Introduction

Prehospital catastrophic haemorrhage refers to severe and life-threatening bleeding that occurs outside of a medical facility, typically at the scene of an accident or in the field. This critical condition demands immediate attention and proper management to prevent potential fatalities. When a person experiences severe bleeding, every second counts in providing effective care to prevent further blood loss and increase the chances of survival.

In this article, we will explore the critical aspects of prehospital catastrophic haemorrhage, including the causes, symptoms, treatment options, and the crucial role of first responders in managing these emergencies.

Catastrophic Haemorrhage Definition 

Catastrophic haemorrhage is defined as severe and uncontrolled bleeding that can rapidly lead to hemodynamic instability and potentially life-threatening consequences.

The exact definition catastrophic haemorrhage varies depending upon context and medical guidelines, but it generally encompasses severity of bleeding, haemodynamically instability and acute-and life-threatening.

Recognising Catastrophic Haemorrhage

Early recognition of catastrophic haemorrhage is vital to initiate timely interventions. Some signs to watch for include:

External Bleeding

• Look for visible signs of active bleeding, such as blood-soaked clothing or pooling of blood around the patient.
• Pay attention to the location and extent of the bleeding. Profuse bleeding from a single site may indicate a major vascular injury.
• Assess for spurting arterial blood, which suggests a high-pressure bleeding source.

Hypovolemic Shock

Catastrophic haemorrhage can lead to hypovolemic shock due to significant blood loss. Look for signs of shock such as:

• Pallor
• Cool, clammy skin
• Rapid, shallow breathing
• Rapid, weak pulse
• Decreased level of consciousness
• Hypotension

Mechanism

Catastrophic haemorrhage can occur because of various causes, including traumatic and non-traumatic events.

Clinical Assessment

• Assess the patient’s overall clinical condition, including mental status, respiratory distress, and signs of poor perfusion.
• Observe for signs of internal bleeding, such as abdominal distension, periumbilical ecchymosis (Cullen sign) and Flank ecchymosis (Grey Turner sign).

Ongoing Monitoring 

Continuously reassess the patient’s vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation.

Observe for any signs of deterioration or worsening bleeding during transport.

Life saving techniques for prehospital catastrophic haemorrhage

Interventions for catastrophic haemorrhage focus on controlling bleeding and stabilizing the patient’s condition. The specific interventions may vary depending on the location and severity of the bleeding.

Direct Pressure 

Apply direct pressure to the bleeding site using sterile dressings or a gloved hand. Firm and continuous pressure helps promote clot formation and control external bleeding.

Tourniquet Application

If direct pressure fails to control severe bleeding from an extremity (e.g., arm or leg), apply a commercial tourniquet proximal to the injury site.

Place the tourniquet high on the limb, between the injury and the heart, and tighten it until the bleeding stops. Document the time of application.

Haemostatic Agents

Use haemostatic agents, such as combat gauze or haemostatic dressings, in combination with direct pressure or tourniquets. These agents contain substances that promote clotting and help control bleeding, especially in areas where direct pressure or tourniquet application may be challenging.

Junctional Tourniquets 

For bleeding in areas where tourniquet application is not feasible (e.g., neck, axilla, groin), specialised junctional tourniquets or pressure dressings designed for these regions can be utilized. These devices help control bleeding by applying pressure to the arterial supply.

These are not commonly available in public prehospital care.

Fluid Resuscitation

Administer intravenous fluids, such as crystalloids (e.g., saline) or blood products, to replace the lost volume and restore perfusion. Rapid fluid administration can help stabilize the patient’s condition and support circulation.

Rapid Transport 

Immediate transportation to an appropriate hospital with capabilities of advanced trauma care should be facilitated. Pre-alert is crucial to allow the hospital to prepare for the patient’s arrival and activate the necessary resources.

Continuously monitor vital signs, including blood pressure, heart rate, and oxygen saturation en-route.

Reassess and reinforce bleeding control measures as needed.

Maintain intravenous access for fluid resuscitation.

Key Points

• Prehospital Catastrophic haemorrhage refers to severe and uncontrolled bleeding that can lead to haemodynamic instability and life-threatening complications.
• Common causes include trauma, medical, surgical, and spontaneous bleeding events.
• Immediate interventions focus on controlling bleeding and stabilizing the patient’s condition. These may include direct pressure, tourniquet application, haemostatic agents, and fluid resuscitation.