Our first series is covering massive haemorrhage control management and today’s topic is the blast dressing. Blast (Media, 2022) - The Blast Bandage was designed to provide the ability to quickly package traumatic amputations, burns and large pattern wounds with minimal use of supplies and effort. - Large non-adherent wound pad can be easily wrapped around limbs and secured with the attached elastic wrap. - It provides a large sterile protective covering for shrapnel wounds or burns. - It is large enough to cover the entire back or chest of most casualties. - A removable occlusive layer will cover a 48 x 48cm area or can be used to cover abdominal contents minimizing the loss of heat and moisture. - The Velcro strips or "brakes" within the elastic wrap are especially helpful during the dressing of amputations, providing multiple points of adhesion preventing slippage of the elastic during the wrapping process thus creating a more secure, effective bandage. Evisceration injuries - DO NOT push protruding abdominal organs back into the abdominal cavity as this risks further injury. Cover with warm, moist dressings. - In cases of haemorrhage, apply a field dressing (e.g. as blast) and direct pressure (JRCALC, 2022). - In these cases, consider your patient positioning - flexed knees or the fetal position will help to relieve pressure over the abdomen (First Aid Services 2022). References First Aid Services. 2022. Abdominal Injuries: What Is Evisceration? -. [online] Available at: https://firstaidservices.ca/abdominal-injuries-evisceration/#:~:text=If%20possible%2C%20flex%20the%20patient%E2%80%99s%20uninjured%20limbs%20towards,anything%20by%20mouth.%20Watch%20out%20for%20possible%20vomiting. [Accessed 11 September 2022]. Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives (2022) Abdominal Trauma. In: JRCALC clinical guidelines [app]. Version 1.2.17. Bridgwater: Class Publishing. Available from https://jrcalcplus.co.uk [accessed 31st August 2022]. Media, M., 2022. Tactical Blast Bandage - 50 X 50cm at SP Services (UK) Ltd. [online] SP Services (UK) Ltd. Available at: https://www.spservices.co.uk/item/TacticalBlastBandage-50x50cm_23_0_3897_1.html [Accessed 31 August 2022].

Welcome to another #traumatuesday! Our first series is covering massive haemorrhage control management and today’s topic is the olaes pressure dressing - The olaes trauma bandage is indicated in haemorrhaging wounds that may benefit from a pressure dressing. - It features 3m of wound packing gauze and a removable occlusive plastic sheet behind the dressing pad. - It has a unique pressure cap that generates true pressure when on top of required wound site. - The pressure cap can also be used as an eye cup for treatment of ocular injuries. - The velcro control strips provide security throughout the application process and prevent accidental unravelling. - The correct amount of pressure must be used when applying the dressing as an excess may result in a tourniquet effect in the underlying limb. - Once an olaes dressing is applied, monitor the circulation distal to the point of application. If any problems arise, the dressing should be relaxed and reapplied. (JRCALC, 2022 and Media, 2022) References Media, M., 2022. Olaes Modular Trauma Bandage/dressing at SP Services (UK) Ltd. [online] SP Services (UK) Ltd. Available at: https://www.spservices.co.uk/item/OlaesModularTraumaBandageDressing_23_0_3896_1.html [Accessed 31 August 2022]. SWASFT Clinical Group (eds.) (2018) Major Haemorrhage and Crush Injury – Pressure Dressing Clinical Guideline (Supplements JRCALC Major Haemorrhage clinical guidelines 2022) In: JRCALC clinical guidelines [app]. Version 1.2.17. Bridgwater: Class Publishing. Available from https://jrcalcplus.co.uk [accessed 31st August 2022].

Today we’ve got a two for one deal – we’re going to demonstrate how to pack a wound and then apply an olaes pressure dressing. Wound packing refers to the process of feeding in a long bandage into a wound, applying direct pressure to the bleeding point deep inside and gradually filling the cavity with the bandage or haemostatic agent before applying firm direct pressure on top of the packed wound. Haemostatic gauze · Can be used on open wounds where haemorrhage can not be controlled by direct pressure or there is soft tissue loss. Cavities should be packed with gauze down to bone. · It is of particular value in junctional areas where a tourniquet can not be applied such as the groin, axilla and neck. · When used on facial wounds, avoid contact with eyes. · Do not blindly insert into the thorax or abdomen if the terminal point of bleeding can not be visualised. Method (Forrest, 2020): 1. As always, protect yourself and apply PPE 2. Explain to the casualty that this may be painful, but the bleeding must be controlled. 3. Gently but swiftly scoop out any blood from the wound and look for the bleeding point whilst assessing the depth of the wound. 4. Apply focussed direct pressure to the bleeding point with your fingers or thumb (think stiletto effect). 5. Place the end of the bandage or haemostatic agent directly onto the bleeding point and gradually feed in more of the dressing whilst maintaining firm pressure on the bandage already in the wound. *Ideally this is a two person technique where one packs the wound and the second provides a constant feed of dressing.* 6. Do not rush this process – if the bandage is just stuffed into the wound without a methodical application, the casualty will continue to bleed, the bandage will become saturated and the process will have to be started again. 7. Continue packing out the wound until the cavity is completely filled with firmly packed in bandage. 8. Apply firm direct pressure on top of the packing for at least 3 minutes to allow a stable clot to form. 9. Continued significant pressure may be required to control bleeding after the application of haemostatic gauze dressings. Secure with a pressure dressing such as a blast or olaes dressing. 10. Recheck dressing after moving the patient and on arrival to hospital. Leave haemostatic gauze and pressure dressings in situ. Reference Forrest, M., 2020. Rescue Trauma and Casualty Care Manual. V1.2 Lancashire: The ATACC Group. Recommended further reading: SWASFT Clinical Group (eds.) (2018) Major Haemorrhage and Crush Injury – Haemostatic Gauze Clinical Guideline (Supplements JRCALC Major Haemorrhage clinical guidelines 2022).

Welcome to another #traumatuesday! Our first series is covering massive haemorrhage control management and today’s topic is tourniquet application. Arterial tourniquets are indicated where there is a massive external haemorrhage from a limb that cannot be controlled by direct or indirect pressure. In summary: • Protect yourself and wear PPE • Fully expose the bleeding point (cut or tear clothing) • Apply firm, focused direct pressure with thumbs or fingers (stiletto effect) or with heal of hand/ an absorbent sterile dressing (if the wound is large) whilst a tourniquet is being sourced. • Apply the tourniquet around 5cm above the site of injury (or ensure the application is on tissue sufficient to allow the tourniquet to remain in situ) – this includes over a lower leg or forearm. • The tourniquet should be tightened until bleeding has stopped. Remember this is painful for the casualty – do not be tempted to immediately twist the windlass as tightly as possible. Instead check to see if bleeding has stopped with each twist. • It may be necessary to apply a second tourniquet above the first (consider over a single bone in this instance). • The time of application must be recorded and handed over with the casualty. • Whilst there is no absolute safe time for an arterial tourniquet to remain in place without long-term complications, the risk of limb loss increases after 3-4 hours and is practically inevitable after 6 hours (Shackelford, 2015). For this reason, the current widely accepted duration of arterial tourniquet application is 2 hours. For health care professionals: • In cases of blast injury, amputation, mangled limb or crush injury, the tourniquet should remain in situ and tightened until the casualty reaches definitive care (operating theatre). • When applied for other circumstances (as part of CABC or MARCH approach, inability to apply direct pressure to haemorrhage point or non-permissive environment) the tourniquet can be released once suitable direct pressure has been achieved (e.g. with a pressure dressing or in conjunction with haemostatic gauze). This should ideally occur within 15 minutes of application (refer to JRCALC guidelines 2022 or employer standard operating procedures). Reference: Shackelford, S., Butler, FK., Kragh, JF., Stevens, RA et al (2015) ‘Optimizing the use of limb tourniquets in Tactical Combat Casualty Care: TCCC Guidelines Change 14/02’, Journal of Special Operations Medicine, vol. 15, no. 1, pp. 17-31. Recommended further reading: SWASFT Clinical Group (eds.) (2018) Major Haemorrhage and Crush Injury – Arterial Tourniquet Clinical Guideline (Supplements JRCALC Major Haemorrhage clinical guidelines 2022). TacMed Australia (2016) Arterial Tourniquets [Online]. NSW: TacMed Australia. Available at: https://www.linkedin.com/feed/update/urn:li:activity:6964828076195074048/?actorCompanyId=81764660 (Accessed: 23 August 2022) – *disclaimer: graphic content The Royal College of Surgeons of Edinburgh (2017) Position Statement on the Application of Tourniquets [Online]. Available at: position-statement-on-the-application-of-tourniquets-july-2017.pdf (rcsed.ac.uk) (Accessed: 23 August 2022) - Our mission is to make a difference by #empoweringothers to have the knowledge, skills and confidence to alleviate suffering and save lives. Access further CPD and learn more about the courses we teach at www.coderedtraining.co.uk For more #traumatraining like this, check out our free webinar on Major trauma injuries and management available here: https://www.coderedtraining.co.uk/cpd# #Coderedtraining #ATACCGroupPartner #newtrainingopportunities #freetraining #freecpd #freewebinars #freetraumatraining #freevideos #lifeskills #lifeskillsbristol #southwestengland #bristol #NEWtraumacourses #RTACC #BTACC #FTACC #FTACCE #traumatraining #casualtycare #ATACC #QNUK #immersive #simulation #prehospitalcare #highriskindustries #security #securityindustry #securityservices #securityguards #doorsupervisor #nightclubs #closeprotection #closeprotectionoperative #sia #firstaid #emergencyfirstaid #level3firstaidcourses #lifesavingskills #empoweringothers #makeadifference #uptodate

Welcome to #traumatuesdays! Every Tuesday, Code Red Training plan to release a free short #traumatraining post or video through our online platforms. We will discuss a range of different clinical skills taught on our The ATACC Group trauma courses and include some #coderedtips on how to optimise casualty management. We are kicking off this series with massive haemorrhage control management and starting with how to apply direct pressure using the ‘stiletto effect’. In summary: - Protect yourself and wear PPE - Fully expose the bleeding point - Apply firm, focused direct pressure with thumbs or fingers (stiletto effect) - If the wound is large, apply firm direct pressure using the heel of the hand or an absorbent sterile dressing - If bleeding continues, firmly apply a second sterile dressing or consider a tourniquet. - 90% of external haemorrhages can be controlled with well performed direct pressure, so tourniquet application is rarely necessary (Forrest, 2019). Our mission is to make a difference by #empoweringothers to have the knowledge, skills and confidence to alleviate suffering and save lives. Access further CPD and learn more about the courses we teach at www.coderedtraining.co.uk

Webinar - Trauma Injuries - Presented by Stephanie Moreland (Code Red Training) - UK ============================== ABOUT OUR RESCUE WEBINAR SERIES: These presentations are delivered to emergency service members, with the intent to expand knowledge and understanding of different techniques, equipment and agencies. These webinars are for information only and do not endorse or qualify you in any skillsets or qualifications. Always ensure to work within your scope as defined by your agency and adhere to any Standard Operating Procedures and Policies they have. This is a program managed by NSW SES - Port Stephens Unit. Feedback Your feedback is greatly appreciated and all feedback received is 100% anonymous. To leave feedback, please go to: https://tinyurl.com/RescueWebinarFeedback Webinar Channel To see all of our recorded webinars, please visit our hidden Rescue Webinar YouTube channel at: https://tinyurl.com/RescueWebinarPlaylist Contact Us If you would like to get in contact with us, please email: pts.training@ses.nsw.gov.au We hope you enjoyed the webinars, NSW SES - Port Stephens Unit

Webinar - Vehicle Relocation Concepts - Presented by James Coomber (Avon Fire & Rescue Service) - UK ============================== ABOUT OUR RESCUE WEBINAR SERIES: These presentations are delivered to emergency service members, with the intent to expand knowledge and understanding of different techniques, equipment and agencies. These webinars are for information only and do not endorse or qualify you in any skillsets or qualifications. Always ensure to work within your scope as defined by your agency and adhere to any Standard Operating Procedures and Policies they have. This is a program managed by NSW SES - Port Stephens Unit. Feedback Your feedback is greatly appreciated and all feedback received is 100% anonymous. To leave feedback, please go to: https://tinyurl.com/RescueWebinarFeedback Webinar Channel To see all of our recorded webinars, please visit our hidden Rescue Webinar YouTube channel at: https://tinyurl.com/RescueWebinarPlaylist Contact Us If you would like to get in contact with us, please email: pts.training@ses.nsw.gov.au We hope you enjoyed the webinars, NSW SES - Port Stephens Unit

The simplest of all of the relocation manoeuvres, This controlled roll requires approximately 5 rescuers including the Commander. The Commander co-ordinates their crew to relocate the vehicle simply. The medic inside is responsible for releasing and applying the handbrake (Parking brake) while the rescuers prepare to relocate. The medic should remain in the vehicle wherever possible, their role is to let the patient know what is going on at all times and communicate with the Commander outside the vehicle should they need to stop for the patient. Top tip: Use wedges under the wheels both before and after relocating to prevent any uncontrolled movement.

If there is nothing to spread or ram away from, the winch might be your next best option. A good example of this might be a vehicle resting against a hedge where access is very difficult. The commander will need to coordinate this manoeuvre with the winch operator and the medic inside the vehicle. Apply the strops or chains around the lower and upper wheels or axles and take them to a focal point where you connect the winch. This angle should not exceed 90 degrees. Keeping the pull low helps prevent the vehicle from digging in and allows for a more efficient pull. Have appropriate stability ready to put in position once the manoeuvre is complete. This might include struts and large wedges. The medic should remain in the vehicle wherever possible, their role is to let the patient know what is going on at all times and communicate with the Commander outside the vehicle should they need to stop for the patient. Top tip: Keep the winching cable low to the ground to reduce the chance or pulling the vehicle over onto all 4 wheels in an uncontrolled way.