVs, and other medicines for cardiac issues.>>So EMTs might be first
on the scene but there’ll be certain drastic measures
that can’t be taken by EMTs and you have to wait for
the paramedics to arrive.>>Correct or in a more
advanced urban ambulance system you’ll have an EMT and a
paramedic partnered together so that the EMT can compliment
the paramedic by doing the easier tasks and the paramedic can do the more complicated stuff.>>Jenna: Yeah.
>>I would love to believe like a paramedic is like a
Michael Scott kind of, you know, they show up and you’re like “Eh, this seems more
like an EMT job to me.” [laughter]
>>Sometimes that happens.>>Really?
>>Yes [laughter]>>Yeah it does, depends on who
you’re working with but yeah.>>So asking for a friend,
can you write prescriptions?>>No, not at all.
>>No.>>What are we learning today?>>Okay, so we’re going to
start with bleeding control. There are two main types of bleeding. There’s your compressible bleeds and your non-compressible bleeds. So if you were to be stabbed or shot, that’s a compressible bleed. That’s, you’re bleeding to
the outside of your body. That can be stopped.>>Anything that gets stopped when you squeeze it is a compressible bleed?>>Basically.
>>For example, when I split my knuckle open shattering the lock
and then did this. ♪ ♪ [sharp impact, small metal fragments bouncing]>>Oh!
>>Yeah dude, it totally shattered.>>Oh and I think they’re in my pants.>>Cut my knuckle.>>What’s that?
>>I banged my hand [mumbles].>>Oh hell, it burned through my shirt.>>So what does it look like when you discover a non-compressible bleed?>>Well a non-compressible
bleed is something internal so if you were to be
involved in a car accident or another blunt force
trauma and you were bleeding to the inside of your
body, a lot of times in the abdomen you can feel,
what we call pulsating mass. And that’s actually the
blood inside your abdomen.>>Let’s say a rib fractures
and pokes something and then stuff is bleeding
so I would imagine the blood would fill a void and then what you’re actually feeling is
the pulse just, sort of, because it has nowhere to go
so it just blub, blub, blubs.>>It’s starting to come out there.>>Boy, that’s awful.>>Into the tissue.
>>Yeah.>>You can also check your blood pressure. When your blood pressure
starts to drop but there’s no obvious reason, that
is a clue that it could be an internal bleed especially
if trauma’s involved.>>So what do you do in that case?>>Well a lot of times we call
it lights, sirens, and diesel.>>Yeah.
>>LSD.>>Get them to a hospital
as fast as possible.>>Okay, okay, okay.>>And get to a trauma surgeon because that’s sometime the
only way you can get that fixed.>>Is it a case where there’s
a general rule of thumb about how much time you have if you know you have an internal bleed?>>Yes so, especially the
system where I work, we have a 15 minute time limit for
certain trauma categories. So certain things,
including internal bleeding, if you figure it out, we’ve got 15 minutes to get off the scene and get going.>>Wow.>>What if something stupid
happens like you get cut by steel wool or something like that?>>I’m bleeding.>>How’d you do that?>>I don’t, I think. [laughs]>>That’s not necessarily trauma category so if we were to, and I actually did this, where there was a dude who had crashed his scooter and he broke his wrist. That’s not a trauma activation. It’s something we can splint
and we have time to get to the hospital but if
someone’s involved in a massive car accident
and they’re unconscious, we’ve got 15 minutes to get going.>>Was it one of those dumb Lime scooters?>>Yes.
>>Whoa, whoa, you take that back! Those are the best things
to happen to America.>>You still administered aid.>>Absolutely.
>>Yep.>>I do my job.>>So what are we learning here?>>Okay so this is just a simple
wound trainer that we built. It’s just a pool noodle
with some PVC in it but it represents an arm or
a leg with bone in there. Basically if you were
to get cut in your arm, there are certain types of
bleeding that you can see like capillary bleeding, venous bleeding and arterial bleeding.>>So venous bleeding is what, veins?>>A vein.
>>Those are the ones that comically go bloop, bloop, bloop.>>No, that would be an arterial bleed.>>Yep.
>>There you go.>>So a capillary bleed when
you so often cut your finger–>>Okay…
>>Is usually what’s going on there.>>Capillary bleeds, those are minor.>>Those are the very minor, a small cut. It’s just oozing out of the wound. Bright red or slightly darker blood.>>That’s the one that usually
you stick in your mouth first and then you squeeze and–>>Put a Band Aid on it. A venous bleed is, a vein. It’s slower and dark, almost blue. Dark purple kind of color.>>And this is the
oxygenated or non-oxygenated?>>Yes.
>>Non-oxygenated.>>That would be non-oxygenated.>>Oh that’s right, that’s right because it’s more red when
its got the oxygen in it.>>That’s when it’s leaving the body.>>Got it.
>>And that’s where they take blood
when you’re giving blood.>>I never realized that.>>That’s a vein, not an artery.>>Yep, that’s a vein.
>>And you can tell because it goes out in a smooth, if it was an artery it would
go bleugh, bleugh, bleugh.>>Yeah, it’s a lot lower pressure.>>Yep.>>Arterial bleeds are the worst ones. They’re the ones that comically spray.>>And they’re bright red, like bright red.
>>Bright red. If you recognize one of
those which is very easy to recognize, the first thing
you do is get pressure on it. Anything you have, whether
it be your hand, if you have any kind of gauze at all
or if you need to take off your tee shirt.
>>Plastic bag, tee shirt,>>Anything at all.
>>Anything.>>Get pressure on that wound. A lot of times that’s not
going to help anything because it’s under such pressure and you can’t just get
enough pressure there.>>Wait, do you do the thing where you raise it above your heart? Is that a thing?>>So it can help but
honestly you’re under so much pressure that it’s not going to do anything except get blood on you.>>You want to put the
pressure like on the wound directly, not in the surrounding area,
not like, okay, here’s where I think the blood is coming from.>>Directly on and if, say
it’s your arm, if you can get on a table and then press
down as hard as you can.>>Press as hard as you need
to to cause the blood to stop.>>>Yes.>>If blood is still
coming, press even harder.>>Right.
>>Yes.>>At what point do you get into
tourniquet territory?>>So a lot of times when
that’s not working, people have said that it doesn’t
help to put the tourniquet on because all you’re going
to do is kill your hand but I’d rather have an
amputation than be dead. And when all your blood
is gone, you’re dead.>>Okay so this ties into all
the way back in Cub Scouts, I remember hearing like,
the moment you put a tourniquet on something, that’s gone.>>Not necessarily.
>>Okay.>>It’s surprising especially,
depends on where you are. Because if you’re out in the
boondocks doing something and you get cut like that,
you could probably say goodbye to your arm but it’s
better that than dead. If you’re in a city and you
cut yourself on a rusty pipe or something, then as long as you get to the hospital soon, they
can generally save it.>>Wow.>>It’s within four hours, right?>>Yeah four hours is a good–>>Generally speaking.>>It’s a good window.>>What is the first thing you do when you come across one of these?>>We got it, pressure, got it, pressure.>>So pressure on, if you can
put something on there like a cloth, a tee shirt, whatever pressure.>>You can constantly
talk about whether or not it’s going to get into college. You can ask how it’s doing on its SATs. If its finished its homework.>>All the pressure.
>>You stay with me!>>Don’t you die on me. If that’s not going to
work, we’re going to have to go to the tourniquet. And this is a very simple,
it’s a triangle bandage we had but honestly a piece of tee shirt, anything you can tear into
a strip is going to work. And you’re going to want to
put it on high and tight.>>So at least two inches above the wound.>>But honestly if you can get
it up as far up as possible–>>Yeah the higher you
can get it, the better.>>Not near the wound necessarily.>>Not even necessarily.>>So let’s say the wound is here, would you put the tourniquet up here?>>I would.>>Whoa, really?
>>Yeah.>>High and tight is just the general rule so I’d want to get it as high as possible and as tight as possible
and that’s going to give you the best chance of stopping that bleed.>>Tourniquets of course, also only apply to the limbs, right?>>Right.
>>Yes.>>You’re not going to try to like–>>Right.
>>Yes.>>You’re like, “Put it around
the neck, high and tight!” I just realized I’m still
putting pressure on this. [laughter]>>Good man.>>If this was a real
scenario, you’d be good but it only works on the limbs. And sometimes the legs you’re
going to need two or three because there’s so much mass there.>>Whatever the strip is, you
wrap it around and then what? You put a stick in there
and twist or something?>>Yeah, I’m going to use my
wife’s arm as an example because–>>Oh, that’s safe.>>Yes it is. So she’s got a bleed down here,
the pressure isn’t working, I’m going to get it high and tight. I’m going to kind of tie it off here.>>So the first part it’s basically like you’re tying your shoes.>>Yes.
>>Kind of, yeah. I’m getting it as tight as possible and I’m going to put a pen in there.>>What’s the pen for?>>A windlass.
>>It’s a windlass.>>Wait, a windlass?>>Yeah.
>>It’s called a windlass. I’m going to try to tighten this up.
>>I’ve never heard that.>>So you would just tie it kind of like you’re tying a double knot type deal.>>And then you got to–>>Oh, you’re trying to get
it as tight as possible.>>Oh yeah.
>>Absolutely.>>Basically you get it snug,
you wrap it over on the bottom and then you tie it over top and then you just start twisting
and then the whole thing just gets tighter and tighter and tighter. You’re building a little motor.>>It’s the same principle, uh, when you choke someone with a garrotte.>>Yes.>>Well yes.>>And then you get it
as tight as possible and the goal is…
I shouldn’t feel a pulse. [gasp] And that’s the point.
>>Wait, do you not feel a pulse?>>I do not feel a pulse.>>So this is a trick that–
>>Better do it quick.>>Get an ax! [laughter]>>So psychics would
claim to go into a trance and actually stop their
heart and they would make a big deal about having a nurse there taking their pulse the whole time. They would just have a
tennis ball in their armpit and they would just squeeze down until and then you couldn’t feel the pulse.>>Fascinating.>>But I’m going to bet that a tennis ball is not as effective as a tourniquet.>>Definitely not.
[laughter] So if compression is not working on the outside, you go
a tourniquet, right?>>Absolutely.>>Then what are we learning
besides the tourniquet then?>>Well there’s other places
that you can stop bleeding so if for example I were to shoot
you with a gun right here–>>Then I would consider that rude.>>That would be very rude but–>>Dick move, Daniel. [laughter]>>And I thought we were friends!>>Totally. You can pack that wound and
stop the bleeding there. It’s very painful for whomever’s been shot but it’s better than dead, right?>>Really the only places
you pack on your body are like this area here or this area here.>>Definitely, I mean with
anything like a gun shot in your leg, you can tourniquet that. But if you get up here,
you can’t really tourniquet that, it’s too high but it
still bleeds a lot, right? I mean if I where on the ambulance
I’d have one of these but anything, again, works, a tee shirt, something like that.>>Wait a minute, I’ve heard that tampons are really good to plug gun shot wounds.>>Tampons are very good.>>Tampons will work, yeah.
>>Yeah. If this was a gun shot,
I can pack this wound and then you go in to
where you find the bone and you can actually find the bleed and the whole point of this is to keep as much pressure on it as possible.>>Brian: And the whole time they’re just definitely screaming.>>They’re probably screaming.
>>Yeah.>>And you’re just getting
as much in there as possible.>>Right.
>>So it won’t take anymore. It’s a lot like packing your teeth when you have your wisdom teeth removed.>>For sure, yeah, yeah.>>Very much like that.>>And we’ve even been taught
to get your knee on it.>>Oh geez.
>>Yeah.>>Daniel: And just sit on them until you get help.
>>I would be so pissed at you.>>Oh yeah.
>>Like, “Dude I got shot there stop!”>>Yeah.>>So is the thinking
on this that basically you’re creating pressure from
inside by filling the void and it’s pressing down
on all the capillaries?>>Absolutely and even
find where the bleeding is coming from, find the arterial source and push directly on that.>>Wow so just a dude’s thumb in your chest
>>So find where the blood– as you’re walking into the trauma ER.>>Essentially.
>>Yeah.>>You see that in like
dramatizations and ER movies and what have you where
they’ll root around in there to find the
actual vein and tie it off.>>Yeah that was Black Hawk Down there.>>So we’ve got packing the wounds,
we’ve got putting pressure on it, we’ve got tourniquets, is there anything else we need to know?>>I mean, if you have quikclot gauze, that’s an option we’ve got–>>Quik, quikclot gauze, is that what you?>>Quikclot gauze, yes.>>Quikclot gauze.>>Say that five times fast, right?>>That’s right, I will not.>>This is kind of a military thing but you can buy it civilian use. It’s just got some
hemostatic agent in there.>>Like instant coagulant basically?>>Right.
>>Yeah.>>So the blood comes
out as a liquid, normally it would coagulate and turn into a jelly and then kind of a scab, this
just speeds everything up.>>Yep.
>>Most definitely.>>You’re saying the gauze is
actually made in such a way that it too, on its own,
will help with clotting.>>Definitely.
>>Yes.>>That’s why you don’t want
to take gauze off if you’ve put it on, if it gets soaked
through, you just put more on so that it’s actually clotting
because it’s woven properly.>>And so I assume that’s
all just maximal surface area because the surface area, more exposure to the air and look at this, I’m sw– We’re getting very science-adjacent. We’re getting better by the minute.>>We’re practically doctors.>>So you come up, the
first thing you want to do is find out what kind of
bleeding are they have. Is it capillary, is it arterial or venal. Wait venal, isn’t that a type of sinning? [crosstalk]
Venous! Venous, okay. [laughter]>>Same Latin root.
[laughter drowns out sound]>>Kind of the same, venal
versus mortal, I mean. [laughter] Figure out what the bleeding
is, apply pressure until it stops, if it doesn’t
stop go to tourniquet.>>High and tight.>>High and tight! If it’s in a place that
you can’t tourniquet, then you pressure, you plug,
if you need to you dig in, you find the vein, you pinch it off and then you go call trauma ER.>>Call 911.>>Oh yeah.>>That’s an important number anyhow.
>>That makes sense.>>Call them, call the, yes.>>Internationally there’s all different–>>Definitely.
>>Yes.>>Is it 999?
>>Yes.>>Jason: There is.>>I think that’s Britain.>>Know where you are and then call that number. [laughter]>>Yes.
>>Right, that’s a good one.>>Although actually that’s
pretty good because if you’re traveling then that’s something that you might not consider
in an emergency situation. Do you guys have anything to plug? Or…>>No.
>>Well, I mean, now this– [laughter]>>If you get hurt in Austin.>>Is there a resource that
people should in general go to to get emergency
preparedness training?>>You know, there really isn’t
anything nationally noticed but you can always go to
your local fire EMS station, whatever you have and they’ll most likely be glad to help you out.>>Right on. [quieter]
>>Oh no, yeah, because
people were doing it sitting. And he flipped it over
and got the leg, shink.>>Brian: Oh my God.>>Jet ski’d down, ended up
going through the dry wall. Compound fracture.>>Yeah because the other
sides a whole lot smoother so it’s a faster ride.>>But about halfway
down the nose caught–>>Brian: Oh geez.>>Yeah.

100 thoughts on “Rapid Response Week: Controlling Bleeding

  1. Fun fact: if you call 911 in another country most modern phones will redirect you to the country you’re in’s emergency services. Other countries emergency services work in different countries all though I’m not sure on the specifics, not all work.

  2. aldo do not forget that you can use sugar. it acts like quick-clot. it clots up the blood / wound to help keep from bleeding out. great to buy time until you get to the hospital /for the emt's to get to the scene.

  3. Um… That's not a real tourniquet… That's a strip of rubber and a sharpie. I get that you use what you can get your hands on but why not show people how to use a CAT and recommend they keep a few around?

  4. In regards to civilian training, he said "there isn't anything nationally noticed" That is not true. Stop The Bleed Foundation regularly offers free courses all over the country. Usually facilitated by local Fire / EMS departments, churches, and schools.

  5. more stuff like this pls. this is the most useful thing you've done, and is exactly the sort of information a modern rogue needs.

  6. Paramedics know actual pre-hospital pharmacology, have more advanced training in pathophysiology and performe invasive procedures to provide life support.

  7. I remember when my husband cut that area just below where the thumb stops being a thumb (so like the wrist) and it didn't bleed for half a second before it just gushed out! I ran so fast, out of the house and up the street while barefoot. Apparently I saw blood and my body said "flight" it was so weird. I couldn't stop running nor did I know why I was running, my body was just out of my control.

  8. Always place the tourniquet TWO inches above a wound (if possible), not as high as possible. In the off-chance the person does lose their arm, it's better they have more limb than not. Also, it's very unlikely someone may lose a limb due to tourniquet placement. After 6+ hours the limb may or may not be considered lost, anything below, the limb is saved. It's also very unlikely you or any patient will be 6+ hours away from a trauma surgeon.

  9. i got a Venus bleed on my arm, i was playing with knives
    what we did is wrapped it in TP so i can walk home and do what i needed(by then it stopped bleeding and i basically washed it and put a bandaid on), Cool scar from it tho!

  10. for most people traveling in Europe take a look into 112. https://en.wikipedia.org/wiki/112_(emergency_telephone_number)

  11. Fun fact. In most countries all emergency codes will work. For example if you were in Britain and you dialed 911 it would just automatically reroute you to 999.

  12. Fun fact: during wwi (I believe) they used cylindrical cotton rods to stop bullet wounds, the nurses that would administer them later realized that these little things work really well for Menstruation. Thus later turning them into tampons. Now, disclaimer, do not use today’s tampons to stop bullet wounds. They have changed over the years and won’t work the same way.

  13. And somewhere a certified AEMT is ranting about being relegated to being "The middle one no one uses" 😛

  14. Moral of the story:
    If someone's got blood on them, squeeze them.
    Unless the blood is around their pits or their bits, then provide a tissue or ten.
    And if someone's got a weird bulging mass, provide LSD.

    Oh, and if squeezing them doesn't work, put it around the neck, high and tight.

  15. You don’t really need to know where you are, nowadays if you use what’s considered an emergency number 911/999 in most countries it will automatically transfer you to the countries emergency services.

  16. I actually learned that if you’re in a foreign country and dial, for example, 911, the call will reroute to the local emergency service dispatch in the country you’re in. Also, you don’t need cellular service, or even a SIM card to call emergency dispatch. Phone manufacturers are legally required to put components in it that allow an emergency call at any time.

  17. If you call any emergency number in any contry it will redirect you to your local authorities so if you call 911 in Sweden then it will redirect you to the swedish athorities

  18. What if you get stabbed in the leg (thigh) with a knife and arent able to get to proper medical care for at least a day? I'm currently planning out a graphic novel in which one of the characters finds themselves in this situation, and tbh I dont really know enough about the subject to know what would realistically happen to him.
    P.s. him losing the leg isnt an issue from a plot point of view if that is what would really happen.

  19. Pretty ok video. The concept that a tourniquet is needed is almost never true. The only times a tourniquet should be used is in a life or limb situation out in like the wild and you are many hours if not days from a hospital. If you are relatively close to a hospital and can call an ambulance just apply pressure and pack the wound. Packing sucks but it is the better option along with applying pressure.

  20. Something else with the tounriquet I learned in the Army. Mark the victim's forehead with a letter "T" using a marker, their own blood etc.

  21. Your local volunteer fire department will quite happily teach you some advanced 1st aid, and most of them offer EMT training every couple years (sometimes you have to pay for that, but the EMT cert is well worth it)

  22. Okay this has a few problems , I guess for someone who’s completely medically illiterate it’s better than nothing, but there are far better resources on YouTube .
    Skinnymedic and Prepmedic come to mind

  23. Do NOT use tampons to try to stop bleeding. The chemicals in them stop your bodies natural clotting process and the chemicals entering the blood stream has adverse affects on your body. Tampons only absorb blood, they do not have any pressure compressing the wound.

  24. As an army medic, in a rapid situation going to a tourniquet is the first choice different line of medical training but stopping the bleed is top priority

  25. Just putting it out there no matter what emergency number you call it will put you though to the local emergency services. Whilst on holiday in France I was in a traffic accident and had to call for a ambulance for some reason I panicked and called 911 (I’m English btw ) but was put on to the french ambulance service

  26. I saw a video where a cop got shot in the leg and his buddy put a tourniquet on him and got back in the fight ( it looked like a tourniquet at least)

  27. I know you think you’re funny, but trying to be the class clown when someone is trying to teach you how to save your life is fucking childish and stupid.

  28. When I was younger I used to think that tourniquet was bad bc it hurts like shit when it's tightened, then I discovered wound packing. Now I'd rather be shot in the head than have a wound that needs packing

  29. Thanks now I know if I have an internal bleed I can call myself an ambulance and say. " I have and internal bleed you have 15 minutes to get to me or I'm dead." Then I will set a timer for 15 minutes and the alarm sound will be the cod voice over guy saying "mission failed. We'll get them next time."

  30. If they started packing a gun wound on me I would just be yelling “just let me bleed out this is way worse than death”

  31. So basically the moral of the story is never take any risks or even leave your house because literally everything can and will kill you.

  32. 13:00 I understand why you would think that different places have different number but nowadays it really doesnt matter 911 and 999 are both so common with most smartphones its basically illegal to not equip them with the ability to call 911 anywhere even without service and same with 999 you can call those two virtually anywhere
    for example, if I was in china I can call 911 even though I'm not in the US, same with the US and 999

  33. "High and tight" and thats why he is a EMT and not a Paramedic. The s3 Polytramuma Guideline says as distal as possible and just one Hand proximal to the wound. You can argue if you use te distal Humerus because further down you have two bones to compress, but officialy you go down there.

  34. I was told by my last company to never tourniquet for a snake bite. I’d rather be an amputee I said. And they insisted to let the venom go to your heart. I respectfully left that idiotic job.

  35. My dad drilled a hole into his hand and was bleeding quite a bit and since I didn’t have any gauze, I used an infilled tampon to patch him up.

  36. High and tight? This guy is fucked up… 2-3 inches off where you think the artery is damaged rule of thumb is 4 inches… arteries retract into the body when severed

  37. My friend fell over his handlebars on his scooter, fractured his humerus, afew carpals, tore 3 ligemants, tore a muscle and bruised a nerve. Almost had to have it amputated… atleast he can still play rainbow six siege

  38. I've watched a lot of gore and I'm definitely desensitized when it comes to blood in movies etc but the idea of someone stopping the pulse in my arm is very disturbing to me for some reason

  39. I am guessing they do things different in Texas as compared to Pennsylvania, because they are telling you to do thing I was never taught in 30+ years as a EMT. But then maybe it has changed in the past 5 years.

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