A/N: Sorry folks, you can't improvise an effective tourniquet out of a belt or a rope. You might be able to get enough pressure to control the venous blood- what's going back to your heart- but what you need to get at is the arterial blood- what's going out from your heart. Arterial supply is deeper in the limb than venous and at much higher pressure- arterial spray can go about two metres. The best use of a belt, preferably a rope, in this situation is as an improvised bandage to hold the dressing on, but if you don't have a bandage your hands are usually better if you can spare them.
Also a properly applied tourniquet HURTS. A LOT. We're talking morphine, lots of morphine and shoved into the patient quickly levels of pain.
Using one doesn't mean they're going to lose the limb, surgeons can do some amazing things these days, but the most important thing is saving the patient's life.
Your three best friends for managing a severe bleed are direct pressure on top of the wound, elevating the wound- ideally above the level of their head if possible, and something clean and absorbent as a dressing pad to soak up the blood. If you don't have a first aid kit with a big enough dressing this can be clothing, towels, paper towels, spare nappies, sanitary pads, etc. Tissues and toilet paper tend to break down pretty quickly, but if that's all you've got, that's all you've got. The best thing to do is to fold it down until it's a little wider than the wound, it gives you a lot more pressure and control. One, two or all three of these should control or slow most bleeds.
Using pressure points such as the femoral artery in the groin, is iffy. You need the right spot and the ability to deliver enough pressure to be effective. I have met a few folks where getting to the right spot and applying sufficient pressure to be effective would be difficult.
Using antiseptics such as iodine is more a hospital thing. The wound is going to be bleeding anyway so that will push some of the debris out and a flush with saline (sterile, slightly salty to match your body's salinity water)/clean water should deal with anything else. Please don't put 'rubbing alcohol' on a wound, it hurts, your patient will object. Strenuously.
"Ooh... that's bad, isn't it?" Fischler hovered over Gordon's shoulder, right in the aquanaut's personal space as he gawked at the widening pool of bright red blood that Gordon was trying to not kneel in and did very little that was actually useful.
Gordon, busy pressing someone's folded up scarf into the wound, triggered his internal comm with his chin so Fischler couldn't hear him. "Guys, get me the haemo kit and someone get rid of Fischler before I do!" He snapped. "Got a major bleed here in his control room."
"On my way." Alan replied crisply. "Just waiting for Virgil to open the doors for me, the controls are fried and it's too dense for my can opener, Virg is using his 'universal key'." Faintly, over the sounds of panic and the staccato explosions outside, Gordon could hear the squeal of protesting metal as Virgil took the door apart with his exo-suit. "I'll be there in a minute, what's the patient status?"
"Status one. Unconscious but breathing, adult male, signs of shock, major wound to lower left leg, it's not amputated but close to it. I've got pressure on the wound but it's going to need a tourniquet and fluids. I'd estimate about 500 mls on the ground, bright red, arterial bleed." Gordon reported.
"F.A.B."
"If the GDF doesn't do something about this guy…" Gordon shook off the thought as he focused on his patient, an unfortunate bystander who happened to be in the wrong place at the wrong time when Fischler unleashed his newest creation on the streets of Dubai. He'd made some sort of recycling drone -not unlike the W.O.R.M.s used in trash mines- with the intention of them going after street litter but the gizmos went haywire and attacked the surrounding buildings for the wiring and other metals in the walls. That was if they weren't overloading and randomly blowing up.
One of the drones had made it through the walls of Fishler's building, triggered off Langstrom's 'safety features' along the way- some kind of blast-proof door- and promptly exploded in the jury-rigged control room while Gordon was trying to link his comm into Fischler's systems so EOS could piggyback down and shut everything off.
His suit, reinforced for the incredible pressures under the sea and threaded with Kevlar, had saved him. But this poor guy, one of several who'd fled in here for cover, had taken a chunk of razor sharp debris to his lower left leg. It was very deep- Gordon could see the white of bone and yellow-white of fat amongst the bright red muscle tissue, and he was only just slowing the flow of blood.
Finally the doors gave way with a deafening shriek of rending metal, boots clattered on the marble floors and his brothers were there, Alan coming to him while Virgil made for the drone controls. Fischler stood up and started shrieking too, haring after Virgil and yelling something about damages and 'always sticking your nose in'.
Gordon tuned it out.
Alan dropped to one knee beside Gordon with a medical bag and used his shears to cut away the patient's trousers up to mid thigh to fully expose the wound. "Oh. Bad." Alan grimaced as he glanced at Gordon. "Can you keep hold of that while I get the CAT on?"
"Yep, just be quick." Gordon grunted, his hands and arms aching from the effort.
"F.A.B." Alan dug out the bright orange Combat Application Tourniquet, a simple device that had gone unchanged for decades consisting of a velcro strap and buckle, a windlass attached to an internal strap inside the velcro and a clip to lock the windlass into place. He had the strap placed roughly an inch above the wound in moments, made sure it was flush against the skin and snug, then twisted the windlass. Gordon let go as he did so, knowing that they had to see if the blood flow was contained. Despite being unconscious, the patient groaned as the internal strap tightened on his leg. "Sorry, mister." Alan apologised as he forced the windlass into one more rotation before locking it into place and noting the time on the handy square of white fabric provided for the purpose.
"Okay, I think that's taken care of the bleed." Gordon nodded. "Alan, you flush and pack this, I'll check him for any other injuries and get the IV set up, he's going to need Ringer's." He ordered.
"Gotcha." Alan took an IV bag of saline out of the medical pack, stuck the running line into it and snipped the end off. He slung the bag over his shoulder and used the running line like a hose to wash the worst of the blood out of the wound and get a good look at it. When that was done, he took several large dressings and dampened them with more saline, using them to cover the exposed bone and tissue and keep them moist and mostly clean.
In the meantime, talking softly to their patient and explaining every step as he went, Gordon clipped a monitor to his shirt and swept his hands down the man's body from head to toe, checking for any other injuries that might have been missed and checking his wrists for any medical alert bracelets, finding none. The patient was already on his side and Gordon adjusted his head just a little more to make sure his airway would stay clear and he wouldn't suffocate on his own tongue.
That task complete, once again the shears came out and what was probably a very expensive suit jacket lost its sleeves. Gordon had two IVs set up in moments, one in the inner elbow for the Ringer's, the second in the back of the other hand for the morphine he was sure the guy was going to be needing soon.
"I've got the Ringer's set up." Alan reported, holding out the line to the bag of Ringer's Lactate, a blood replacement substitute almost as good as the real thing. IR routinely carried bags of O- blood and plasma, but those were frozen and all the way back in the module.
"That looks interesting, a lot less bleed-y everywhere."
Both Tracys repressed their sighs as Langstrom made an appearance yet again, he must have escaped Virgil. Gordon flashed a grin at Alan, that sharp edged grin that he reserved for moments when he wasn't feeling particularly nice. "Actually I've got a really important job for you, Fischler." He told the inventor in a tone of voice so innocent you wouldn't think he was the prankster of the family. He screwed the end of the feeder tube into the elbow IV port and handed the 1000 ml IV bag of clear fluid to Fischler. "I need you to hold this really high in the air, right above your head." He instructed, checking that the fluid was running free as Fischler took the bag and obediently held it above his head.
"I can do that! Oh, hey, this is easy. Bit heavy though. Oof, actually, very heavy." Langstrom winced, holding the bag up with both hands.
"Keep that bag right up there for us, it's important!" Alan encouraged as he drew up the morphine and diluted it with saline, then prepped a second syringe of saline to 'flush' the IV with after every dose of morphine used.
"Okay, numbers are looking good, all considered." Gordon nodded as he looked over the latest readout from the monitor. "Oxygen's sitting at 96%, heart rate of 90, blood pressure still low 105/60, shocky still compensating, just." He took one of the man's hands and pressed on his fingernail, watching as it blanched and returned to it's normal shade. "Cap refill of three seconds, understandable. Pass me a nasal?"
"Here." Alan passed over the nasal cannula and a mini bottle of oxygen.
Gordon had it feeding into the patient's nostrils and feeding him a trickle of supplemental oxygen in moments. "Okay, oxygen's in. John? What's the ETA on local ambulance? We've got a status one bleeding patient here."
"Five minutes from their safe forwarding point, they can't enter the danger zone until Fischler's drones are stopped." John's voice sounded in his ear. "Scott's chasing down the last one now, Virgil had to go and help him."
"F.A.B."
"..uuuhhhaaaah!" The rousing patient on the floor drew their attention as his groan became a scream as his nerves suddenly dumped a backlog of pain signals into his brain.
In the background the half empty bag of Ringer's hit the ground with a splat as Fischler, muttering something about other places to be, decided to absent himself. Alan simply rolled his eyes and slung the bag over his shoulder to provide the needed elevation.
"Sir, my name is Gordon, I'm with International Rescue." Gordon immediately snapped into his 'rescue voice', calm and firm as he took the man's hand. "You've been hurt, I want to give you some morphine for the pain but I need to know if you have any allergies to morphine or medical conditions."
"Ahhh! No! No issues! Help me, please! It hurts!" He howled, writhing in pain.
"I know, sir, I know, we're taking care of that for you now." Gordon soothed, nodding to Alan to start pushing the morphine in. "You're going to feel a bit fuzzy, okay?"
"Five mls of morphine in." Alan reported, switching to the other syringe to flush the morphine through.
"Give him the full ten and get another one set up." Gordon ordered.
"F.A.B." Alan acknowledged and set to work and mercifully the patient began to relax as his pain was eased. "How's that sir?" He asked.
"Uh, better… thank you." The man groaned softly and lay limply on the floor. " 's much better now…"
"The last drone is history, local ambulances are on their way." John reported.
"F.A.B. Thanks John." Gordon sighed in relief.
A/N: If you ever pass an accident and see someone holding an IV bag over their head, they really irritated the medics. It just needs to be above the patient, not all the way up in the air. We have a collection of things we get irritating people to do to make them useful and get them out of our hair.
When something happens there's a bunch of things you can do or get others doing to help first responders:
Clear a path to the patient, turn the lights on if it's dark, collect up their medication, write down their name, whatever medical ID number is used in your country, D.O.B, allergies and medical history and pack an overnight bag- undies, toiletries, change of clothes, phone and charger. If someone is going to ride with the patient, decide before we get there. Lock up your dogs and any other pets that are roaming free. Cats have stowed away on ambulances before and while under normal circumstances I believe you when you say your dog wouldn't hurt a fly, these aren't normal circumstances.
If you are on a shared driveway, a housing development with a gate, an apartment block or anywhere else people can get lost easily, if you have someone spare, get them to meet us at the road/gate/etc. If you've found a car crash, get bystanders to manage traffic, preferably wearing hi viz if you can find them.
Most importantly, in the immortal words of the Hitchhiker's Guide to the Galaxy- don't panic.
'Shock' is not the fright you get when you open up your credit card bill. Shock is your body in crisis mode because you've lost fluid- through bleeding, burns, dehydration, heat stroke etc. Signs of shock include paleness, increased breathing rate (to try and compensate for the lower blood volume), nausea, light-headedness and increased capillary refill. If you press on your fingernail you should see it blanche- go pale. When you release it, it should return to normal in two seconds or less, if it takes longer it means they've lost blood somewhere.
When there's exposed bone, such as this situation or an open fracture, bones like to be kept moist. Gold standard is a sterile dressing draped over the wound, dampened with saline. Don't use water, it's not sterile and isn't the right salinity.
A 'safe forwarding point' is used when there's a danger where we need to be. We'll gather there and wait for the all clear to go in.