HELP! Pressure points and bleeding control

[Chief1C]

I'm not apologizing for standing with my beliefs. Prehospital care is a little bit of a form of art, and a big part of BLS, is elementary first aid. A lot of courses really don't touch too deeply on that anymore, and to get the most out of your equipment, it really helps. I had one before I was certified, so I freely suggest folks take one before or after. Not for the card, but to maximize your skillz.

[Lone Star]

Thanks for the picture, that is really helpful!

I am however a little insulted that you told me to take a basic first aid course... as I said, in my EMT class we used the current national recommendation that pressure points really arent' the best option when dealing with bleeding, and it is better to just use a tourniquet, and on the ambulance I worked on we had tourniquets and quick clot for bleeds (not that I ever had a call where any of the above techniques were necessary!)

I dont think that reccommendation was meant to insult you, but with the bare minimum of information being presented as the 'core building blocks' in the EMT-B course, the basic first aid course would have given you this very information.

[armymedic571]

Besides using an old BP cuff, or utilizing a piece of cloth and a windlass, there are several good commercial tourniquets on the market now a days. The US Army uses the CAT (Combat Application Tourniquet) http://www.combattourniquet.com/, and the US Marine corp uses the SOFT-T (Special Operational Forces Tactical Tourniquet) https://www.tacmedsolutions.com/07/products/product_detail.php?prod_id=2

Having utilized both, they are much better then rigging one. They are a little pricey, and but who puts a prive on a human life.....oh wait, medicare, medicaid, the government............never mind:whistle: ...................

[Richard B the EMT]

... as I said, in my EMT class we used the current national recommendation that pressure points really arent' the best option when dealing with bleeding, and it is better to just use a tourniquet, and on the ambulance I worked on we had tourniquets and quick clot for bleeds (not that I ever had a call where any of the above techniques were necessary!)

Showing how times have changed, in 1974, the prerequisite for my NY State EMT class was the American Red Cross First Aid and ARC Advanced First Aid courses.

So, just making sure I understand this right, once the bleeding is under control with a pressure point, after 5 mins, you can release the pressure point (assuring the wound is bandaged)?

Again, taking local protocols into account (NYS DoH and FDNY EMS) the pressure point and/or Tourniquet ARE what is controlling the bleeding. Remove them, and the bleeding usually starts up again, hence, the need for a Trauma Center ER or OR.

The biggest problem I see with the application of pressure points is, in a multiple casualty Incident (MCI), it goes against the theory of using the few (EMS responders, all levels of training) for the best benefit of the many (all them injured folks laying on the ground). While my phrasing may be a bit tongue in cheek, the message is clear, I hope.

[fakingpatience]

OK, back up a second here... Why are you all assuming that I haven't taken first aid? I have taken both the red cross and other first aid classes numerous times, courtesy of my other jobs. I guess the classes are all taught a little differently, because again, I did not learn about which pressure points to use, or how to use them appropriately. But moving on...

Richard, you could probably help me with this, since the test I am taking is coming directly from the NYS EMT-B skills test... For the bleeding/ shock control management, after I use a pressure point, the examiner says "the bleeding is now controlled", and then I am supposed to bandage the wound and treat for shock. How could I do all this if one of my hands is still holding the pressure point? Am I able to release the pressure point at this part of the testing?

The current thinking that I was taught in my EMT-B class (1 year ago) about bleeding control, is that tourniquets are much easier than using a pressure point, and get the job done faster and more effectively (no fumbling around to make sure you are grabbing the right spot)... so I guess it could also be part of the NREMT making the curriculum simpler... I don't know, but that is what it is now, and how my class taught it.

Here is a link to the NREMT skills testing for the bleeding control section

http://www.nremt.org...g%20Control.pdf

As you can see, pressure points are not mentioned in it at all.

Regardless, I need and want to learn how to use pressure points correctly, and appreciate any advice

[JakeEMTP]

I read in an earlier post (I believe it was one of Lone Star's) explaining the pressure points as the brachial artery for a upper extremity and the femoral artery for a lower extremity. These are correct. Of course the post also mentioned how difficult it is to put enough pressure on a femoral artery. I think that's where the use of a tourniquet came into the conversation.

We use a tourniquet for femoral arterial bleeding as well as field combat gauze. You will get some good advise here. Sometimes it is hard to express the proper tone intended in type. Do not take offense to posted replies. Most here are only trying to help.

It is true that the EMT-B course does not spend a lot of time on hemorrhage control, which is a shame. That is one thing a EMT-B can do on a scene.

[armymedic571]

OK, back up a second here... Why are you all assuming that I haven't taken first aid? I have taken both the red cross and other first aid classes numerous times, courtesy of my other jobs. I guess the classes are all taught a little differently, because again, I did not learn about which pressure points to use, or how to use them appropriately. But moving on...

Richard, you could probably help me with this, since the test I am taking is coming directly from the NYS EMT-B skills test... For the bleeding/ shock control management, after I use a pressure point, the examiner says "the bleeding is now controlled", and then I am supposed to bandage the wound and treat for shock. How could I do all this if one of my hands is still holding the pressure point? Am I able to release the pressure point at this part of the testing?

The current thinking that I was taught in my EMT-B class (1 year ago) about bleeding control, is that tourniquets are much easier than using a pressure point, and get the job done faster and more effectively (no fumbling around to make sure you are grabbing the right spot)... so I guess it could also be part of the NREMT making the curriculum simpler... I don't know, but that is what it is now, and how my class taught it.

Here is a link to the NREMT skills testing for the bleeding control section

http://www.nremt.org...g%20Control.pdf

As you can see, pressure points are not mentioned in it at all.

Regardless, I need and want to learn how to use pressure points correctly, and appreciate any advice

Patience,

Easy wee fella. Nobody here doubts your skills or knowledge! It is OK to disagree......but I digress.....

To answer your question- to become proficient at pressure points, I would recommend a partner, the use of 4c6's chart and some simple practice. Apply the pressure point to your partner, check a distal pulse. No pulse.....GOOD....Note placement of that point and how much force you needed to arrest the distal pulse, and repeat.

Will this hurt your partner.....maybe.......but it shouldn't cause any lasting neuro deficit..........

Anywho, that's my 2 cents.......

Edited August 10, 2010 by armymedic571

[Richard B the EMT]

If I was persevered as saying you didn't have any first aid training, oops, I did not say anything along those lines, as I was referring to my own training back 1973-1974.

Richard, you could probably help me with this, since the test I am taking is coming directly from the NYS EMT-B skills test... For the bleeding/ shock control management, after I use a pressure point, the examiner says "the bleeding is now controlled", and then I am supposed to bandage the wound and treat for shock. How could I do all this if one of my hands is still holding the pressure point? Am I able to release the pressure point at this part of the testing?

The instructors I have had, at this point of the skills testing, would either have you state " I now pass the application of pressure to the pressure point to my assistant...", and continue the testing with the bandaging and shock treatment, or they will say, "OK, you pass the application of pressure to the pressure point to your assistant...", and continue the testing. You'll know which, as the way they teach the skill is the way they test. The actual wording will be at the discretion of the class Instructor/Coordinator.

[fakingpatience]

Thanks for the help everyone

Sorry if I came off as a little touch in my earlier posts, I had the skills and lifting test today (kinda a pre-interview testing... you need to pass it to get to the interview) for a new job, and was really really nervous. I passed all the sections though!

Now I just need to wait and see if they call me for a real interview, and in the mean time, spend some time studying the protocols in this state...

Again, thanks all for your help, it is amazing to be able to ask a question and have so many responses in just over a day. There sure is a wealth of knowledge on this site, glad I found it

[armymedic571]

Plus 1 for humility.

Good luck, and keep asking questions!