Training Day: Why you should practice using different kinds of hemostatic agents
It’s critical that EMS providers understand how to properly use available bleeding control tools
Sponsored by Bound Tree Medical
By Tim Nowak for EMS1 BrandFocus
Excessive bleeding ... check!
Open hemostatic agent packaging ... check!
Has this been the extent of your agency’s hemostatic agent deployment training and product discussion? What about hands-on training on how to use the products that you purchase – especially those that seem to defy what we’ve traditionally been taught (that is, not to stuff anything into someone’s body)?
Training with hemostatic agents can be a bit tricky.
WHAT DO YOUR PROVIDERS KNOW ABOUT HEMOSTATIC AGENTS?
Here’s a little experiment for you to try: In a classroom setting, use whatever simulator you have to replicate major bleeding and give your participants a couple of different hemostatic agents to use to control the bleeding. Don’t prompt or instruct them in how the product is supposed to be used. Start with letting them figure it out, then see what kind of results you get.
- Did they simply apply the dressing over the site, or did they pack it into the wound?
- How about direct pressure? Did they hold it firmly in place and wrap it with some roll gauze or tape a bandage over it, or did they firmly press on the wound and hemostatic gauze for at least 60 seconds, or until the bleeding was controlled?
- What about folding the hemostatic gauze in half before you pack it into a wound – does that make sense to do?
Which reply is the correct answer? Well, it depends on what you’re using.
PACK AND PRESS TO STOP THE BLEED
Many static training environments simply don’t replicate the presence of major hemorrhage (exsanguination). A puddle of fake blood over a mannequin’s abdomen isn’t realistic in the least. A fluid bag under a little bit of pressure as it pushes out a concentrated, red liquid until the “wound” is compressed hard enough is an entirely different training situation.
Replicating a situation where the use of hemostatic agents is indicated – followed by how to properly pack and press these products into the wound – is the training approach that we need to instill and build into our providers’ muscle memory. Equally important is understanding the nuances between each specific product – how it’s designed to be used (packed).
Again, it goes against traditional education to talk about packing any sort of bandage into someone’s wound, but in these circumstances, and with these products, that’s exactly what you’re supposed to do.
Which types of injuries could this apply to? Here’s a list of likely suspects requiring aggressive hemorrhage control:
- Gunshot or stab wounds to the abdomen.
- Gunshot or stab wounds to the extremities (when a tourniquet isn’t indicated, or in conjunction with them).
- Large lacerations.
SET UP YOUR TRAINING (AND YOUR TRAUMA BAG) FOR SUCCESS
The right tool doesn’t do you any good if you don’t know where it is or you don’t have access to it when you need it. This certainly applies to hemostatic agents. Storing all of them in the back of some cabinet inside of your ambulance hardly does your crews (or patient) any good.
Critical pieces of equipment like hemostatic agents need to be readily accessible patient-side. When you incorporate product use into your training scenarios, don’t simply set out everything that’s needed to run the call on a tabletop – put in a replica training bag in the same location, packaging and with the same pull tabs and misaligned zippers as your everyday bags and train like you work.
TRAIN REAL, TRAIN OFTEN
Working in pairs, start with the first provider applying direct pressure to a bleeding wound with their gloved hands. Then, introduce a sterile dressing, followed by a hemostatic agent. Pack the wound, apply direct pressure and then switch providers, maintaining firm, direct pressure in the process.
This type of training shouldn’t just be a once-a-biennium event. We (you) need to regularly talk about hemorrhage and train providers both on how to physically control bleeding and how to incorporate escalating tools like hemostatic agents to help keep the leak at bay.
Visit Bound Tree for more information on hemostatic agents.