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Stop the Bleed®

Yesterday, I got my first taste of clinical medicine and doctoring as a new medical student. I had the opportunity to participate in a Stop the Bleed® course organized by the USC Trauma Division. It still hasn’t quite sunken in that I’m a medical student. It was sort of surreal being introduced as an “MS1.” I enjoyed interacting with fellow students across all four years as well as meeting some of the LAC+USC Trauma faculty and residents. I’ve been familiar with Stop the Bleed® for some time, and even organized a course for AMSA while at Cal Poly, but never had the opportunity to take the course myself. 

Stop the Bleed® is a national public awareness campaign that arose out of the Hartford Consensus, which were recommendations of a panel of experts that convened following the tragic mass shooting at Sandy Hook Elementary School in Newton, CT in 2012. Their goal was to evaluate the response to such emergencies and improve victim survival following mass casualty events.

I learned a lot yesterday, from the technical aspects of hemorrhage control to ethical principles in mass casualty triage and trauma care, and it’s gratifying to know that I now have a new skillset that could potentially save a life. After all, that’s what these experiences are all about. I also hope to get out into the community and teach these skills to laypeople now that I’m certified as an instructor. Educating the public about bleeding control is especially vital in LA County, given the high incidence of penetrative trauma.

I thought I’d jot down some of what I found to be the greatest takeaways from yesterday’s course, both to share this info with anyone interested, as well as reinforce my own learning:

1. Mass Casualty Triage: Our discussion regarding mass casualty triage stemmed from a student’s question regarding the role of hemorrhage control in a patient who has gone into traumatic cardiac arrest. First, it is important to note that hemorrhage control loses precedence as the arrested patient will have lost their palpable pulse and will be in a very low output state. ACLS protocols should be prioritized. In regards to triage, a mass casualty situation turns the conventional prioritarian approach to triage on its head. A prioritarian approach treats the sickest patient first. In standard emergency care, for example, a patient with a suspected MI would be seen before a patient with a broken arm. In mass casualty situations, on the other hand, a more utilitarian (or maximizing) approach is taken in order to return the greatest overall benefit for the population. That is, patients with less severe injuries are prioritized because they are more likely to survive. While this runs counter to the moral intuition of helping the sickest patient(s), saving the most lives takes precedence.

2. Impaled Objects: Impalement injuries occur when a solid object, such as a knife, pierces a body cavity or extremity with great cavity. These can be further classified as type I or type II impalement injuries:

Type I: human body in motion strikes immobile object

Type II: moving object collides with immobile person

While classified differently, the management of type I and type II impalement injuries is the same. Now, should the impaled object be removed or left in place? This seemed to be the $64,000 question yesterday. Interestingly, the recommendation to leave impaled objects in situ during patient transport is one that dates back nearly 150 years, having been first described in a 22-page essay by Dr. JH Bill titled “Notes on Arrow Wounds,” and is stilled followed today. The main reason for this recommendation is that the piercing object has a tamponade effect (puts pressure) on the surrounding injured vasculature, which controls bleeding.

That’s all for now. Until next time.