Post Fight Survival
The ability to render emergency first aid in the events following a critical incident can save lives. Imagine if well prepared citizens had been prepared to Stop The Bleeding at any of the recent mass killings. Consider how many people may still be alive, as a result of a few hemorrhage control kits being in close proximity to the mass killing zones.
If you carry a gun on you for personal protection and you do not carry a means to stop the bleeding, you are wrong. Let me say it another way. If you carry tools to put holes in bad guys but no tools to plug holes in good guys, you are wrong.
There is absolutely no reasonable excuse why everyone should not have a bleeding control kit in their vehicle or on their person. I am not referring to a massive pack you might envision from a Vietnam War movie, but a small kit containing crucial items for hemorrhage control.
This blog post and other content on this website DOES NOT constitute or form an instructor-student relationship between the author (me) and the reader (you). Online content can only supplement in-person formal instruction, it cannot replace it. It is your responsibility to seek formal instruction and training, and to understand the laws in your jurisdiction.
Furthermore, I have had medical training (Including TCCC) but I AM NOT a licensed medical professional. The content contained within this post IS NOT for educational purposes.
I make it a point to link-to and refer you to resources for formal training and education.
Note: The featured image in this blog post does not contain a real injury. That is fake blood.
How Do People Die?
This may sound like a rhetorical question, but it is important to understand the specific mechanisms of death in order to better understand how to mitigate them. Generally speaking, everyone dies of shock. Basically, shock occurs when there is not enough blood flow in the body to transport oxygen and nutrients to cells and organs.
There are 5 main types of shock:
- Cardiogenic shock (Induced by heart problems)
- Hypovolemic shock (Too little blood volume)
- Anaphylactic shock (Severe allergic reaction)
- Septic shock (caused by infections)
- Neurogenic shock (Damage to nervous system)
Numbers 2 and 5 are in bold because these are the two mechanisms we will be focusing on for the purpose of this discussion. These two forms of shock are the leading mechanisms of death during a mass killing incident or other deadly force encounter.
Hypovolemic shock occurs if someone is hemorrhaging after being shot, stabbed, or otherwise cut.
Neurogenic shock occurs when the nervous system is severely damaged (i.e. bullet/knife/damage to the brain or spine).
It goes without saying, but we each only have a finite amount of blood in our body at any given time. The average adult has anywhere from 4-6 liters of blood. People can die from losing 1/2 to 2/3 of their blood. Therefore, if someone is shot or stabbed after a mass killing or other deadly force encounter, the countdown begins. The rate at which someone will die from hemorrhaging is dependent on where the injury is, how severe, their physical health, and a few other factors.
Treating Neurogenic shock (nervous system injury) is certainly beyond the scope of this discussion, and likely beyond the scope of your training (unless it’s not). Therefore, we will only focus on Hypovolemic shock.
Just remember, if you encounter a victim who is bleeding to death, you have the rest of their life to figure out how to make the bleeding stop.
S.M.A.R.C.H. stands for Security, Massive Hemorrhaging, Airway, Respiration, Circulation, Hypothermia. This lists the procedures treating trauma victims from greatest to least priority.
This post will mainly focus on Massive Hemorrhaging. We will briefly touch on tools you can use to help a victim with a gunshot wound to the chest.
As with all things, it is crucial you receive formal training on these topics.
When someone’s body gets punctured, their blood will flow out of that puncture, thereby lowering the amount of blood in their body and bringing them closer to Hypovolemic shock. This process will continue until either the opening is blocked by a foreign object, the blood clots, or the flow is blocked. For minor cuts, our bodies typically do a pretty good job of utilizing vitamin K to coagulate and clot our blood around the leak and block the flow. For larger cuts, the use of a bandage or other object to block the flow may be necessary. For severe hemorrhaging, it might be necessary to shut off the blood flow upstream of the opening.
What it is
Tourniquets have been used for a while. Early versions consisted of simple pieces of cloth that were wrapped tightly around a limb and then tightened further with a stick or some other object that could be used as a windlass. Modern tourniquets are specifically designed for bleeding control and undergo rigorous testing before being certified to certain standards. Tourniquets are used to stop otherwise uncontrollable bleeding. The World Health Organization (WHO) has declared uncontrolled bleeding to be the leading cause of preventable traumatic death. 
What it does
A tourniquet is a device that is applied to a limb and blocks the flow of blood beyond the point of application, when applied correctly. Imagine if you had a garden hose with water flowing freely through it and out the end. Then you wrapped a piece of rope around the hose and tightened it until the hose was kinked, and the flow stopped. This is what a tourniquet is intended to do to the blood vessels running along our bones. It compresses those blood vessels against the bone until blood can no longer flow freely across the point of application. This prevents the victims blood volume and blood pressure from decreasing.
Types of Tourniquets
With the popularity of tourniquets growing, there exist many brands and types of tourniquets. However, I recommend you stick with the brands and models that have been tested and that have years of real-world battlefield data backing their efficacy. There exist many counterfeit tourniquets on the market.
NAR is one of the most, if not the most, reputable manufacturers of trauma medical supplies.
How to use it
Again, this discussion is not intended for educational purposes and I am not a licensed medical instructor, so I refer you to the instructions below. While these instructions cannot and should not replace formal medical training, they provide a good example of how to use the devices.
North American Rescue (NAR) Tourniquet Application Instructions
What is NOT a tourniquet
While it may be true that any device applied on a limb to stop the bleeding can be considered a tourniquet, it is important to remember that some objects are not effective or can even cause damage. CATs are specifically designed to evenly distribute forces around the limb without breaking and are wide enough to not cut into the skin or cause nerve damage.
If no other option exists, a belt may be the only option. However, if the belt does not provide even forces and has an area where pressure is not being applied, then it could fail to block the blood flow.
Furthermore, if you use something that is too thin, this could cause nerve damage or even cut into the victim and exacerbate the hemorrhaging.
What it does
Just as the name implies, a Pressure Dressing provides pressure over a wound. It can be applied directly over a wound to block the hemorrhaging, help with the clotting process, and protect the wound. Chances are you have used a form of a pressure dressing before, because a Band-Aid is form of pressure dressing.
How to use it
What it does
Hemostatics, or Antihemorrhagics, is a substance that produces hemostasis (stops bleeding). If you have heard of the name, QuickClot, this is an example of a hemostatic agent. Hemostatics essentially aid in speeding up the clotting process at the wound.
Types of Hemostatics
As far as I know, hemostatics come in two forms: powdered form and those infused in pressure dressings. There are also different compounds, but that is well beyond the scope of this discussion.
How to use it
Are You Prepared?
Individual First Aid Kit (IFAK)
IFAKs are carried by military and law enforcement personnel. Their purpose is to provide each person with basic life saving pre-hospital equipment. IFAKs are typically small pouches that can be attached to the soldier’s or police officer’s vest. While Medics and Corpsmen still carry more complex trauma gear, the idea behind an IFAK is that each person is carrying enough to keep themselves alive until advanced help can arrive.
It would be wonderful for every civilian to carry an IFAK on them; however, this is not realistic or practical. Therefore, there are other, more convenient options that would be practical for civilian every day carry (EDC).
You can either piece together a kit with the gear mentioned previously, or purchase an assembled kit. At a minimum, I recommend carrying at least 1 tourniquet to arrest uncontrollable bleeding. There are also compact vacuum sealed kits that could be stored in your vehicle, purse, or backpack.
Whatever you choose to carry, please do so consistently and with proper training, because you never know when you will be called upon to save a life.
It is just as important that communities (Churches, businesses, clubs, shooting ranges, etc.) have accessible aid stations, should a mass killing or other disaster occur, resulting in mass casualties.
Many businesses invest in first-aid stations for minor work related injuries. However, it is just as important (maybe more so) to stage bleeding control kits throughout the company’s campus.
These kits may not only save lives during a mass killing or natural disaster, but could also save a life in the event of a severe workplace related injury.
For example, consider you work at a factory with large machinery. If a careless employee were to injure a limb in a break-press, they would likely experience massive hemorrhaging. Many run of the mill first aid kits are not appropriate for this type of injury. While it may be possible for someone to fashion a makeshift tourniquet on site, the ability to quickly respond with a pre-packaged bleeding control kit may be the difference between life and death.
As with all things, your attitude and mindset towards medical preparedness will determine how seriously you decide to approach the topics covered in this post. Although the likelihood of you needing to treat someone with massive hemorrhaging is statistically low, it’s just as likely that you’ll need to use your firearm in self defense.
If you do not, or cannot legally carry a firearm, it is just as important for you to be prepared to render first aid, as it may be minutes before first responders arrive.
Just as having more armed good guys enables us as a nation to eliminate the threats, having more citizens prepared to stop massive hemorrhaging can greatly increase the survivability of victims.