ENA Position Statement: Hemorrhage Control

Abstract

Uncontrolled external hemorrhage is a common cause of preventable death and is increasingly recognized as a serious public health concern. 1 Bulger E.M. Snyder D. Schoelles K. et al. An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2014; 18: 163-173https://doi.org/10.3109/10903127.2014.896962 Crossref PubMed Scopus (130) Google Scholar , 2 Chambers J.A. Seastedt K. Krell R. Caterson E. Levy M. Turner N. “Stop the Bleed”: a U.S. military installation’s model for implementation of a rapid hemorrhage control program. Mil Med. 2019; 184: 67-71https://doi.org/10.1093/milmed/usy185 Crossref Scopus (9) Google Scholar , 3 Charlton N.P. Swain J.M. Brozek J.L. et al. Control of severe, life -threatening external bleeding in the out-of-hospital setting: a systematic review. Prehosp Emerg Care. 2021; 25: 235-267https://doi.org/10.1080/10903127.2020.1743801 Crossref Scopus (9) Google Scholar , 4 Lei R. Swartz M.D. Harvin J.A. et al. Stop the Bleed training empowers learners to act to prevent unnecessary hemorrhagic death. Am J Surg. 2019; 217: 368-372https://doi.org/10.1016/j.amjsurg.2018.09.025 Abstract Full Text Full Text PDF Scopus (33) Google Scholar , 5 Weinman S. Retention of tourniquet application skills following participation in a bleeding control course. J Emerg Nurs. 2019; 46: 154-162https://doi.org/10.1016/j.jen.2019.10.020 Abstract Full Text Full Text PDF Scopus (7) Google Scholar Bleeding can be a life-threatening emergency, causing death within minutes. Immediate bystander intervention is critical to controlling bleeding, minimizing blood loss, and saving lives. 3 Charlton N.P. Swain J.M. Brozek J.L. et al. Control of severe, life -threatening external bleeding in the out-of-hospital setting: a systematic review. Prehosp Emerg Care. 2021; 25: 235-267https://doi.org/10.1080/10903127.2020.1743801 Crossref Scopus (9) Google Scholar ,6 Zwislewski A. Nanassy A.D. Meyer L.K. et al. Practice makes perfect: the impact of Stop the Bleed training on haemorrhage control knowledge, wound packing, and tourniquet application in the workplace. Injury. 2019; 50: 864-868https://doi.org/10.1016/j.injury.2019.03.025 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar In recent years, active shooter and terrorist attacks using knives and explosive devices have highlighted the need for strategies to deal with uncontrolled external hemorrhage at the incident scene. 2 Chambers J.A. Seastedt K. Krell R. Caterson E. Levy M. Turner N. “Stop the Bleed”: a U.S. military installation’s model for implementation of a rapid hemorrhage control program. Mil Med. 2019; 184: 67-71https://doi.org/10.1093/milmed/usy185 Crossref Scopus (9) Google Scholar ,7 Goolsby C. Strauss-Riggs K. Rozenfeld M. et al. Equipping public spaces to facilitate rapid point -of-injury hemorrhage control after mass casualty. Am J Public Health. 2019; 109: 236-241https://doi.org/10.2105/AJPH.2018.304773 Crossref Scopus (10) Google Scholar ,8 Moore K. Stop the Bleeding: the Hartford Consensus. J Emerg Nurs. 2017; 43: 482-483https://doi.org/10.1016/j.jen.2017.06.009 Abstract Full Text Full Text PDF Scopus (6) Google Scholar Delays in clinical intervention are due to the emergency service response time and personnel restrictions related to safety concerns at the scene. 3 Charlton N.P. Swain J.M. Brozek J.L. et al. Control of severe, life -threatening external bleeding in the out-of-hospital setting: a systematic review. Prehosp Emerg Care. 2021; 25: 235-267https://doi.org/10.1080/10903127.2020.1743801 Crossref Scopus (9) Google Scholar ,9 Lowndes B. Law K. Abdelrahman A. et al. Preliminary investigation of civilian clinician perspectives & just-in-time guidance for tourniquet use to “Stop the Bleed”. Mil Med. 2019; 184: 28-36https://doi.org/10.1093/milmed/usy331 Crossref Scopus (4) Google Scholar As a result, multiple strategies have been devised to enable bystanders to control the bleeding until emergency medical services (EMS) arrive and transfer the patient to a definitive care facility. 4 Lei R. Swartz M.D. Harvin J.A. et al. Stop the Bleed training empowers learners to act to prevent unnecessary hemorrhagic death. Am J Surg. 2019; 217: 368-372https://doi.org/10.1016/j.amjsurg.2018.09.025 Abstract Full Text Full Text PDF Scopus (33) Google Scholar ,10 Scerbo M.H. Holcomb J.B. Taub E. et al. The trauma center is too late: major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock. J Trauma Acute Care Surg. 2017; 83: 1165-1172https://doi.org/10.1097/TA.0000000000001666 Crossref PubMed Scopus (64) Google Scholar Nurses may take on numerous roles within these scenarios, including applying hemorrhage control techniques within their scope of practice, being involved in community injury prevention programs, and researching and evaluating hemorrhage control interventions. 5 Weinman S. Retention of tourniquet application skills following participation in a bleeding control course. J Emerg Nurs. 2019; 46: 154-162https://doi.org/10.1016/j.jen.2019.10.020 Abstract Full Text Full Text PDF Scopus (7) Google Scholar Ultimately, the involvement of all nurses, not just emergency nurses, in hemorrhage control is an opportunity to save lives. Alison Day, PhD, MSc, PGCE, BSc, RN, FAEN Twitter: @alisondayrn . ORCID identifier: https://orcid.org/0000-0003-2410-6208.