This week for training, we are covering blood related emergencies and how to treat them. At the Snow Bowl we commonly see soft tissue injuries: abrasions or bruising from falling on ice, open wounds from the edge of a ski or snowboard, and burns and cuts that occur in the kitchen. For the most part, these injuries are not life threatening, but the added element of blood can startle first responders, as there is no great way to prepare or train with a bleeding patient. Our goal is ensure that every patroller is confident in their dressings.
Blood related emergencies include:
- closed injuries (contusion, hematoma, crush injury)
- open injuries (abrasion, incision, laceration, avulsion, amputation, puncture, open crush injury, high-pressure injection, mechanical tattooing)
- burns (caused by thermal or frictional heat, chemical, electrical)
Responding to soft tissue injuries begins with BSI (rubber gloves) and scene safety. A quality assessment of ABCDs is essential before jumping directly to treating the apparent injury.
For closed injuries such as contusions or hematomas, the acronym RICES is a helpful tool. Even if bruising does not yet show, having a skiers Rest the affected limb, Ice the injured area to slow bleeding in the tissue and relieve pain, Compress the injury site with a compression bandage like an Ace wrap to reduce tissue bleeding, Elevate the injured limb, and Splint the injured limb immobilizing it to prevent further bleeding. (note: For a closed crush injury, follow the same guidelines but encourage rapid transport if bones appear to be broken or if CSMs are reduced).
For open injuries, control bleeding using one of the following techniques. For arterial, veinous, or capillary bleeding direct pressure should be applied to the area. Even if the skier is on anticoagulants, direct pressure should be enough to stop bleeding, it may need to be held for upwards of 30 minutes though. On the hill, we carry gauze in our response packs. If one 4×4 gauze soaks through, it is important to apply another on top of the first because removing that gauze can stop the clotting process. Once the bleeding subsides, roller gauze is wrapped snugly around the injury site, keeping pressure on the area, but not impacting CSMs.
If direct pressure is not enough to stop a severe arterial bleed or there is a more extreme injury such as an amputation, a tourniquet can be used. At the Snow Bowl, we have a tourniquet based in the bottom hut but every ski patroller carries the supplies to quickly make an improvised tourniquet.
Another potential open wound emergency is a puncture wound. With impaled objects, the practice is to leave the foreign object in the body, address bleeding, and immobilize it for transport. — If a patient were to show up to a doctor with pencil lodged 3′ into her heart, the doctor would know the situation immediately, as opposed to the patient showing up bleeding from a whole in her chest.– The impaled object partially acts as a cork and requires a higher level of care to remove. Doughnut dressings can be made to slide over a round impaled object like a stick.
During our blood related emergencies training, we also discussed hemostatic dressings, occlusive dressings used for sucking chest wounds, and protocols. One of the changes implemented in the bottom patrol hut is the use of biohazard bags from human fluids and a biohazard waste bin.