EMT STANDING ORDERS

CLINICAL INDICATIONS

• Life-threatening haemorrhage that cannot be controlled by other means (direct pressure).
• Serious or life-threatening haemorrhage and operational considerations prevent the use of standard haemorrhage control techniques.

PROCEDURE:

• Routine Patient Care.
• Attempt to control hemorrhage with direct pressure.
• If direct pressure is ineffective or impractical and hemorrhage is not controlled, apply a tourniquet or hemostatic agent as indicated.
• Refer to Shock Protocol - Adult (56 Medical) or Shock Protocol - Pediatric (60 Medical).
• Minimize scene time.
• Call for Paramedic intercept, if available. If not available, call for AEMT intercept.
• See Trauma Triage and Transport Decision Protocol (5 Triage).
• Apply tourniquet for wound amenable to tourniquet placement (e.g., extremity injury). Use a commercially produced,
• Place tourniquet 2 - 3" proximal to wound.
  • Tighten per manufacturer instructions until hemorrhage stops.
  • Secure tourniquet per manufacturer instructions.
  • Note the time of tourniquet application and communicate this to receiving providers.
  • Dress wounds.
  • Do not release a properly-applied tourniquet until the patient reaches definitive care.
  • If delayed or prolonged transport and tourniquet application time ≥ 5 hours contact Medical Direction.
  • Consider the application of a second tourniquet just proximal to the first for failure to control bleeding.
• Apply a topical hemostatic bandage, in combination with direct pressure, for wounds in anatomical areas where tourniquets cannot be applied and sustained direct pressure alone is ineffective or impractical. (Junctional/torso injury or proximal extremity location where tourniquet application is not practical.)
  • Only utilize a topical hemostatic bandage in a gauze format that supports wound packing.

AEMT/PARAMEDIC STANDING ORDERS

• Establish IV/IO access.
• Administer 500 mL bolus 0.9% NaCl IV/IO. (Pediatrics: 20 mL/kg bolus 0.9% NaCl IV/IO. May repeat to a maximum of 60 mL/kg.).

Prehospital External Hemorrhage Control Protocol:

• Apply direct pressure / pressure dressing to injury
  • Direct pressure effective (hemorrhage controlled)
  • Direct pressure ineffective or impractical (hemorrhage not controlled)
    • Wound amenable to tourniquet placement (e.g. extremity injury)
      • Apply a tourniquet or junctional tourniquet
    • Wound not amenable to tourniquet placement (e.g. torso injury)
      • Apply a topical hemostatic agent with direct pressure