I had a chance to take a look in the “trauma bag” outside the woodshop when I was in the shop on Wednesday. It has a lot of stuff in it, but unfortunately too much of the wrong stuff and too little of the right stuff. Here are my concerns with that bag specifically:
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The zipper on top of the kit is broken. Things are falling out just while hanging on the wall, not to mention what might happen if a person tries carrying it somewhere.
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There are no instructions on/near/in the kit. In an emergency, it is good to have a really simple set of pictorial instructions so that people can focus on doing one thing at a time rather than trying to remember what to do next.
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The minimal organization system in such a large bag necessitates digging for whatever you’re looking for, which makes hard to find if in a state of panic. A tackle-box style kit like the ones above is easier to use. Paramedics come on scene with giant bags full of all kinds of things, but we’re not looking for paramedic-level aid and don’t have paramedic-level training. We’re looking for bystander intervention until paramedics can arrive - simple is the name of the game.
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A lot of the stuff in there is just clutter in any situation in which you might need the kit. Boxes of bandaids, 4 Ace bandages, antibiotic ointment, Ibuprofen? This is all detrimental in a bleeding emergency - it makes it harder to find the things you might actually need.
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The tourniquet is poor quality. It is the style of a belt (rather than the large velcro straps included in every Stop The Bleed kit I’ve ever seen, including the ones offered currently by Cintas) and does not have a sufficient tightening mechanism. While it may be better than nothing, in a situation where I needed a tourniquet for myself or someone else, I would not trust this one.
Let’s lay two scenes that might put a finer point on it:
A scene with a victim of an injury causing massive blood loss from the right arm in the machine shop featuring our current trauma bag:
Imagine a person in a panic hurriedly running from the Woodshop/Auto first aid column towards an injured person on the ground somewhere else in the space in a rapidly expanding pool of blood. Now imagine them carrying a large bag - difficult enough. Now add on that the bag has a broken zipper so they’re trying to keep things from falling out along the way.
Our good samaritan arrives at the scene of the injury in a panic and can’t remember what they were looking for. Doubt begins to creep in - did they drop it along the way? Are they even going to be able to do any good at all? What’s the first thing they should do again? They freeze.
Our good samaritan is panicking. There’s all this stuff and it just keeps getting in the way. They dump everything out of the bag.
Our good samaritan is still trying to remember Step 1. Now they’re surrounded by heaps of medical seeming stuff. They’re becoming overwhelmed by the amount of stuff and none of it says when or why to use it on the package. “I didn’t go to school for this,” they think to themselves, “I don’t have any idea what I’m doing.” They’re getting overwhelmed - a normal physiological response to this type of stress that is nonetheless detrimental to rendering quality first aid. Doubt is increasing - similarly unproductive.
Our good samaritan has found the tourniquet in the heap. They have a surge of confidence and try to put it on the other person’s right arm, which is rapidly gushing blood. The victim is starting to look paler and seems to be having trouble breathing. The good samaritan pulls the tourniquet as tight as they can, but just can’t get it any tighter. The bleeding has slowed a bit but won’t stop. The tourniquet simply can’t be pulled any tighter. The good samaritan sits with the victim until paramedics arrive several minutes later.
The paramedics thank the good samaritan for doing what they can and quickly apply a high-quality tourniquet above the one the good samaritan put on. The bleeding slows, but the victim is very pale and taking only shallow breaths. The paramedics rush our victim off to the hospital and we hope for the best possible outcome.
Or, a scene featuring the same victim, the same good samaritan, and a bleeding control kit (from Cintas, the American College of Surgeons, or another vendor):
Imagine a person in a panic hurriedly running from the woodshop/auto first aid column towards an injured person on the ground somewhere else in the space in a rapidly expanding pool of blood. They’re carrying a plastic box about the size of a large lunch pail. It is securely closed and they just focus on getting back to the victim.
Our good samaritan arrives at the scene of the injury in a panic and can’t remember what they were looking for. Doubt begins to creep in - did they drop it along the way? Are they even going to be able to do any good at all? What’s the first thing they should do again? They freeze.
They decide to open the box. There is a clear sheet of instructions, like the ubiquitous choking poster, on the inside of the lid. It says to put on gloves and cut off the victim’s clothes around the wound.
Our good samaritan looks at the box, dons the gloves that are right on top and grabs the trauma shears. They cut along the now blood-soaked sleeve to reveal a large, gushing wound. Our good samaritan takes a deep breath, suppresses their oncoming feeling of nausea and looks back to the instructions.
“Step 2: apply pressure with gauze,” our good samaritan reads aloud to themselves. They grab the large package of clearly marked gauze, tear it open, and press down on the wound. The bleeding won’t stop. They panic but look back at the instructions. “If the bleeding does not slow, apply a tourniquet as follows,” they read aloud, relieved to have such clear instructions with pictures.
Our good samaritan quickly identifies the bright orange tourniquet. They follow the printed steps as well as they can, slipping the tourniquet over the victim’s arm before fastening it with the velcro as tightly as they can. They begin turning the rod to tighten it more. It gets harder to tighten but they keep going, as the instructions say, until finally, the bleeding slows to a trickle before stopping completely. Our good samaritan isn’t exactly sure what to do now that the bleeding has stopped - the instructions have ended - so they sit with the victim until paramedics arrive several minutes later.
The paramedics thank the good samaritan for doing such a good job controlling the bleeding and rush the victim off to the hospital. Our victim makes a complete recovery, left only with the scar on their arm from their nasty accident. After several weeks to months they return to DMS, where they teach classes on Stop the Bleed and the proper use of a vice for securing the work down to the mill. It really does pay to double-check that the material is secure, even if you’re absolutely certain that you tightened the vice all the way…
Both scenes are obviously dramatized for effect. Everyone on this chat and at DMS is obviously acting to the best of their knowledge and ability to keep everyone safe, I just think that it is worth thinking through some possible outcomes. The current trauma bag is almost certainly there as a result of someone looking out for everyone’s safety, thinking that see might need more trauma-type equipment, and making it happen, and it is certainly better than not having the current trauma bag at all. In fact, I’m glad that it is there today. I just think that we can do better. There are lots of ways to resolve what I think are a few issues with it, I’m just proposing one.
While we’re still working on the equipment side, I just heard back from Dr. Miller about Stop the Bleed training. She’s on board and we will have a call next week to begin planning.
