Violence & Trauma in South Africa

Unfortunately, the levels of crime and violence in South Africa are unacceptably high. The reasons for that can be discussed elsewhere, although ultimately our authorities must take responsibility for the sad state of affairs.

In addition to that, our road accident rates are very high as well.

In any event, ordinary people have to deal with that horrible reality as best we can.

Thus, if you are unfortunate enough to be involved in, or witness to, a shooting, stabbing, car accident, or other nasty traumatic injury, you may be faced with having to deal with massive life threatening blood loss.

This article discusses, from a lay person’s perspective, why it is probably a good idea to improve your ability to control heavy bleeding, if you ever need to.

Time is Critical when Treating Massive Blood Loss

The video below explains what happens to the human body when heavy bleeding is in progress.

In that video, note the following points:

• If you are trying to treat your own arterial bleeding, you better do it quickly, because you may lose consciousness after just nine seconds!
• You can lose all your blood from arterial bleeding after about three minutes.
• Most adults have about five litres of blood. If you lose half of that, you are not likely to survive. So you need to stop the bleeding before no more than about two litres or so is lost, which is not that much when you think about it.

It is thus clear that time is extremely critical when treating massive blood loss. You cannot wait for an ambulance to get there.

What to Look For

• Spurting blood, or steady heavy flow out of the wound.
• When the flow of blood is not stopping.
• Blood that is pooling on the ground underneath the victim, especially when that pool is steadily getting bigger.
• Clothing or bandages that are soaked with blood and getting worse.
• A bleeding victim who becomes confused or unconscious.
• Anything which seems to be “a lot” of blood, not a minor scrape or cut.

It’s critical that you find the source of the bleeding and stop it as soon as possible.

The MARCH Algorithm

In military circles, a mnemonic used to remember the order in which to deal with traumatic symptoms is:

• M – Massive haemorrhaging (bleeding). Note that uncontrolled bleeding is the first thing you deal with, before all others. It’s critical to stop massive blood loss as soon as possible.
• A – Airway Control. Make sure the patient’s airway is clear.
• R – Respiratory Support. Assisting the patient, or taking over their breathing for them, via CPR etc.
• C – Circulation. Suggested treatments can include laying the patient flat, chest compressions, maintaining body temperature, and putting them on a drip, among other things.
• H – Hypothermia. Keeping a patient who suffered massive trauma warm is very important.

The American “Stop the Bleed” Initiative

After the Sandy Hook School mass shooting, a group of American trauma surgeons got together, to formulate expert advice and training courses aimed at improving the rate of survival of patients with severe bleeding. This was apparently also combined with experience from the military, as well as law enforcement agencies.

The Stop the Bleed initiative has recognised that training people how to respond quickly in traumatic incidents of severe bleeding, can make a big difference. The object is to teach ordinary people how to slow down, or stop, severe bleeding as soon as possible. This will potentially save lives, because by the time the professional paramedics get there, it may be too late.

There is no reason why the same should not be true here in South Africa, especially given our very high violent crime and road accident rates.

Direct Pressure, Tourniquets and Wound Packing

Preliminary research on the subject, suggest that ways to control heavy bleeding include:

• Applying direct pressure to the wound. Use your knee if necessary, to generate enough pressure to stop the flow.
• If the wound is on a leg or arm, and direct pressure is not working, one can apply a tourniquet (which apparently should be removed, but only by a doctor, after about 2 – 6 hours, to prevent damage to the limb).
• If direct pressure is not working, and the wound is on a part of the body where a tourniquet cannot be applied, but there is still sufficient muscle mass into which you can pack material to generate pressure on the blood vessel, such as shoulders, neck, groin etc, then one needs to “pack the wound” firmly with gauze (or any other available cloth), to fill the wound up completely and then apply pressure.
• Chest wounds and abdominal area cannot be packed apparently.

Please note that you should consult a medical professional for proper instructions and training in the application of any of the above methods.

Get Professional Training

Like everything else in life, getting proper training is always a good idea. In this case, it could literally save someone’s life!

There are available courses in South Africa dedicated to bleeding control. However one can also take a two day Level 1 First Aid Course, which includes “Wounds & Bleeding”.

Additional Medical Kit You Might Want

Most commonly available first aid kits do not seem to include things like tourniquets, pressure bandages and compressed gauze for packing wounds. So you might want to add those items to the medical kits you keep in your car and at home.

The video below (again from “Skinny Medic”), discusses the sort of medical supplies that are typically used in America, after one has attended a “Stop the Bleed” course.

Obviously the exact same brand of medical supplies mentioned in that video might not be available here in South Africa, but no doubt the equivalent types of kit can be ordered from a reputable paramedical supplier.