# Treating Bleeding -- Segment Two -- Time 11:12

John:

One of my favorite tools is a triangular bandage. Why do they call this
a triangular bandage? Three sides, very good. What were going to do is,
I'm going to make a little pressure bandage, I love these. These
triangular bandages I can fold them up. Tom, will you come have a seat
right here please. What I'm going to do is I'm going to make a pressure
bandage on a fake injury, right here on Tom's right arm. And what we're
going to do is we\'re going to try to remember to use the right tool for
the right job. I want to give you a little bit of a lessons learned. One
time I was trying to save money on our program, we were using too much
supplies, and what I did is I told everyone I don't want you to open the
4x4's I want you to just take the package, hold it over the would and
pretend that you opened it. I was trying to save us money, but the
problem is that people do not do what there told to do they do what they
are trained to do. Then I got a phone call from one of the paramedic
ambulances saying that they had gone across somebody who had taken a 4x4
package, put it over the top of somebody's wound, I think it was on the
head, and then wrapped it up. Because that's the way they were taught by
the paramedic who was teaching them. So we don't do that anymore. Just
out of curiosity can this person help us help them? It's probably one of
the toughest things that you can teach in medical school or paramedic
school or EMT school that these people can help you help them. I
remember back when I was a rookie we had a bus accident and these people
had been thrown out of the front of the bus. We were told to go down the
side of the bus to go take care of them and as we were walking by there
was an individual hanging out the bus window and he had a large cut on
his arm. And he said to my trainer, he said hey come over here and take
care of this. And as we're walking by my trainer says to him, no you put
pressure on it. And three times this guy says no you come over here and
you help me with this. So my trainer turns to me and says, what we need
to do is, we need to motivate this person to help us help them. So he
walks over, he takes his bandage material and puts it over the top and
he says, you hold this or your going to die, and then walks away. And he
said to me later on, do you think we motivated that person to have him
help us help them? I walked back ten minutes later and he wouldn't even
let me look at it. That person did help us help him. So these people can
help you.

What were going to also do is first were going to place our bandage, I'm
going to make a pressure bandage. I take some material from my
triangular bandage and what I'm going to do is go right from the top of
this, I'm going to come around to the side, I'm going to put significant
pressure on this, and then I'm going to tie a knot, where? Right on top
of where it's bleeding. I'll secure this up and I'm going to put a nice
little bow in this. Direct pressure combined with elevation will handle
ninety-five percent of the bleeding that you ever see. What does
elevation mean? Show me elevation. Good. When you combine direct
pressure with elevation you will handle ninety-five percent of the
bleeding that you ever come across. We made a nice little pressure
bandage here and I'm going to keep this in the elevated position by, I
want you to hold that right there. I will tell you if you try to get
people to hold it up, guess how long you patients will hold their wound
up in the air like that? Right up until the time you do what? You turn
around, that right. So put this into a position of comfort. And you may
say, John why did you put a nice little bow in there? Because one of the
things that we learn during disaster events is that your equipment
becomes very important to you. And what I would suggest to you in about
ten minutes or there about, this patient is going to walk back over to
you and he's going to say my hand is turning blue. My hand is tingling.
I can't feel my hand anymore. What's wrong? It's too tight. But, this
patient can walk over to you in ten minutes and they can tell you that.
When you have a bunch of people who are bleeding out there you do not
have time to be making nice pretty bandages. You make them secure, you
make them solid, and you do not waist your materials. If I tie a double
knot or something in here where I can't un-tie this and I take my handy
dandy scissors or knife and I have to cut that, have I wasted that
material? Absolutely. You loosen this up to a comfort, but it's still
working, make a nice little bow, and put him back in the position of
comfort. Just out of curiosity, how do you know if you bandage is not
working? He's still bleeding, it falls off. Those are usually good
indicators that what you're doing is not working well. But using this
technique you can very quickly treat bleeding problems and maintain
pressure for a period of time. It's amazing how many people want to make
nice pretty bandages. But in this class what we want to end up doing is
we want to make these things effective and we want to make them rapid.
Lilly, would you come help me please.

Ok, Lilly what I want us to do is now that, what were going to do is
we\'re going to do a little demonstration. We like to call this the
bandaging rodeo. Cause what were going to try to do is see if we can't
tie this person up. Do you have rodeo's in Memphis? I think so. What I
want you do is take this triangular bandage and fold it up like I was
doing just a few minutes ago. There you go just like that. Three to four
inches wide. Tom what I want you to do is if you'll just put your arm
out for me. What were going to do is now that the two of you are working
together and one person is the victim and one person is going to be the
rescuer. What I want you to do is I want you to place this over the top
of the wound, tell the patient hold this or you're going to die. And
then what I want you to do is take this, put it over the top of the
wound, wrap it around just like I did, tie it up, but I want it really
tight, ok, do not be shy don't let that happen. Make a nice little bow
and then what I want you to do id finish just like this. All right? Were
going to do this a couple times. All right. Very good, Tom put your arm
out for us. And what were going to make sure we do, over the top of the
wound, around to the side, and when you get to the side I want you to
put good solid pressure here. When you get out here I want you to end up
pulling on it, nice little bow, and there it is, very nice. Does that
feel pretty solid in there? Ok, take it off and lets do it again. When
you approach this training on this, one of the things that you can see
is how important, if we had twenty-five to thirty people that were
budded up, so you've got fifteen couples around, how important a team
teaching approach is. You got ahead of me a little bit. Do me a favor,
back up a little bit. Ok, I want you to do the same thing, but now I
want you to go a little bit faster. Ok, Tom put your hand out there. Go.
Good, Good. Very Good. All right, last time. I want you to do it even
faster this time. Ok. All right you got to go fast now.

Very nicely done. Wow, very nicely done. That was wonderful, now what I
want you to understand is that what were trying to do is everybody gets
a chance to do this. One person's the victim one's the rescuer and what
we end up doing is everybody repeats this stuff over and over the idea
is that three will give you a good idea of how to get this done
effective and move onto the next patient. What we don't want to do is we
don't want people making nice pretty bandages. You make this thing solid
you make it work and then you move out, because time is relative to the
patient who's waiting for you and these things have to be effective
enough to do the job. Could you use other material to do this?
Absolutely, you could use just about anything it is not the wrap that
stops the bleeding it's the pressure that stops the bleeding so you use
what ever material you have available to do that. All right? Ok, if some
one, if you don't take care of the bleeding problem some one can go into
shock. Help me define shock in a very simplistic manner that I