OSF NORTHERN REGION EMS STANDING MEDICAL ORDERS BLS/ILS/ALS. Topic: Acute Hemorrhage Management

Transcription

1 OSF NORTHERN REGION EMS STANDING MEDICAL ORDERS BLS/ILS/ALS Topic: Acute Hemorrhage Management Policy Statement: This SMO will cover the management priorities for hemorrhage control. 1) Scene Safety 2) Body Substance Isolation (gloves, eye shields, gowns, as required by policy/procedure) 3) Perform survey of the body for hemorrhage. Sweep hidden body regions, under head, neck, back, buttocks and legs. 4) Expose any sites of bleeding to identify the injury site and mechanism. 5) Immediately stop any serious and continuing hemorrhage by applying direct pressure. Consider compression of proximal limb arteries to help. 6) If bleeding cannot be controlled by direct pressure dressing or if continued application of manual pressure is not practical, then apply appropriately apply tourniquet. ( refer to section on tourniquet use for information about proper application of tourniquets) 7) Consider using hemostatic agent with tourniquet if steps 1-5 fail to control arterial bleeding. 8) Special use devices: IT clamp hemostatic. 9) IT clamp hemostatic device may be of use to stop bleeding from large soft tissue lacerations/scalp wounds. Utilize the IT clamp device when appropriate per attached IT clamp protocol 10) Treat Shock per trauma protocol.

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3 OSF NORTHERN ILLINOIS EMS STANDING MEDICAL ORDERS EMT Basic, Intermediate, Paramedic SMO: Hemorrhage Control Tourniquet Use Overview: Stopping hemorrhage as soon as possible is the highest priority in patient management when confronted with significant hemorrhage. Follow standards of care regarding management of bleeding and the sequence in which patient interventions are performed. The normal sequence for hemorrhage control in the field is: 1) Body Substance Isolation (gloves, eye shields, gowns, as required by policy/procedure) 2) Initiate direct pressure with a gloved hand once bleeding wound is identified 3) Assess significance of bleeding wound, capillary bleeds or very slow flowing hemorrhages may be effectively controlled with directed pressure and standard gauze dressings 4) A tourniquet may be used to control potentially fatal hemorrhage only after other means of hemorrhage control have failed. PRECAUTIONS: A tourniquet applied incorrectly can increase blood loss. Applying a tourniquet can cause nerve and tissue damage whether applied correctly or not. Proper patient selection is of utmost importance. Injury due to tourniquet is unlikely if the tourniquet is removed within 1 hour. In cases of life threatening bleeding, benefit outweighs theoretical risk. A commercially made tourniquet is the preferred tourniquet. If none is available, a blood pressure cuff inflated to a pressure sufficient to stop bleeding is an acceptable alternative. Other improvised tourniquets are not allowed.

4 PROCEDURE 1) Apply non-sterile gloves 2) First attempt to control hemorrhage by using direct pressure over the bleeding area. 3) If a discrete bleeding vessel can be identified, point pressure over the bleeding vessel is more effective than a large bandage and diffuse pressure. 4) If unable to control hemorrhage using direct pressure, apply tourniquet according to the manufacturer specifications and using the steps below: 5) Cut away any clothing so that the tourniquet will be clearly visible. NEVER obscure a tourniquet with clothing or bandages. 6) Apply tourniquet proximal to the wound and not across any joints. 7) Tighten tourniquet until bleeding stops. Applying tourniquet too loosely will only increase blood loss by inhibiting venous return. 8) Mark the time and date of application on the patient s skin next to the tourniquet. 9) Keep tourniquet on throughout transport a correctly applied tourniquet should only be removed by the receiving hospital. Clearly inform hospital staff of the presence of the tourniquet both in prehospital communication, bedside report and written documentation. Medical Control Contact Criteria If any question exists as to the best option for the patient Documentation of adherence to protocol Document need for use of tourniquet Document location, type, and time device was applied Document approximate blood loss

5 OSF NORTHERN ILLINOIS EMS STANDING MEDICAL ORDERS EMT Basic, Intermediate, Paramedic SMO: Hemorrhage Control Hemostatic Agent Overview: Stopping hemorrhage as soon as possible is the highest priority in patient management when confronted with significant hemorrhage. Follow standards of care regarding management of bleeding and the sequence in which patient interventions are performed. The normal sequence for hemorrhage control in the field is: 1) Body Substance Isolation (gloves, eye shields, gowns, as required by policy/procedure) 2) Initiate direct pressure with a gloved hand once bleeding wound is identified 3) Assess significance of bleeding wound, capillary bleeds or very slow flowing hemorrhages may be effectively controlled with directed pressure and standard gauze dressings 4) Hemostatic agents may be used for serious hemorrhage that can not be controlled by other means. CONTRAINDICATIONS: Not to be used for wounds involving open thoracic or abdominal cavities. PROCEDURE 1) Apply approved non-heat-generating hemostatic agent per manufacturer s instructions. 2) Supplement with direct pressure and standard hemorrhage control techniques. 3) Apply dressing Approved commercial agents include: HemCon from HemCon Medical Technologies QuikClot

6 Medical Control Contact Criteria If any question exists as to the best option for the patient Documentation of adherence to protocol Document need for use of hemostatic agent Document location, type, and time hemostatic agent was applied Document approximate blood loss

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8 OSF NORTHERN ILLINOIS EMS STANDING MEDICAL ORDERS EMT Basic, Intermediate, Paramedic SMO: Hemorrhage Control Use of Mechanical Devices-IT Clamp Overview: Stopping hemorrhage as soon as possible is the highest priority in patient management when confronted with significant hemorrhage. Follow standards of care regarding management of bleeding and the sequence in which patient interventions are performed. The normal sequence for hemorrhage control in the field is: 5) Body Substance Isolation (gloves, eye shields, gowns, as required by policy/procedure) 6) Initiate direct pressure with a gloved hand once bleeding wound is identified 7) Assess significance of bleeding wound, capillary bleeds or very slow flowing hemorrhages may be effectively controlled with directed pressure and standard gauze dressings 8) If direct pressure will not be effective (either due to hemorrhage rate or lack of resources), apply the itclamp(s) as described below 9) For extreme extremity injuries not amenable to itclamp application (e.g. the skin edges cannot be approximated) consider tourniquet application in accordance with policy and procedure. 10) Transport patient to appropriate facility for definitive care of wounds CONTRAINDICATIONS The ITClamp50 is contraindicated where skin approximation cannot be obtained (for example, large skin defects under high tension). PROCEDURE Apply non-sterile gloves Bring package into close proximity to patient wound

9 Open the sterile package by pulling forward on the outer tabs Remove the device from the package by lifting up, taking care to not close the device until it has been applied to the wound o If the device has been inadvertently closed, push the side buttons inward with one hand, and pull the device open (using the device arms, do not slide fingers beyond the safety bar) Locate the wound edges Align the device parallel to the length of wound edge. Position the needles approximately 1-2 cm from the wound edge on either side. o For very large wounds the device can be applied to one side of the wound first and then pulled over to the other side, or the tissue can be approximated by hand and then the itclamp applied. Press the arms of device together to close the device. Device safety seal will break with pressure. Ensure the entire wound is sealed and bleeding stops, using your gauze pad to wipe the area to verify no leaking of blood from the wound. o A gauze or compression wrap can be placed around the device on the wound to protect the device and increase the pressure on the wound to limit hematoma expansion. o NOTE: More than one device may be required for large wounds. If bleeding continues: o If the device is in the correct position (pressure bars parallel to the wound edges), close the device more firmly by applying further pressure to the arms of the device. o o If bleeding continues because the wound is too large: apply a second device (or as many devices as needed) to the open section. If bleeding continues because the device is not positioned correctly, remove the device according to instructions and reapply. Medical Control Contact Criteria If any question exists as to the best option for the patient PRECAUTIONS AND COMMENTS This device is intended for temporary use only; use beyond three-hours has not been studied Patients must be seen promptly by medical personnel for device removal and surgical wound repair

10 Only use device as directed to avoid needle stick injury Do not use where delicate structures are near the skin surface, within 10 mm, such as the orbits of the eye Will not control hemorrhage in non-compressible sites, such as the abdominal and chest cavities Ensure personal protective equipment is utilized to protect against potential splashing of blood during application Single-use, disposable device; not for reuse. Re-use of contents may cause cross contamination, leading to patient risk and complication(s). Can be repositioned. itclamp50 is provided sterile (sterilized by EtO). Do not use if sterility seal has been tampered with or packaging is damaged. Not compatible with Magnetic Resonance Imaging (MRI) procedures. Dispose of the device in accordance with local guidelines for biohazard sharps. The devices and/or component(s) are not made from natural rubber, latex free. Documentation of adherence to protocol Document need for use of device Document location, type, and time device was applied Document approximate blood loss Removal: o NOTE: Removal, except to reposition the device, should be done in a medical facility prepared to manage the wound. Hold the device by the gripping bars, press the device further closed to release the lock

11 While maintaining this pressure on the arms, press both release buttons with your other hand. While pressing the release buttons, pull one of the gripping bars open and rotate the needles out of the wound, one side at a time. Pick up the device ONLY by the buttons to prevent accidental contact with needles Dispose of the device in accordance with local guidelines for biohazard sharps.