Haemorrhage is a very common problem in those who are badly injured. Particularly in penetrating trauma (knives and guns), we sadly see the effects of very severe haemorrhage on a daily basis. We have been searching for solutions to the severe haemorrhage problem for some time.
It is clear that for those who are truly exsanguinating from major blood vessels, there is a risk that they will bleed to death within minutes if the bleeding isn’t stopped by someone, or if the bleeding doesn’t stop by itself. Even with the fastest response by our teams, there are patients who regularly exsanguinate before the team arrives. The key to helping these patients is in prevention, and in the role of bystander intervention. For those who have been stabbed, and who are visibly bleeding, pressure (significant pressure) must be applied to the bleeding site and this can be done by anyone who is present.
- Altered sensorium
- Low or falling ETCO2
- Air hunger
- Venous collapse
- Hypotension (low volume or absent pulses)
- Tachy or bradycardia
In the pre-hospital phase of care it is vital that medical teams don’t delay care by intervening at the roadside, but that we intervene immediately for those who need treatment quickly. We have found that those who are truly exsanguinating at the roadside demonstrate some key features and our teams find these signs helpful on scene in determining who can be transported to hospital and who needs an intervention such as REBOA immediately. Senior clinicians use their experienced judgement to assess the risk of a patient by looking fort the following signs (amongst others).
Patients with blunt trauma (road traffic collisions) and those who have internal bleeding can be difficult to diagnose at the roadside. Accurate diagnosis is essential if opportunities to intervene are not missed, and to avoid preventable deaths. Blood transfusion at the roadside was an important innovation for our teams, introduced in 2012.