During primary assessment instruction students can watch and then practice opening manikin airways and delivering effective ventilations. It is much more difficult to simulate severe bleeding control and to overcome one of medicine’s most pervasive myths.
I honed my technique for teaching severe bleeding control over dozens of Wilderness First Aid classes for Wilderness Medical Associates:
1. With the class gathered around me I say, “Imagine our patient has a large bleeding wound on his thigh. What should I do?”
2. Class answers, “put on a dressing and press hard.” I comply.
3. Me, “Dressing is now totally soaked with blood, what should I do?”
4. Class, “Apply another dressing.”
5. I add another dressing.
6. Me, “This dressing is now totally soaked through with blood. What should I do?”
7. Class, “Apply another dressing.”
8. I repeat steps 5, 6, and 7.
9. After four or five dressings have been applied and bleeding is still copious and a few students are expressing puzzlement about the efficacy of this treatment. I ask, “What has not happened?”
10. Brave student, “You haven’t controlled the bleeding.”
11. Me, “What should I do next?”
12. Brave student, realizing a medical myth is about to crumble timidly states, “Find the actual source of bleeding.”
13. Me, “So I am going to remove these blood soaked dressings to find the source.”
14. Most of class gasps. One already trained expert will always say, “But you will break apart the clots.”
15. Me, “Which clots?” Insert dramatic pause. “If there were clots and bleeding was controlled we wouldn’t have four or five blood soaked dressings.
16. Me, “Find the source of bleeding and apply well-aimed direct pressure.”
Read more about effective bleeding control and watch an amazing video, in an excellent post, from the Rogue Medic.