First Responders Guide for Treating Major Haemorrhage

Hey Isaac I felt compelled to reach out and contact you after recent tragic events. I wrote this little guide on controlling limb haemorrhage originally intended just for my little spearo crew. It’s been shared on a few forums in the last few days. It’s attached below. Feel free to use it and share it however you want. I’m happy to help out in any way to share this message.

To provide some background, I’m a doctor from the Sunshine Coast and a specialist in both emergency medicine and pre-hospital and retrieval medicine. I split my time between the hospital and the local helicopter rescue service. I’m also a passionate spearo and waterman. We’ve lost a couple of local spearos in the last 12 months.. Matt Tratt who died on sat was also part of our local “pressure project freedive group” and my colleagues from the rescue helicopter tried in vane to save him. I didn’t know either of them personally but they were both friends of friends. Its always a reminder of the dangers we face when something happens close to home.

Without any criticism of anyone (who I’m certain did their best and bravely came to Matt’s aid on the weekend), a bite to the limb should be something we’re all prepared to deal with. Someone should hopefully never die of any isolated limb bite. I deal with life threatening emergencies and complicated medical procedures everyday in the field or in hospital. We train for and visualize how we will approach these crisis. I try to bring this same approach to our sport. We need to have thought about and visualize how we are going to solve any crisis well before it happens.

Another example – I once had a trout brick me under a ledge. After an unsuccessful extraction and at the end of my breath hold I headed for the surface only to become entangled with my float line around my belt. I panicked and instead of simply dropping my belt I went to cut my way out. We always buddy very tightly but of course this was that sneaky little dive you do while my buddy boated a fish. Two simple errors which could have cost me. I’ve since thought about my approach to entanglement and I’m prepared. Hope this info helps someone. Rob

This First Responders Guide for Treating Major Haemorrhage might save someone’s life.

It’s also another good reason to always dive with a buddy. We all dive around sharks all the time. Sometimes we get complacent. People with massive bleeding from the limbs are able to survive if we act quickly.

There’s 2 ways to stop a limb bleed

  1. Direct Pressure. Use a small as possible pressure point right into the spot that’s bleeding. In physics pressure = force/ surface area. Ie A large pressure can be delivered if it’s applied over a small area.
  2. Tourniquet. This will stop all blood supply to the limb. It can stay on for hours if required. The key is it must be really tight. If it’s too loose then it will still allow arterial blood supply while blocking venous supply. This would be just like when you get a blood test. It can make you bleed more! Don’t do this.

Options for what to wrap the wound with

  • If in the water on a shore dive, then use a float line.
  • If on a boat dive, then use a bandage if one is handy.

You can buy arterial tourniquets really cheap. To get a tight tourniquet one needs a windlass. Some sort of stick that you wind up really tight (hopefully you’ll see the bleeding stop- if not go tighter). The tricky thing is finding what to use as a windlass. You could try a dive knife but there’s obvious issues with that. I’ve got a fish stringer on my float that would work. Once the windlass is wound up you need to stop it unwinding. Try tucking it under some other rope.

Hey Isaac. I did a bit of messing around today with tourniquets and took some dodgy photos with my phone. I’m no Boy Scout so I’ve improvised knots which is exactly what people are going to do if they’re making a tourniquet out of their float line.

Commercial tourniquet

Commercial tourniquet (like this one)

Rope (eg float line) MacGyver Tourniquet

Rope or float line Tourniquet

How to macgyver a tourniquet 101...

How to macgyver a tourniquet 101…using a bandage

FAQ

Where do I apply the tourniquet? Some teaching suggests as far down the limb as possible so less tissue lacks blood supply. In saying that It can be harder to compress the vessels below the knee or the elbow because there’s 2 bones instead of one. It probably doesn’t matter. Just get it on there. If there’s a bleed really high up the leg and you can’t get a tourniquet high enough then add direct pressure to the wound plus try and compress the big femoral vessels in the groin. Feel where your own pulse is for a guide. Once again remember a smaller object pushed onto a vessel will apply more pressure. Something like a small ball shape pushed onto the vessel. Find something to wrap round the leg or pelvis to hold it really tight or hold it in place with all your weight.

Happy to clarify any further questions!

– Rob Giles

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