LIFESTYLE

“We’re At War” // High School Stop the Bleed Training // School Faculty Meeting

On May 9, 2019
By Kimberly

Our Thirty Minute Stop the Bleeding Training for faculty at my high school began with a warning from our county Florida Department of Health trainer; “We’re at war. For whatever reason, we are at war.”

And that was the start of our training – a good wake-up call that anything can happen anywhere.

Serious Introduction

“Isn’t it sad we’re talking about this. It’s terrible we’re talking about this.” Our trainer, Michael L. Patterson, a Health Services Representative from the Florida Department of Health, got right down to business letting us know that the skills we were about to learn were necessary.

I had wondered how a trainer would open such a grim topic, and he gave it the seriousness that was needed. Our faculty seemed to be fairly receptive, and listened attentively. He mentioned working with several of our staff over the years – including our career and technical education health instructor. So, after a few personal greetings, he continued.

There were a few side conversations going on, so I moved from the fourth row to the front row so I could see exactly what the presenter did, showed, and what he said. I wanted to make this thirty minutes in person count, and learn as much as I could.

Wound Packing Covered First

After a bit of information about what was in the kits we would receive, he launched right in to demonstrations.

He had a segment of a leg, a model, and he first demonstrated wound packing. I could hear some squirming in the audience.

The volume of material that he worked into the prosthetic seemed to really surprise some of the audience.

Are Teachers Reluctant to Learn?

Laurie Shertz from Crisis Medicine has asked me a couple times if and why teachers are reluctant to undergo bleeding control training. I still don’t have an answer for her. Here’s a skill we can learn fairly quickly, in anywhere from five minutes to eight hours. Any training will be better than none.

The presentation of the training apparently makes a difference in application technique retention later, and she’s sending me some statistics about the difference six months later in tourniquet application by someone who had been exposed to a pamphlet on how to apply tourniquets, or has been exposed to a short video performed differently six months later.

So, with that in mind, I listened to our presenter.

Tourniquet Placement

“You got thirty seconds to get the tourniquet on,” our trainer said. Mentally, I wondered where in that thirty seconds was I going to get those gloves on my hands. I was glad I was taught to stage my tourniquets in advance.

He said the tourniquet should be placed proximal to the wound. I suspect some of the audience had no idea what that meant. It means near the center of the body – so – closer to the heart.

As he opened the tourniquet packet, he said we should undo it all the way and put it above the wound. He said to wrap it around, straight as you can, and push this through – indicating the end of the red tab. “Make it right to start with,” was his advice.

He demonstrated that the tourniquet should go closer to the heart. He did not say between the heart and the wound, but I understood what he meant.

Twisting the Windlass

Then he proceeded to the windlass – the “stick” that tightens the tourniquet. “Wind this around until bleeding stops or you can’t wind the stick any more. Put it in the clamp. Write the time on the label.”

He told us, “You don’t want to put it on a joint,” as he demonstrated on his model.

“You gotta remember when you put this on thinking it’s gonna hurt, it’s gonna hurt. A lot,” he said as he demonstrated first putting the tourniquet around the leg, then tightening it, then using the windlass to further tighten the strap.

He indicated men’s privates, and said, “Make sure that’s not going to interfere with the tourniquet.” He added, “Watch out for things in mens’ pockets.”

At this point, he continued to crank on the windlass until the model bulged above and below the tourniquet.

“Twist until the bleeding stops or you can’t physically turn the windlass any longer,” he instructed.

One of the teachers asked if you could accidentally twist the windlass too much. “Nope. Never too tight,” he responded.

He encouraged us to practice on one of the tourniquets that would be in our front office, and watch videos, especially American College of Surgeons.

“If it doesn’t work, put on another tourniquet,” he said, addressing a “what if” the first does not stop the bleeding, even with adequate windlass turns.

He told us, “The second strap goes above, closer to the heart.”

Tourniquet Improvisation

Then he demonstrated making a tourniquet using a piece of wide, flexible webbing material. He advised us to tie it in a square knot. I imagine teachers probably would need training to learn this. He said don’t use an ink pen because it will break.

As he twisted, he asked, “Think that would hurt a little bit? A lot. You have to be persistent if you’re going to save this child’s life.”

Someone asked, “When do you loosen it?” He replied, “Never.”

Different objects were discussed for use as possible tourniquets. He said a name tag lanyard would work ok, but, “Don’t use a belt, it’s one of the worst things to use, and you gotta have a stick.”

A former marine on our staff asked about specially-designed, softer type nylon belt, and he still said no. I think what he meant was that the very heavy, stiff web belts would not work because you can’t get any twists on a windlass with them. It turned out the former marine purposely wears a belt that is designed to act as a tourniquet, complete with a one-way ratcheting buckle specifically designed as a backup tourniquet.

Wound Packing or Tourniquet

The conversation went back to wound packing, and what amount of material would be necessary, and the pressure required. Some teachers wanted to know if they should try that first.

He discussed areas of the body where a tourniquet could not be applied, like on a shoulder. “Not an extremity. They might be bleeding to beat the band. You can and should put direct pressure. Use roller gauze. Isn’t that gross,” he said as he stuffed the practice wound. “That’s pretty gross. Once you can’t get any more in there, put direct pressure.”

“If you have put on a tourniquet and they are still bleeding, do that,” he said, indicating wound packing. “Wear your gloves, because it’s gross.”

Someone asked if they should try wound packing first, before going to a tourniquet. “No, ma’am!” he said. “Tourniquet first, then packing.”

Chest and Abdominal Injuries

Patterson talked about chest injuries, and abdominal injuries. He said if the bleeding is internal, you need a surgeon.

He also mentioned maybe you could use an ABD pad, or combine dressing, and if that fits, then put direct pressure.

“Isn’t it sad we’re talking about this. It’s terrible we’re talking about this,” he repeated.

Parting Advice

His parting address was, “Stay safe. Learn the ABC’s of bleeding. Look at your area. If a child is out in the hallway and bullets are flying by, don’t step out,” he cautioned. “The deputy has a gun. He can return fire. We can’t.”

“Call 911. Virtually every kid has a cell phone,” he said. “Stay safe, secure your room.”

Audience Questions

Patterson then opened the floor for questions.

“Use direct pressure, use stuffing the wound with dressing or roller gauze.” I jotted this down, intending to look up more about this later. I realized he meant for us to stuff the wound with the gauze that is wound in a roll.

One of our union representatives asked if they should remove clothing. He emphatically said, “Yes, remove clothing. Cut the clothing.” A female instructor further questioned – “Take their pants off?” “He said yes, take their pants off.” He possibly did not realize we are worried about ethical questions later.

“You gotta do your homework. You gotta review this,” he said. Upon hearing we would have a practice tourniquet for a couple days in our front office, he said, “Go get that tourniquet. Play with it.”

He said that there were no shears in our $17 kits that are coming “Because all classrooms have scissors.” Actually, we don’t. Printers, paper, white out, and scissors are not as prevalent in classrooms these days. We’ve gone digital, you know.

There was no discussion of where to keep the kit, or of adding to the kit. This meeting was for bleeding control training only. I learned later that eventually, our kits will be affixed in some manner in a visible location in our classrooms.

We were told not top open the kit, that it would be sealed, and that was to keep it sterile. While several teachers nodded in agreement, actually, this kit will be used in the field; not in a sterile hospital setting. It does not have to be sterile, and the bullet wound we are treating won’t be sterile either.

One teacher asked if wounds really will be spurting. He told them they would.

Just like that, in under thirty minutes, we were trained. He recommended that we seek more training, and I must agree. We could all use more practice.

Training from Crisis Medicine

Crisis Medicine – excellent training. History buffs and anyone who appreciates the backstory of whatever they are studying will appreciate the precise attention to detail. Also very graphic, and also what will serve you well to experience. Dr. Shertz from Crisis Medicine says the first time you see blood shouldn’t be when you have a loved one or student in front of you. Please use my link above and my code “DeepWH” for 20% off the Tactical Casualty Care TC2 online course.

Using my links helps me continue to bring free content to you and increase the number of supplies in my own CFAK. I usually add a few more items to my bag every couple paydays, so thank you in advance for your care for your own students and co-workers’ safety.

Or: Finding a Good Bleeding Control Kit for Your Office or Classroom

Or Maybe: Classroom Bleeding Control Kit // High School Teacher Packing in the Classroom

What to Watch: Classroom Bleeding Control Kit Unboxing

Or: : Classroom Bleeding Control Kit // High School Teacher Packing in the Classroom

Or Maybe: Tourniquet Memory Device // Distinguishing CAT, SOF, Rats